“Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love…” D. Rock 63 Yrs Old with Fat Droopy Eyes – Salt Lake City, UT
Movement of our facial muscles (called animation) allows us to smile, frown and grimace. Movement of muscles moves the overlying skin, which results in dynamic lines or wrinkles. In our youth, these are not visible once we stop animating the face. However, over time, changes in skin where these lines of animation form result in more permanent lines. For example, the constant use of the forehead leads to horizontal forehead lines, and smiling results in radiating lines on the outer corners of our eyelids, commonly called Crow’s feet. Vertical lines between the brows are a result of overaction of our frown muscles and are commonly called elevenses. There are numerous other areas on the face where major or minor lines or wrinkles may form. With an accurate knowledge of anatomy and physiology of human facial muscles and skin, it is possible to modulate some of these lines and bulges with considered use of botox. This is not injection by the numbers: faces differ, sexes differ, the degree of overaction of muscles and the depth of lines and prominence of bulges also differ. This is where the careful use of toxins gives excellent results. Botox is one of such toxins. There are several different types of botulinum toxin on the market, including Botox, Dysport, Myobloc and Xeomin.
HOW DO I KNOW IF I AM A CANDIDATE FOR BOTOX?
WHAT IS BOTOX?
Botox is a one of a group of chemicals termed “neurotoxins”. Simply put, it is a chemical that blocks the transmission of impulses from a nerve ending to a muscle. Therefore, the muscle is not able to function when such
an injection is administered.
WHAT IS THE EFFECT OF BOTOX INJECTIONS?
As the muscle is unable to contract after the injection of botox, several effects are seen. Where muscles tend to cause a bulge, like the frown muscles, these bulges are relaxed. Where the contracture of the muscle causes a groove, like forehead grooves and frown line grooves, these become shallow (during the duration of the effect of the injections). And because of the decrease in contracture of the muscle, the overlying skin wrinkles also look better. The effect should be to leave you looking relaxed and rejuvenated, with fewer worry and frown lines, but at the same time leave you with the ability to still express yourself. This is very important so as to avoid the overly “botoxed” face, so common these days.
BUT ISN'T BOTOX A POISON?
Botulinum toxin is, indeed, a poison. However, when the toxin is modified and weakened to very accurate scientifically determined levels, the chemical is able to decrease the movement of the muscle without any systemic effect: that is the chemical that we inject: you should have no concerns about any systemic effects from the controlled injection of the botulinum toxin. Millions of injections of botox have been administered safely over more than 30 years.
HOW DO I KNOW IF I AM A CANDIDATE FOR BOTOX?
WHAT AGE DO I HAVE TO BE TO GET BOTOX?
We use botox for medical reasons in patients of all ages, from babies to older patients. For cosmetic reasons, it is wise to only consider injections when you are an adult and able to comprehend the pros and the cons of such injections.
WHAT DO I EXPECT FOLLOWING TREATMENT?
The effects of the injections are usually seen three to four days after injections although some of our patients claim to see results almost immediately. When the chemical takes effect, the areas injected will show an improvement in fine lines as well as deeper wrinkles. Where the intention is to reduce the movement, one will notice such reduction in movement: for example in the brow area where injections are administered to reduce the movement of the frown muscles.
WILL I BRUISE?
I HATE NEEDLES: WILL IT BE PAINFUL?
HOW OFTEN WILL I NEED INJECTIONS?
HOW LONG WILL THE EFFECTS OF THE INJECTIONS LAST?
IF I KEEP ON GETTING THE INJECTIONS, WILL I EVENTUALLY NOT NEED THEM ANY MORE?
I HAVE TRIED BOTOX BUT IT DOES NOT WORK ON ME?
WHO WILL INJECT ME?
- Occipitofrontalis muscle
- Temporoparietalis muscle
- Procerus muscle
- Nasalis muscle
- Depressor septinasi muscle
- Orbicularis oculi muscle
- Corrugator supercilii muscle
- Depressor supercilii muscle
- Auricular muscles (anterior, superior and posterior)
- Orbicularis oris muscle
- Depressor anguli oris muscle
- Zygomaticus major muscle
- Zygomaticus minor muscle
- Levator labii superioris
- Levator labii
- superioris alaeque nasi muscle
- Depressor labii inferioris muscle
- Levator anguli oris
- Buccinator muscle
WHY IS IT IMPORTANT TO KNOW WHERE TO INJECT?
