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Ask Dr. Roher – Founder of SD Botox

Dr. Roher SD Botox Blog


Today’s question:

What is the difference between Microneedling and dermarolling?

Microneedling and dermarolling both use tiny needles to inflict micro-injuries to the skin. This leads what we call CIT or collagen induction therapy, where the injury stimulates cells in the skin to produce more collagen and healthier appearing skin.

Microneedling uses a pen-like device that oscillates at high RPM and punctures the skin with 9-27 needles per puncture. There are hundreds to thousands of punctures per minute. The depth of the needle puncture can be adjusted from 0.25 millimeters to 2 millimeters.  A skilled doctor or nurse will adjust the depth based on clinical endpoints.
Dermarolling uses a rolling pin with hundreds of needles attached that penetrate the skin and causes similar micro-injuries. It can be done at home although the FDA is cracking down on their sale.

Are at-home products just as beneficial as in-office?

Home products can be beneficial, but they have their limitation. The apparent benefits are they are less expensive and can be performed without leaving the house. They have their disadvantages too, however.
One problem with dermarolling is the user must have some anatomical knowledge with regards to depth of needle penetration. If a user knows what they are doing, multiple dermarollers of varying needle length are necessary to achieve similar results to microneedling and longer length needles are difficult to purchase legally.
Another advantage to microneedling is it is done in a clean medical environment.  Because the procedure punctures the skin, it is important to keep the area very clean to avoid infection.
Additionally, trained medical practitioners can use topical anesthetic cream to make the procedure tolerable, especially when using longer needles for deeper penetration.


Does this process work? Is this done in a medical spa? Doctors office?

This procedure works, and it has a better safety profile than other skin procedures that use energy or heat to stimulate collagen and improve the appearance of the skin. One such advantage is that microneedling can be performed on patients of all skin types, from very pale to very dark, without the fear of lightening or darkening the treated area.
We recommend going to a doctor’s office and having a formal evaluation to determine if you are a good candidate. We also offer the VI chemical peel as an alternative.

We hope this was helpful. Feel free to make a free consultation with SDBotox at 844-732-6869 or 844-SDBotox. Have a great day.

-Dr. Roher, M.D.

I have had uneven sagging jowls my whole life. Is there something that can help me out?

-Casey P.


Hello Casey

Young people tend to have a lot of volume in the top half of their face and less volume at the bottom.  Think of an egg on its apex.  As we age, however, a lot of the volume that was previously in our upper and midface begins to fall to our lower face, and our face becomes bottom heavy.  We develop jowls and marionette lines. Sometimes, an individual may have this appearance at a young age which seems to be the case with you, Casey, since you are asking the question.

The good news is that our doctors and nurses and SDBotox can likely help you out. Consultations are free, and we invite you to come in so we can assess your face and put together a complete plan. Having not seen you, however, I can give you a general idea about we typically treat jowls and marionette lines.

First, we would likely recommend adding volume to the midface, specifically the front and side cheek. We would achieve this with strategically placed dermal filler. This will pull up/elevate the sagging tissue creating the jowls and marionette lines. It will also restore the top-heavy appearance of the youthful face. Remember the egg on its apex?  Depending on the dermal filler we choose, the product typically lasts 1-2 years, and costs range from $500-$900.

Next, we would likely inject Kybella into the jowls. Kybella is the trade name for Deoxycholic Acid. It permanently destroys fat cells and tightens overlying skin, fundamentally the opposite as a dermal filler. It is FDA approved for submental fat, commonly called a double chin, but we have seen success in jowl reduction. Patients typically require three procedures four weeks apart. Results are permanent and cost usually run around $500/treatment ($1500 total).

Finally, following the last Kybella treatment, we would reassess your face and determine if you would benefit from dermal filler in the Marionette lines themselves. We are typically prudent with adding volume in this area because, again, we usually like to add volume to top and middle of the face and decrease volume to the lower face recreating the youthful egg on its apex. Marionette lines, however, can be injected with a small amount of dermal filler to decrease their appearance. We may even put a small amount of dermal filler in the Marrionette lines and the rest of the product in the cheeks for further enhancement. Depending on the dermal filler we choose, the product typically lasts 1-2 years, and costs range from $500-$900.

SDBotox Prime: $475

We hope this was helpful. Feel free to make a free consultation with SDBotox at 844-732-6869 or 844-SDBotox. Have a beautiful day

-Dr. Roher, M.D.

Why do some clinics recommend more Botox than

The patient’s question:  I wanted to get Botox on my forehead and looked at your pricing list.  Your suggested recommendation is 13-18 units for women’s Frontalis. I had talked to another office that said they typically recommended 25 units for that site. Can you educate me on why there would be such a difference?
My response:  The Frontalis is a broad but very thin muscle. As a result, there are a lot of injection sites and very little Botox injected at each location.
I usually inject 13 to 18 units in women’s frontalis.  The average is 16. This is more than enough to accomplish most patient’s goals (i.e., paralyzing the muscle to the point of not being able to create the wrinkle but still able to lift her/his eyebrows). It accomplishes a more natural look and is technically more challenging.
That being said, some patients prefer a completely frozen forehead.  I have put as many as 35 units in this muscle to accomplish this.
An advantage of injecting a lot of Botox is it tends to last longer.  Instead of coming back every 3-4 months you can probably stretch it 4+ months.
Just a word of caution, however, it is up to the individual practitioner how she/he dilutes Botox.  Someone could very easily tell you are receiving 25 units, charge you for 25 units, and only inject 16.
As someone who has performed thousands of injections in Frontalis, I can assure you 16 units is enough.  If a patient is unsatisfied, I can simply add more (but this rarely happens).
Dr. Alex Roher M.D.


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