BEFORE AND AFTER PHOTOS
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Men and women find that wrinkles of the forehead, between the eyebrows (glabella), bridge of the nose, and crow’s feet make them look older and tired. Not only do these changes affect the perception of others, but self-perception is affected as well. Even self-confident patients report an enhanced self-image. It is tempting to speculate whether the physical inability to frown may have any positive emotional effect. Rather than emotions affecting facial expression, can facial expression affect emotions?
How It Works
Botox (botulinum toxin type A) is taken up locally by the nerve endings and blocks the release of the neurotransmitter acetylcholine. The nerve endings recover function in about 3 months, but the antiwrinkle effect typically lasts 4 months. Botox is one of the few treatments that is effective and has no downtime (HA fillers are others). This powerful toxin is injected in extremely minute quantities. It paralyzes (the kinder term is “relaxes”) the facial muscles. Paralyzing these muscles removes the contracting force on the overlying skin. This contracting force is what creates the wrinkles in the first place.
Eyebrow position and shape greatly affect our appearance and how our mood is interpreted by others. A depressed medial brow gives the impression of anger and disgust. Elevation of the lateral brow produces a “surprised” look. Over-elevation of the medial brows can make people look sad. It is remarkable how a few mm movement of the brow in one direction or the other can alter how others perceive your mood. Such differences can have very real social implications. No wonder Botox was so quickly embraced, not only for its antiwrinkle effect, but also for its ability to influence eyebrow position and shape.
Cosmetic Uses of Botox
Botox works very well for:
• Forehead muscles
• “Corrugator” muscles that cause frown lines
• “Bunny lines” on the bridge of the nose
• Crow’s feet
• Chin dimpling or “cobblestoning”
Botox can also help:
• Upper lip vertical wrinkles “smoker’s lines”
Operators have used Botox to treat the lower face, but there is a risk of weakening the smile or the corner of the mouth, so it is less useful here. The lower face is better treated with fillers and laser resurfacing.
Botox Relaxes, Hyaluronic Acid Refills
Frequently, patients confuse Botox with HA (hyaluronic acid) fillers such as Restylane and Juvéderm. Botox is a toxin that relaxes muscles but has no substance. It is a liquid that is absorbed and has no bulk. Fillers are simply inert spacers used to fill in creases.
Botox Cosmetic and Migraine Relief
Many patients report that their migraine headaches are improved after Botox injection. They have fewer episodes and their symptoms are less severe. Some patients report that they no longer experience the nausea that used to accompany their migraine attacks. This is a particularly welcome side effect for these patients. Perhaps this relief is due to reduced compression of the sensory nerves that supply the forehead. In such patients, Botox serves dual purpose, relieving wrinkles and frontal headaches.
Patients generally know that Botox is an extremely powerful poison. They wonder how safe it is to be injected with such a substance. They are reassured to learn that the amount injected is so infinitesimal there is no detectable level of the toxin in the bloodstream after injection. In fact, Botox vials would not make a good bioterrorism agent because it would take about 300 bottles to achieve a lethal inhaled dose in humans and much more for a lethal oral dose! There are some neural diseases that are contraindications to Botox injection, such as ALS (Lou Gehrig’s disease), Lambert-Eaton syndrome, and myasthenia gravis.