Since various forms of botulinumtoxin A, including Botox Cosmetic®, and collectively referred to as neuromodulators, first started being used nearly 30 years ago as a treatment for unwanted fine lines and wrinkles of the face, it has become by far the most commonly performed aesthetic procedure by cosmetic dermatologists in the world. Over this time period, the number of indications for the cosmetic use of neuromodulators has expanded substantially, while our treatment techniques and understanding of this revolutionary treatment have continued to evolve.
The principle behind the cosmetic benefits of neuromodulators lies in their ability to relax targeted muscles by interrupting the nerve signal your body sends to a muscle to cause it to contract. This gives them the unique ability to target and substantially improve facial wrinkles that are caused mainly by the movement of underlying facial muscles, otherwise known as dynamic wrinkles. “As a rule of thumb, when my patients ask me which wrinkles I use Botox for, I tell them if you drew a horizontal line just underneath your eyes and across your cheek bones, most of the fine lines you would find above this line would be treated with the injection of botox,” says Dr. Paul Kuzel, board-certified dermatologist and medical director at Rejuvenation Dermatology Calgary. The 3 most classic treatment areas include the frown lines which develop between the eyebrows; the horizontal lines which develop on the forehead, accentuated when we lift our eyebrows; and the horizontal lines which commonly form on the upper cheek just lateral to the outer margin of the eye (commonly called “crow’s feet”).
“Many factors determine when and to what degree patients will begin to develop wrinkles in the 3 classic botox treatment areas of the upper face, including sun exposure, genetic factors and facial expression patterns” says Dr. Kuzel. “What remains true for all patients, however, is that prevention has very much become a crucial part of the treatment paradigm. Although well-established, deep wrinkles can be treated very effectively with neuromodulators, we are able to achieve the best results and maintain them more effectively over time the earlier we begin treatment, when fine lines are first starting to appear.”
Today, neuromodulators are used in many new and exciting ways to help subtly enhance a patient’s facial aesthetics. Sometimes, when a patient smiles, an excessive amount of their upper gum shows, referred to as a “gummy smile”. This common phenomena is caused by overzealous lip-elevator muscles, and can be effectively treated with a few expertly-placed units of Botox in the lower face. Patients who grind their teeth at night or chew a lot of gum may develop overgrowth of a prominent facial muscle called the masseter muscle, which connects our upper to our lower jaw and can be felt contracting on the sides of our cheeks when we firmly clench our teeth together. For women especially, this often creates an undesirable squared-off facial contour of the lower face instead of the ideal V-shaped tapering from the cheek bones down to the lower jawline which aesthetic dermatologists typically strive for. By relaxing the contractility of this powerful muscle with neuromodulators, we can help to achieve a more feminine, slimming contour of the lower face by causing a controlled atrophy of the masseters.
• Bunny lines – caused by contraction of the nasal muscle, resulting in prominent wrinkles along the sides of the nose and a deep horizontal frown line along the upper nasal bridge.
• Eyebrow lift – expertly placed Botox can be used to achieve an aesthetically pleasing eyebrow and upper eyelid lift.
• Lipstick lines/smoker’s lines – vertical lines running perpendicularly to the lips in a circumferential fashion. Use of Botox in the upper lip can also result in more “show” of the upper lip, popularly referred to as a “lip flip”.
• Resting lip downturn – a muscle of the lower face which functions to pull the corners of the mouth down called the DAO can be precisely targeted with botox to effectively turn a resting sad face into a smile!
• Mentalis or chin muscle – treatment indicated in patients who notice dimpling of their chin at rest or while speaking, caused by hypertrophy of the chin muscle.
• Platysmal bands – prominent vertical muscular bands which form on the neck, often very prominent in slender patients.
• Infraorbital lines – a small amount of precisely placed Botox directly under the eye can diminish the appearance of fine lines common in this area