WHETHER I GET INJECTIONS INTO THE FOREHEAD, THE FROWN LINES OR THE SMILE LINES, OR ALL THREE, CAN MY SMILE BE AFFECTED? HOW IS IT DIFFERENT?
This is interesting, but why is it so? What’s going on upstairs that creates these two different smiles?Scientists have discovered that these two types of smiles are actually controlled by two completely different parts of our brain. When a patient with damage to the motor cortex on the brain’s left hemisphere attempts to smile, the smile is asymmetrical, with the right side of the smile not moving as it should. However, when that same patient spontaneously laughs, the smile is normal with no asymmetry. This means that the genuine smile is controlled by some other part of the brain. Now, when a patient with damage to the anterior cingulate (part of the limbic system) in the left hemisphere attempts to smile, there is no asymmetry. The smile is normal. However, when that same patient tries to smile spontaneously, the asymmetry appears.
Thus, the “Say Cheese” smile is controlled by the motor cortex while emotion-related movements, like the Duchenne smile, is controlled by the limbic system (the emotional center of the brain). But, does it truly matter if your smile is contrived or authentic?
Apparently, it matters a great deal to your life satisfaction (and quality of marriage, ability to make friends and how you are perceived in business and life!) “Say Cheese” smiles, and the non-smilers.
The researchers followed up with these women at age 27, 43, and 52 and asked them questions about their life satisfaction and status of their marriage. They found that the Duchenne smile predicted positive outcomes in marriage and well-being up to 30 years later.
So remember, a genuine smile will probably make you happier than you think! THAT is why it is important to know the orchestra members, the orchestra and the hall within which they play!
- Damasio, A. (2006). Descartes’ Error. Vintage (Rand).
Harker, L. and Keltner, D. (2001). Expressions of positive emotion in women’s college yearbook pictures and their relationship to personality and life outcomes across adulthood. Journal of Personality and Social Psychology, 80(1):112-124.
BEFORE AND AFTER
ARE THERE ANY SIDE-EFFECTS?
- Bruising and swelling may occur, but that may happen whenever injections are administered.
- Asymmetry: on occasion, you may notice a more or less effect of the botox on one or the other side. This is really not a side-effect and can easily be corrected. It is best to wait four weeks to ensure that one is not over-injecting.
- Ptosis: this is a droop of the upper eyelid. This may happen in about 3% of injections when administered in the frown area for the elevenses. If this happens, the droop disappears within a few weeks. Although there is a drop that can be used to lift the eyelid temporarily, your pupil may look a little bigger after the use of this drop. Ptosis is not a serious side-effect and in most cases disappears in two to three weeks.
- Allergic reaction: Although there have been reports of allergic reactions, I have never personally seen one. A few patients sometimes develop a tiny dot at the site of the injection which may be a little tender to the touch. These just disappear within a few days.
- Oedema: this is swelling. Remember, our facial muscles allow us to pump fluid away from certain areas. It is because our lower eyelid and cheek muscles move that we are able to reduce the overnight lower eyelid puffiness that many people get. After botox injections in certain areas, especially the lower eyelids and the smile lines, some degree of puffiness may occur. Again, this is not severe and disappears within a few days.
- Ache and headache: a few patients report a slight headache after the injections for a few hours or a few days. This is unusual. More often, patients notice that those that suffer from frontal headaches actually get relief.
ARE THERE ANY SIDE EFFECTS?
With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.
Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.
All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur.
In the first few days, everyone will experience some degree of dryness and blurry vision. You will also feel that your lids look a little tight on the outer corner where you will also feel some of the deeper sutures if you put your finger there: this is of no concern. The tightness and the bumps under the skin settle over a few weeks.
More serious complications which are very rare include excessive bleeding, hemorrhage and loss of vision.
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CONTACT DR. PATEL
Do you have questions or need more answers?
Dr. BCK Patel MD, FRCS
Salt Lake City, Utah 84106, USA
(801) 413-3599 (phone/text)
Dr. BCK Patel MD, FRCS
617 E Riverside Dr Suite 101
Saint George, UT 84790, USA