Injecting botulinum toxin requires the perfect marriage of science and art. Just as every face looks different on the surface, so too does the anatomy of the muscles and soft tissues under the skin and it’s crucial to take account of this when performing the treatment. The goal of the treatment should always be to leave you looking rested and rejuvenated, which is why a tailored approach is so crucial to achieve this. The upper face is the most commonly treated area with botox and indeed often delivers the best and most reliable results. The individual parts which are commonly treated include the frown lines, the horizontal lines as well as the crow’s feet. In some patients it’s also appropriate to treat the lower eyelids. In this cases the goal of the treatment to reduce the appearance of the dynamic lines which appear when you smile, rather when remove the eyebags caused by protrusion of the lower eyelid fat pads. Some patients also request treatment of so called “bunny lines”, which run across the bridge of the nose. Treatment of the upper face is generally regarded as painless experience and is generally associated with a low rate of complications and side effects. Most people find that the results last 4-6 months at a time although gradually the duration of results starts to increase after you have the treatment repeated several times.
Eventually there may also be a permanent reduction in the appearance of wrinkles meaning that even if you decide to stop having the treatment repeated, you will never go back to the way you were before. Treatment of lower face and neck with botulinum toxin is not quite as reliable as with treatment of the upper face. Areas which respond well to treatment include the fine lines on the upper lip which appear on pursing the lip, as well as the dimply chin appearance which some women develop when they speak. Botulinum toxin has been used to elevate the corners of the mouth, by relaxing the muscles which pull down on the corner of the mouth. In some patients a neck lifting result can be achieved by injecting the platysma muscle in the neck. When the platysma muscle is contracting it acts to pull the neck downwards and so relaxing it using botulinum toxin has the opposite effect, to provide a lifting effect on the neck and jawline. The result of the treatment can be subtle, but is generally much appreciated by patients. The results do not last as long as the upper face and typically need to be repeated every 3 months to maintain the effect.
The concept of providing a face lift effect from botulinum toxin is relatively new and works very well in most patients. If you imagine the face of consisting of 2 groups of muscles: one group which pull the face upwards and the other group which pull the face downwards. In the Botox Facelift technique the idea is to relax the muscles which pull the face downwards thereby increasing the relative forces provided by the muscles which pull the face upwards. The lifting technique works very well on the upper face and eyebrows, to a slightly lesser extent, the neck and lower face. It’s not so good at lifting cheeks however, which are still best treated using volume enhancement with fillers.