What does Botox do?
Botulinum toxin most commonly known by the popular brand name Botox is well known in the aesthetic field. Yet at the same time there was a lot of confusion about what Botox can do.
For example, patients have asked me if Botox is an alternative to surgery or can it completely make deep lines completely disappear .
I’ll help you understand what botulinum toxin like Botox can do for your appearance and how I use it in my practice.
Once FDA approval for cosmetic use occurred in 2002, the popularity of Botox skyrocketed to where it is today.
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What is Botox?
So exactly what is Botox or other brands of botulinum toxins such as Dysport, Xeomin and Jeuveau?
They’re all categorized as neurotoxins and have different chemical structures which fall under the category of botulinum toxin.
A neurotoxin like botulinum toxin when injected into muscles inhibits or limits muscle movement temporarily by blocking signals from nerves to the muscle. It takes about three days for botulinum toxin to take effect with the peak effect being in about two weeks. These effects can last for three to six months.
It’s important to understand that what is injected is a liquid that affects muscle movement. This is in contrast to a filler such as hyaluronic acid which is not a neurotoxin but it’s rather a gel used to enhance some volume wherever it’s placed.
Hyaluronic acid fillers have the unique advantage in that they can be dissolved with an enzyme called hyaluronidase should the need arise. Botulinum toxin cannot be reversed. You have to allow for a few months to transpire before the effects wear off.
With this particular constraint in mind, in my practice I started with more conservative dosing and have my patients come back in two weeks to evaluate their appearance. If additional botulinum toxin is needed I strategically place more at that time. I make note of this for future treatments.
One principle behind the use of botulinum toxin is to reduce the activity of certain muscles, which actively contribute to the formation of deep lines.
Crow’s Feet Lines
An area that can be treated with botulinum toxin are the crow’s feet lines located at the outer aspects of the eyes. These lines result from contraction of a muscle called the orbicularis oculi muscle. By inhibiting movement of this muscle, there isn’t as much creasing in the skin, which can cause the deep wrinkles to be primarily formed.
Since the eyes are so important to your appearance, my patients often ask about crow’s feet lines, wrinkles and discolorations, which remain visibly significant after botulinum toxin treatment.
This is because the wrinkles and discolorations are the result of deficiencies in the skin quality, resulting from causes such as aging,sun exposure and smoking.
My approach to these problems is to customize a strategy to improve the backbone of the skin called the dermis and the surface of the skin called the epidermis.
For example, I use platelet-rich plasma or PRP, which is derived from your own blood for benefits of the healing and growth factors that stimulate collagen production and improve your skin’s blood supply.
I use different lasers to resurface the skin, which refreshes the epidermis as well as radiofrequency technology to help tighten the skin.
Another area where deep lines can be improved by reducing muscle activity is the number 11 lines located between the eyes and on top of the nose. These are also called frown lines or glabellar lines, which is more of a medical term.
These lines have a particularly significant effect on how people perceive you. Very often people with deep glabellar lines appear to look like they’re upset or angry.
By injecting botulinum toxin into the procerus and corrugator muscles, muscle activity is reduced and these vertical creases become less visible.
Horizontal forehead lines also form due to repetitive use of the frontalis muscle, which is responsible for raising the eyebrows. These lines often accompany glabella or frown lines. The frontalis muscle lifts the brows and the corrugator and procerus muscles move the brows in and downward.
Since these are opposing muscles, the key to satisfactory result is to reduce the horizontal forehead lines while preventing the brows from dropping too far downwards.
In addition to the reduction of lines formed by muscle activity, botulinum toxin can be used for enhancement of different areas of the face by balancing muscle activity with muscle relaxation.
For example, I use botulinum toxin for a procedure called a non-surgical brow lift. I achieved this by relaxing the muscles that pull the brows downward, which are referred to as brow depressors. These brow depressor muscles include the corrugator, procerus and orbicularis oculi muscles.
By relaxing the brow depressor muscles that pull down the brows with botulinum toxin, the muscles that lift the eyebrows in the forehead called the frontalis muscle work unopposed, thereby raising the eyebrows.
