Editorials

Botox More than a Wrinkle Cure

Most patients think of Botox as a wrinkle cure; however Botox plays a major role in facial shaping/sculpturing rather than just injecting wrinkles.

Exact knowledge of complex facial muscular anatomy, precise injection technique and artistry are necessary to prevent the paralyzed look and avoid any risks and complications. Botox is the number one cosmetic procedure performed annually. Approximately 2.3 million Botox procedures are performed annually which makes up 22% of all cosmetic procedures performed.

Current applications that I perform include treatment of the Forehead, Brow/between the eyes (glabellar region), sides of the Nose, around the Eyes (lateral canthal region), Upper/Lower Lips, Smile with gum-line show, Upper/Lower corners of the Mouth, Neck platysmal banding (neck bands), Chin region (mentalis), excessive Sweating (hyperhydrosis) of the Hands and Arm-pits (axilla) and the treatment of Migraine headaches. I also treat Nasolabial folds and Marionette’s lines. Botox relaxes the above specific muscles or muscle groupings/regions with a peak effect about 5-7 days with full functional recovery of muscle activity usually within 3-6 months.

Most essential is the understanding of the dynamic mimetic muscular which create expressions on the overlying soft tissue of the face, dynamic facial lines (rhytids) and how the soft tissue will position after the procedure. The depth of injections based on location, thickness and action of the expressive facial muscular is mandatory to achieve the optimal natural balanced result.

During my initial aesthetic evaluation with my patients I evaluate: 1. Brow shaping versus frown line improvement. 2. Patient’s desired result. 3. Brow and eyelid asymmetry.  4. The Depth of the horizontal and vertical frown lines. 5. How best to achieve a balanced relaxation of the various muscle groups with the appropriate amount of animation for a natural look.

In summary completing an aesthetic facial analysis, evaluating any pre-existing conditions/asymmetries, adhering to the principle less is more and listening to my patients’ goals optimizes a Natural Balanced Appearance as opposed to the Paralyzed Look. Careful documentation of injection sites and amount (units) administered at each site allows a reproducible result. With continued use over time one generally sees a longer lasting effect with less Botox needing to be administered.

Satisfaction is high and the goals straightforward.

David Fellows, M.D., M.F.A.
Plastic & Reconstructive surgery
Master of Fine Arts Figurative Sculpturing