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Benefits of Botox

Botox is a muscle relaxant to relax dynamic wrinkles. Read more...


 

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Photo: Techei

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What is Botox?


Botox is a tradename for a brand of neurotoxin injected directly into muscles for the purpose of relaxing the muscle. There are several brands of neurotoxins used in a similar manner. However, the name recognition that Botox has achieved has led many patients and consumers to use the word "Botox" as a verb to indicate a desire to get rid of particular wrinkles.


What are the benefits of Botox?


There are a number of benefits of Botox beyond the expected cosmetic results. Of course, we often think about botox when we start to see forehead furrows, the “11s” along the labella, and crow's feet. However, there are a few other benefits that many people are pleasantly surprised to find.

  • Fewer headaches. Many of my patients that start with Botox are surprised to find that they often experience fewer headaches. So much so that some will even find that they come in for follow-up when their headaches return and not their wrinkles! Although Botox is a recognized treatment for migraines, there is a likely benefit for tension headaches as well. Think about how much tension many of us hold in the forehead by contracting these muscles. This can be released by Botox given the relaxation of the muscle.

  • The possible benefit of improving depression. This study showed that comparing Botox to antidepressant medications for depression can yield similar outcomes. I was not at all surprised by this. This may be multifactorial. However one of the most common groups of patients I have that seek Botox are patients that feel as though their facial features do not reflect how they feel. They often say that people ask them constantly if they are ok or feel like people think they look worried all the time. Since facial rhytides or wrinkles almost “paste an expression” on our faces, it is difficult for some to interpret facial cues in this background. Botox releases these wrinkles so that our faces are free to express themselves again! Of course, much of this outcome is guided by the technique and experience of the injector. The potential for a frozen face with Botox can occur with higher volumes injected. It is worth seeking Board Certified Dermatologists for treatment as most of us were trained as a part of a residency program and not by the industry.

  • Less thickness or heaviness to the forehead. The muscles in the forehead are like other muscles in the body- if you overuse them they do hypertrophy or thicken. By using Botox, these muscles become less active and can then thin out a bit. This makes the forehead less heavy or thickened in appearance.

What should we know before getting Botox?



Always seek out experienced Board Certified Dermatologists and appreciate those that turn you down. Not everyone is a candidate for Botox. The muscles that compose our facial anatomy are a series of bullies. If you relax one muscle, others may become more active which can affect outcomes. Also recognize, especially for those with heavy eyelids, that sometimes we have forehead wrinkles because we are using our foreheads to keep our eyes open! If Botox is used, there is the potential for making the eyelids heavier. Having an evaluation prior to treatment is important as these patients I can often identify and refer these for blepharoplasty to address the eyelids first to avoid complications.



Preventative Botox is a potential benefit for some but not all. Those that have a high tendency towards the 11’s along the labella can likely benefit the most. Although it’s safe and effective to start early, the reality is that it can be costly to figure this into your budget at an early age. I say this as a mom and a dermatologist. Figuring botox into your budget is adding several hundred to a couple of thousand dollars into your annual budget. The best preventative anti-aging intervention early on is sunblock and retinol or prescription tretinoin. Talk to your dermatologist openly and honestly about your concerns and consider either preventative skin care regimens or reduced frequency regimens of Botox to address the preventative component without going overboard.


 



 

What are the cons of Botox?


Botox is a muscle relaxant. The muscles in our forehead are a series of pullies. Recognizing from a physics perspective that the injector must have a deeper understanding of facial anatomy to give the best outcomes is important. Also recognizing that not every forehead is the same is essential. Each pattern of injection can vary somewhat based on targeting muscles that need to be relaxed for the best outcomes.


Can you get botox injected in your lips?



In recent months, we have been receiving lots of inquiries into botox injections for the lips. Botox is a muscle relaxant. There is a round muscle that surrounds the lips margin called the Orbicularis oris that is responsible for pursing the lips and creating various movements of the lips based on how it contracts. Radiating out from this muscle we have other muscles that act as pulleys to pull the outer edges of the lips in different directions to create various facial expressions. Any of these muscles can be injected to impact both the way these muscles contract and the expressions they create while also potentially impacting the facial contours and anatomy based on the thickness of these muscles.



 


 


Why would you get Botox in your lips?



The ‘lip flip’ gained a lot of social media attention in recent months for how injecting the superior portions of the orbicularis oris muscle impact the way the upper lip sits. When this muscle is active it can make the lips pursed as well as pull the upper lip inwards- especially when smiling. By injecting the superior portions of this muscle, the upper lip is under less tension and relaxes in such a way that it remains full, even when smiling.


What does it feel like when you're getting it done and after?



Any injection in the lips hurts, it just does. We can offset much of that discomfort with topical numbing. The injections are quick and only take seconds to perform.


What is a Botox Lip Flip?



The Botox lip flip is an injection technique where botox is injected into the upper vermillion border of the lips at about 4 sites. This is the portion of the lip where the pink portion of the lip meets the skin border. The orbicularis oris muscle lies deep in this region.


Should you get a lip flip or filler? Why?



The lip flip has turned out to be a bit of a fad in that the results do not tend to last long. Botox tends to last in terms of its muscle relaxant effects for 3 to 4 months. We have been finding that the lip flip effects appear to wear off within 6 to 8 weeks for many. There are other challenges with relaxing the upper lip. Pursing the lips is impacted which means drinking through a straw, impacting some aspects of speech, and keeping saliva in your mouth while talking can be a bit challenging.


Filler is much better tolerated while giving longer-lasting results without impacting the function of the lips.


How long does it last?



Botox tends to last in terms of its muscle relaxant effects for 3 to 4 months. We have been finding that the lip flip effects appear to wear off within 6 to 8 weeks for many.


How much does it cost?



Although it is true that it does not require many units of Botox to achieve a lip flip, most practices have a minimum charge for Botox injections.


What about Botox around your mouth? Why would you get this done?



There are a few muscles that radiate out from the orbicularis oris that affect our facial expressions while also aging our look. The most common one to inject with Botox is the Depressor anguli oris, It attaches to the orbicularis oris muscle at the upper lip at the corner where it meets the lower lip. It pulls the upper lip down into the lower lip to give a downward turn to the corner of the lips. This can be the beginning of the marionette lines where a line develops between the chin and the cheek. This line can also accentuate the nasolabial folds. If someone has a strong tendency to create facial expressions that recruit this muscle, it is not unreasonable to consider injecting it to stop tugging the upper lip downwards. That being said, it is also reasonable to use filler to achieve a similar result without altering facial expressions.

The upper outer portions of the orbicularis oris muscle under the upper cutaneous lip (the mustache area) can be injected to decrease the appearance of perioral wrinkles. These lines that radiate out from the lips like spokes in a wheel project towards the lower edge of the nose and can appear as “smokers lines’ - even if you never smoked a cigarette in your life. Injecting these areas does not tend to affect the lip anatomy or speaking as the lower portions closer to the lip margin remain somewhat active. The placement of Botox is key to achieving good outcomes.



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