Vertical Lip Lines
Botulinum toxin can be used to enhance the appearance around the mouth and lips. Vertical lip lines above the upper lip also called smoker lines are associated with the activity of a muscle called the orbicularis oris muscle. This muscle is used when puckering, kissing and in activities like drinking from a straw.
The depth and appearance of vertical lip lines can be improved when the lips are puckered by using botulinum toxin to limit the activity of the orbicularis oris muscle.
For vertical lip lines that are present when the lips are not in motion, a laser procedure can be used to resurface and tighten the skin and improve the appearance of those static lines.
Outer Corner Lip Lift
The downward position of the outer corners of the mouth often seen with the facial aging can be improved by relaxing muscles which pull the outer corners downward called the depressor anguli oris muscles.
When I treat these muscles with botulinum toxin, the muscles pulling the outer corners of the mouth downward work unopposed and so they lift the outer corners of the mouth resulting in a lift that creates a more pleasant expression.
Upper Lip Flip
The upper lip can sometimes almost disappear with smiling. I can strategically place botulinum toxin and make the upper lip more visible when smiling. I refer to this procedure as a lip flip.
Some people feel that too much of their gums are seen when they’re smiling. This can be partially due to excess activity of the muscles that lift the lips. This is often referred to as a gummy smile. I treat the muscle group that lifts the lips to levator labii and the levator labii superioris alaque nasi muscles.
I do that with botulinum toxin so the lips don’t elevate as much when smiling and making the gums therefore less exposed.
A facial imbalance due to the widening of the jaw is associated with thickening of a muscle called the masseter muscle. The masseter muscle is used for chewing and moving the jaw. An enlarged masseter muscle occurs frequently with teeth clenching or teeth grinding.
I inject the masseter muscles with botulinum toxin to reduce the muscle activity that contributes to this enlargement of the masseter muscle. Over time with consistent treatment, the muscle size diminishes and the facial balance is improved.
Multiple small dimples in the chin which is often referred to as an orange peel skin or cobblestone it can also be treated with botulinum toxin. This dimpling is caused by the mentalis muscle often seen with aging. The bone loss also contributes to this hyperactivity and greater visibility of the mentalis muscle action on the skin’s surface.
By reducing the activity of the mentalis muscle with botulinum toxin in the skin dimpling or cobblestone, appearance improves. I often combine this with the placement of long lasting hyaluronic acid filler to add projection to the chin and further smoother the skin surface.
Botulinum toxin particularly the brand Botox has become a worldwide cultural symbol for the natural integration of medical aesthetic procedures into the daily life of anyone who wants to improve their appearance.
A consequence of this ubiquity has led to a lot of aggressive retailing and misinformation, in particular inappropriately minimizing the risks of botulinum toxin injection.
Consumers are being incentivized to self-diagnose and visit any given botulinum toxin dispenser. Some of the most vulnerable consumers fall into two categories. One, people who don’t have the means or don’t want to spend the time and money necessary to see a higher level specialist for more comprehensive guidance as to the value of botulinum toxin for their particular concerns.
Two, people in their 20s who are being overly influenced into undergoing botulinum toxin and other procedures, which they really just don’t need.
Both of these groups fall victim to transaction-driven, lower-cost physicians and non-physicians who have financial incentives to sell as much as possible to anyone who walks into their shop.
Unlike more established higher level physicians with practices and reputations, these people are less concerned about the long-term consequences of what they’re doing to the people who they treat.
I continuously see patients who come in to see me after spending more money and losing time from work after being improperly treated by these medical retailers.
Botulinum toxin like lasers and fillers is one tool in the toolbox of potential solutions for your aesthetic concerns.
The art is knowing how to use botulinum toxin optimally as well as when not to use it. I help a lot of people who come to my practice for their aesthetic needs. One aspect of being successful is that they understand how to leverage their time and resources to maximize certainty in everything they do.
Rebecca is a licensed aesthetician and certified laser technician with almost 15 years experience in the dermatology. Her life-long passion is making people look good and happy.