The Art of the Cosmetic Consult:
I was recently asked to write down my thoughts concerning the factors contributing to the aging face. I always note that our facial appearance is determined by both genetic and environmental (sun, smoking and diet) factors. The good news is aging, although inevitable, is modifiable if the cosmetic work is done in a conservative fashion. When explaining my philosophy on aging to my patients, I point to two main ways we start to exhibit the ravages of time. Specifically, lines and wrinkles form when the skin loses its elasticity and the contraction of muscles under the skin create etched creases overhead. Secondly, volume loss occurs as the collagen, muscle, fat and bone begin to decrease. Gravity then exerts its force on these areas and the face may start to sink and sag. Thus, as we age we develop the fine lines/wrinkles and sinking and sagging.
The way I address facial aging is by softening the fine lines and wrinkles and replenishing the volume. This month’s column will focus on addressing the fine lines and wrinkles. I must first state that when referring to correction it is essential to make any changes naturally and with an artist’s eye. This will ensure that the areas of the face come together in a balanced fashion. Add too much and the results are immediately noticeable and yield an artificial appearance.
With respect to addressing the fine lines and wrinkles I use Botulinum Toxin. Botox, Dysport and Xeomin are the three main products that contain Botulinum Toxin. These products work on the muscles that contract and create the lines on our forehead, the area between the eyebrows called the glabellar lines (or “11’s”), and the crow’s feet around the eyes. The Dysport/Botox/Xeomin relax the muscle so it is unable to vigorously contract and keep etching those lines in. Additionally, these three “train” you to not use those muscles as aggressively. The result is a nice curtain of relaxation where the wrinkle lines soften.
I also use botulinum toxin to decrease the severity of the platysmal bands in the neck (“turkey neck”). Using it to smooth out the puckered appearance in the chin and to improve the appearance of a drooping mouth is also possible. Finally, I use it for medical conditions such as tension and migraine headaches and TMJ issues. I find that even those patients with the most severe migraine issues respond very well and get lasting relief with some well-placed injections.
I use the smallest insulin syringe to make the injections reducing pain, bruising and swelling.
Just as with all cosmetic procedures, the injections should be done in moderation as it is possible to overdo it with botulinum toxin and create a “frozen” appearance. By careful attention to the dosage and location of injections, the muscles can be relaxed so as to soften the lines without freezing the entire face.
The botulinum toxin reaches its peak effectiveness at 7 to 10 days so the results are not immediate. It will typically start to gradually kick in during the first week. The results last three months on average although some patients get 4 to 6 months depending on their metabolism.
As mentioned it is crucial that the injector have a sound knowledge of anatomy as there are certain danger zones on the face where nerves and blood vessels are at risk. Injecting improperly can result in a facial droop where the eyes and one side of the face sag.
Next month I will detail the various methods that are commonly used to replace the lost volume in our face. Until then, see if you can spot the areas where your lines/wrinkles have become more prominent and look for areas where you are beginning to sink and sag. You should be able to point out where your scaffolding has weakened causing the resulting deficits. I will then describe how to treat the cause of the volume loss and bring back a more youthful appearance.
