In this week’s video edition of #AskDrBirchenough, I answer the question: “Can I get my eyebrows to go up with Botox in my forehead?” For more information, please visit www.birchenoughmd.com/botox.
As well-known and ubiquitous as these products are in the popular press and in my office, there is still a lot of confusion from patients over which injectable to use, when, and where. So here’s a primer!
Botox (and other botulinum toxins like Dysport and Xeomin) works by INHIBITING MUSCLE action.
So, if the wrinkles in between your eye brows (the glabella) or in your forehead or the “crows feet” area are caused by the action of a muscle, then you can decrease the repeated skin creasing by injecting Botox into the muscle. Over about 5-7 days the muscle loses ability to contract, allowing the skin to flatten out and not be so creased. It usually lasts only about 3-5 months before the muscle gets back to full strength and you have to inject it all over again.
However, (and here’s the kicker) the muscle can’t be one that is used for critical facial expressions like smiling or closing your eyes. That’s the reason I avoid injecting Botox around the mouth, cheeks, or into the eyelids – you really need those muscles to work properly to maintain normal facial expressions and functions.
FILLERS (including the hyaluronic acids – Juvederm, Voluma, Restylane, Belotero – and other products like Sculptra and Radiesse) do just that – they FILL! Unlike Botox, the effect is immediately noticeable. They are gels that are injected under the the skin (not into the muscle) to fill in creases, increase volume, and make deeper grooves more shallow. Common places for fillers are in the hollows under the inside part of the lower eyelids (nasojugal grooves), the folds next the nose between the cheeks and lips (nasolabial folds), and the deeper grooves that can form from the corners of the mouth down to the chin (marionette lines).
Fillers can also add volume to the lips and cheeks when used in the right amounts and in the anatomic locations. Just puffing up the lip is easy but looks unnatural. I tend to restore lip symmetry and refine the borders of the lip through very small, precise injections of filler. Very fine lines on the upper lip are difficult to smooth out because of the gel quality of fillers.
So, now that you know the basics, you can come on in to get your injectables! For more information on BOTOX, please visit the skin services section of our website.