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Top Doctors: 5 fast facts about Botox

Dr. Martin E. Kessler, 58, who has been

Dr. Martin E. Kessler, 58, who has been a practicing plastic surgeon for over 27 years, at his office in Rockville Centre. (June 26, 2012) Credit: Nancy Borowick

When it comes to injected drugs for the face, there's a noticeable line between the attractive (smoothed-out wrinkles) and the not-so-attractive (a permanent surprised look or the loss of normal facial expressions).

How can you make sure you don't cross that line and overuse Botox and facial fillers like Restylane and Juvéderm? Here are five things you should know:


Botox, a drug that reduces wrinkles by temporarily paralyzing muscles in the face, should be given only about once every four months, said Dr. Martin E. Kessler, a plastic surgeon with offices in Rockville Centre and Great Neck. Facial fillers like Restylane and Juvéderm should be given no more than once a year, he said. They're gel-like drugs that fill in spaces in the face, such as scars, wrinkles and the folds around the mouth.


Dr. Pamela Gallagher, a plastic surgeon in West Islip and Mineola, said she often has new patients come in several times for small Botox treatments so she can monitor their progress. "I'll use the tiniest amount that we can and have them come back several times in a row for more so we can see how they like it and what kinds of doses they need."

Gallagher said she also makes sure to take photos before someone undergoes injections with Botox or fillers. "Patients often forget what they looked like before they had it done, even as much as an hour later," said Gallagher, who also serves as medical director of the North Shore-Long Island Jewish Health System's Hagedorn Cleft Palate and Craniofacial Center. But with the help of the photos, she said, people are better able to see how much things have changed and consider the treatment finished at an appropriate time.

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Overuse of Botox carries with it the chance of developing abnormal facial expressions, Kessler said. "The most common effect is drooping eyelids," he said. "If you put in too much, your eyelids will look like you're asleep."

Botox also can freeze people's faces if they get too much of it. "I'll go to parties and see women walking around and I'll say, 'Oh, boy, this woman had way too much Botox put in; her face doesn't look normal,' " he said. "It's almost a blank stare that they get -- their eyes, foreheads and lips are not moving."

Too much facial filler also can cause someone's face to look "bizarre" rather than "natural and youthful," Kessler said.


"It seems like everybody and their uncle is injecting Botox and Restylane these days," said Dr. Elliot B. Duboys, a plastic surgeon in Huntington. "I probably see one to two patients a month who have been injected incorrectly with Botox or fillers." That can lead to drooping upper eyelids and foreheads, which, he said, are the most frequent problems he sees, but he's also seen "asymmetry of the lips when either too much, or incorrectly placed Botox has been administered."

In New York, injections of Botox and facial fillers must be done only by licensed professionals: doctors and, when supervised by a doctor, a nurse, a physician's assistant or a nurse practitioner, according to the state education department.

As with any medical procedure, consumer advocates urge that prospective patients check not only on the license but also the experience level of practitioners they're considering.


Though they're effective, Restylane and Juvéderm aren't substitutes for surgical procedures like face-lifts, Duboys said, and they won't produce certain kinds of improvements, no matter how much you use.

For example, fillers "buff up and puff up the skin, but they won't get rid of jowls," he said. "A lot of people have that crease from the corner of the mouth to the chin, that jowl overhanging that border by the jaw. No matter how much they pump it up, it won't get rid of that jowl."

Kessler put it another way. "If someone's really looking to get a permanent change, then they have to consider surgical options," he said. "We still do forehead-lifts, face-lifts and laser procedures -- things that are of a more surgical nature, where wounds are being made and longer recovery is needed. But results will be longer lasting."


Plastic surgeons


Today is the second installment of a 26-week series in which Newsday presents Castle Connolly's list of top LI doctors.

Dr. Kaveh Alizadeh

999 Franklin Ave.

Garden City


Dr. John R. Anton

138 Old Town Rd.



Dr. Arnold Breitbart

1155 Northern Blvd., Ste. 110



Dr. Alexander B. Dagum

SUNY Health Science Ctr.

T19-060, Box 8191

Stony Brook


Dr. Gregory DeVita

650 Northern Blvd.

Great Neck


Dr. Vincent R. DiGregorio

999 Franklin Ave.

Garden City


Dr. Naishad Doctor

2000 N. Village Ave., Ste. 103

Rockville Centre


Dr. Sanford Dubner

L.I. Surgical Specialists

410 Lakeville Rd., Ste. 310

Lake Success


Dr. Elliot B. Duboys

864 W. Jericho Tpke.

West Hills


Dr. Marc J. Elkowitz

107 Northern Blvd.

Ste. 203

Great Neck


Dr. Joseph Feinberg

1201 Northern Blvd.

Ste. 202



Dr. David Funt

19 Irving Pl.



Dr. Pamela M. Gallagher

190 E. Jericho Tpke.



Dr. Alan H. Gold

833 Northern Blvd.

Ste. 240

Great Neck


Dr. Robert Gotkin

31 Northern Blvd.



Dr. William E. Groeger

1490 Broadway, 2nd floor



Dr. Ron Israeli

833 Northern Blvd.

Ste. 160

Great Neck


Dr. Armen K. Kasabian

Dept. of Surgery

1999 Marcus Ave.

Lake Success


Dr. Alex J. Keller

900 Northern Blvd.

Ste. 130

Great Neck


Dr. Martin E. Kessler

242 Merrick Rd.

Ste. 302

Rockville Centre


Dr. Lyle S. Leipziger

825 Northern Blvd.

3rd floor

Great Neck


Dr. Frederick Lukash

1129 Northern Blvd.

Ste. 403



Dr. Mark Illan Silberman

650 Northern Blvd.

Great Neck


Dr. Roger Simpson

999 Franklin Ave.

Garden City



How they were picked


Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college, board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at castle -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.

Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)

Physicians selected for inclusion in this "Top Doctors" feature may also appear as Regional Top Doctors online at castlecon, or in one of Castle Connolly's Top Doctors guides, such as America's Top Doctors® or America's Top Doctors® for Cancer.


To see the whole list . . .


Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to, or call 800-399-DOCS.

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