So now we move on to the next step of a cosmetic dermatologist’s anti-aging skin rejuvenation plan of Repair, Relax, Restore, Resurface, Re-drape.

Relax Muscle Action—Reduce Lines

We all have characteristic facial expressions which often run in families. Many patients tell me “my mom (or dad or grandmother) have horrible frown lines. I am starting to get them too and I am afraid mine will be just as bad—help!” Characteristic facial expressions are set early in life, usually by 5 or 6 years old and sometimes even earlier. Once set in childhood they are very difficult if not impossible to change.

Frowns are often not due to anger as is commonly supposed but rather concentration. Unfortunately others subconsciously perceive the frowner as being angry. Patients say “I am so tired of people asking me why am I mad—it makes me mad”. Many people have what are called “hyperexpressive faces” and have a lot of frown activity, forehead expression and even crunch their noses up during animation (called bunny crunch or wolf lines). This gives horizontal forehead lines, frown lines and lines leading down from the bridge of the nose onto the cheeks. Smiling or squinting leads to crow’s feet at the corners of the eyes. At first these lines appear only during expression. Over the years they become permanent, occur at rest and get deeper and deeper.

Now we are able to relax the muscles that cause these lines and reduce the angry, stressed or tired appearance. Injections of pharmaceutically prepared botulinum toxin (Botox or Dysport) are used to treat the specific lines on the upper face that muscle related such as frown lines, forehead lines, and crow’s feet. A “Botox brow lift” will lift the eyebows opening up the upper eyelid and reduce hooding. Some lines under the eyes can be improved. You look more rested and less stressed or angry.

In the lower face and neck Botox or Dysport are also used for anti-aging. Injections in the chin reduce muscle activity that leads to dimpling and to reduce the turn down of the corners of the mouth that occurs with age. They are also used to treat a “gummy smile” where the upper lip rises up too far with smiling showing more of the upper gum than is desirable. The muscles at the outside of the jaw which enlarge with teeth grinding can be slimmed. Bands of muscle in the neck can be softened reducing “cords” and improving the jowls.

• All in all Botox and Dysport have been great additions to our anti-aging treatments, allowing both reversal of signs of aging and prevention of progression. And contrary to the ads, nothings “better than Botox”.

Next—questions and answers about Botox and Dysport.