The first thing I tell everyone about facial rejuvenation is that it is all about the R’s: We can either Relax the muscles, Refill certain areas like lips or cheeks, Resurface the skin, Re-nourish the skin, or sometimes Remove unwanted fat, hair, or blemishes.
Today, we will talk about relaxing the muscles. Wrinkles or creases, such as the lines on the forehead or between the eyes, are caused by repeated facial expressions that cause the skin to slowly break down and become thin at those crease points—much like folding a piece of paper back and forth multiple times. When we relax or paralyze the muscles for several months with an injection of a neurotoxin such as Botox®, the skin is then allowed to slowly relax and get thicker and thicker, slowly improving the creases.
If someone in their twenties has a small crease, often only one treatment will greatly improve the crease line and may only need periodic treatments, roughly once a year to maintain the appearance. As we get older with deeper creases, we can usually get the wrinkle to dissipate after around a year of treatment every three months. Now, just like everything regarding health and vitality, maintenance is essential for long lasting results. As the neurotoxins wear off, the muscle starts moving and the crease will come back in time. So regular treatment is often necessary to keep the skin looking more youthful.
It takes anywhere from 3 to 8 days for the medications to start working after it has been injected and the effects usually last approximately two to three months.
In the United States, there are three FDA-approved neurotoxins in use, while in Europe there are over 10 that are used. Botox® was the first to be approved in the US in 1977 and was originally used by neurologists to treat muscle spasms, strabismus, and migraines. Over the years, many patients noticed that the wrinkles on their foreheads or other areas that were treated, would smooth out and look more youthful. Thus began the cosmetic use of neurotoxins. The FDA approved Botox® in 2002 for that purpose. Dysport® was approved in the U.S. in 2009 and Xeomin® in 2010. The three neurotoxins work roughly the same, by temporarily paralyzing the muscle.
It takes anywhere from three to eight days for the medications to start working after it has been injected and the effects usually last approximately two to three months. The needle that is used for the injection is very small and thin and does not cause much discomfort. Occasionally, there may be a small bruise at the injection site. Bruising can be minimized if the patient is able to avoid taking aspirin, ibuprofen, and naproxen for several days prior to having injections. Dysport® should not be used if someone has an allergic reaction to cow’s milk. There are very few reasons people are not able to use any of the neurotoxins; any problems tend to wear off within three months from the time of the original treatment.
People should carefully consider which provider they use for treatments. The experience of the injector and the integrity of the products used are only two of the key considerations that should be taken into account when choosing the provider. Unfortunately, there are numerous reports of providers not using FDA-approved products, but instead purchasing them at a lower cost on the internet and having them shipped from Canada. Sometimes, they may be using actual products that are manufactured outside the United States and shipped to Canada. However, they can also be using counterfeit knockoffs made anywhere. Most doctors would never risk their medical license just to save a few dollars; but as more and more non-physician locations offer these services, the consumer must be aware and ask the provider where they get their products.
The three main areas that are treated consist of the glabella (the area between the eyes), the forehead, and “crow’s feet” in the temple area. Occasionally, we will put a small amount around the lips to decrease the “pucker lines” and sometimes in the muscles in the front of the neck to soften the appearance of this area. When treating an area, such as between the eyes, with Botox®, it may take anywhere from 10 to 50 units, costing roughly $10-15 a unit. Thus, several hundred dollars can usually treat one of the main areas of concern.
If those lines are starting to get deeper, one can try to not use the facial expression that is causing the wrinkle or can go ahead and try a neurotoxin. Because as your mother used to say: “If you keep making that face, it will stick.”