In the last issue I discussed the concepts of the 4 pillars of Non Surgical facial Rejuvenation. In this issue I will expand on the uses of BOTOX and Fillers which together constitute the first 2 Pillars, RELAX and RESTORE.
Botox and Fillers have totally different actions although in some areas of the face, the end result can be similar. I like to use both at the same time but in different parts of the face so that their actions can synergies, giving a more natural result.
Botox is a medicine made of a purified protein complex that relaxes muscles when injected into them. It works by blocking the transmission of electrical signals from the nerve to the muscle and its action is confined only to the muscle into which it is injected thus making it very safe. It is given in small doses and there is no volume effect (it does not occupy any space).
Fillers on the other hand are synthetic substitutes of the soft tissue “glue” that exists in our body naturally, collagen. They occupy a volume and do just what they are supposed to do – fill! They can be made of collagen(from cows), hyaluronic acid(HA) or now more commonly, hyaluronic acid mixed with a proportion of plastic or bone particles that do not disappear with time, thus making the fillers last longer.
With worry and stress, bad facial habits or just plain age, we tend to develop distinct groups of lines and grooves around the eyes and mouth which make us look old and miserable. Many of these lines are associated with negative emotions such as anger, misery or frustration so that even if you are happy but happen to have these deep lines, you can look unpleasant. This is a very common complaint I get from patients.
The most negative frown lines are the ones that show up between your eyebrows and in the central part of the forehead which are all due to subconscious frowning. I see many young people walking around Orchard Road talking into their cellphones, gesticulating with their hands and frowning intently as they talk. You will also notice that when you frown, the level of the eyebrows drop, in turn making the eyes look puffy and tired. As these lines are due to unwanted muscle contractions the best solution is Botox injections to relax the stressed muscles. If the lines still persist after the Botox has become effective, then it would be appropriate to put some fillers into these lines as well to plump them up.
I like to inject a ring of Botox around the top and sides of the eyes as well as into the forehead, smoothening these areas and giving the eyes a fresh, pleasant and open appearance. If performed well this combination of Botox injections can even give a ‘browlift’ effect, which can save the patients from going through a surgical procedure.
For the deep grooves that stretch down from the nose to the corner of the mouth or from the corner of the mouth down to the jowls, I prefer to use a Filler material. This is because these lines are formed as a result of gravity and loss of volume from the midface rather than from movement of muscles. The logical solution is to therefore restore that volume surgically with internal implants or more conveniently with off-the-shelf Fillers. I also use fillers to restore that important 3-Dimensionality and vibrant appearance to sunken cheeks and facial hollows.
Botox in these areas would not be such a good solution as the Botox may weaken the smile muscles making the patient look asymmetrical or a little peculiar.
The last area I like to rejuvenate with these two treatments is to inject Botox into the chin to relax the muscles there. These muscles actually give the chin a sour and dimply appearance and I would further follow this with the judicious injection of Fillers to make the chin sharper and sweeter and more youthful.
I have been fortunate to pioneer several techniques with BOTOX and have become a frequent guest lecturer at conferences around the world. One of the latest developments with BOTOX which I helped develop is its use for FACIALSCULPTING or FACIALSLIMMING where BOTOX is injected into the jaw muscles on the side of the face causing it to shrink and thus make the face look more slim and trim without any surgery. An added advantage is that it also relieves patients of tension headaches and subconscious grinding of the teeth. This non surgical “facial slimming” has become a popular request in my clinic.
Meso BOTOX or MICROBOTOX is a term and concept I invented two years ago which involves injecting multiple small doses of BOTOX into the skin of the face to reduce the action of sweat and sebaceous glands as well as the superficial layer of facial muscles which are responsible for those very fine, annoying lines of the forehead or under the eyes. The net effect is improved sheen of the face with smooth skin, tighter pores and yet the ability to move all the deeper muscles of the face thus retaining a natural, non “plastic” appearance. My patients have found this to be a welcome complement to traditional BOTOX injections.