The earliest signs of facial aging occur in our eyes, often beginning in the late twenties and early thirties. The earliest signs are fine lines and wrinkles around the eyes, frown lines and crow's feet. Soon we begin to notice that our eyebrows have begun to sag and cover the upper eyelid.
A high arched eyebrow is a classic sign of youthful beauty and alertness. As the eyebrow and forehead descend, a loose fold of skin begins to cover the upper eyelid and make our eyes look tired and old. Botox can help reverse and prevent many of these changes when started early in many people.
Advanced sagging often requires a surgical brow lift, not Botox. However, the early use of Botox can help prevent some of the forces which act to pull the forehead down and cause brow ptosis or sagging.
What Causes Sagging of the Forehead?
As our facial skin ages we lose collagen in the deep layers of the skin. Collagen supports our skin and helps keep the skin tight on our face. As we lose collagen the skin becomes lax and begins to sag.
However, our foreheads and eyebrows are also pulled downward by the action of the muscles around our eyes. When we frown, the frown muscles pull the skin down towards the base of our nose. These muscles the Procerus And Corrugator Muscles are called the frown muscles and contribute to brow ptosis.
In addition, the muscles on the side of our forehead around the eyes, also pull the forehead down when we smile or grimace. These muscles, called the Orbicularis Oculi Muscles cause crow's feet and ptosis or sag.
The combination of facial skin aging with loss of collagen and skin tone and the daily repeated pulling by the frown and crow's feet muscles together, over a lifetime can cause the eyebrow and forehead to sag down over the upper eyelid. This creates a tired older appearance to the face.
How Does the Botox Brow Lift Work?
Botox works by relaxing the muscles that are pulling the forehead down. When Botox is injected into the Procerus and Corrugator frown muscles, the muscles relax and quit pulling down on the forehead near the nose, and the forehead is allowed to elevate. The frown line is also lessened.
When Botox is injected into the upper, lateral or outside portion of the Orbicularis Oculi muscle, the upper crow's feet muscle, the muscle relaxes, stops pulling the outside portion of the foreheaqd down, and the forehead is allowed to elevate.
Two large muscles on the forehead, the Frontalis Muscles, hold and pull the forehead up. The frown and crow's feet muscles pull down against the action of the Frontalis Muscles. When the frown and crow's feet muscles are relaxed by Botox, the Frontalis Muscle can pull up on the forehead unopposed.
What Do Injections Feel Like?
Botox injections should be painless if they are done correctly. I apply a numbing cream to the skin before injection. I also cool the skin and underlying muscle by applying an ice pack or cold titanium roller to the skin before injection.
When these techniques are used, most patients do not even feel the injection.
Are Injections Safe?
Yes when used by an experienced and properly trained physician who is experienced in the use of this agent.
This medication is a safe, carefully prepared synthetic pharmaceutical grade product, and not food poisoning toxin as so often reported in the media.
Like any powerful medication, Botox must be given by an experienced licensed doctor or nurse under direct doctor's supervision.
I do my own injections because I believe technique is very important, and I believe the doctor must understand facial aesthetics and facial rejuvenation principals to achieve the best result possible.
Like any medication, this drug can be over used. However, I have never seen a patient lose their facial expression or look like a figure in a wax museum in my practice. Patients can still smile, show emotion and look normal after injection, they just do not have deep frown lines and crow's feet.
What Are Possible Complications?
Complications are very unusual in my experience. Temporary droop of the eyelid is the most frustrating, but recovery and return to normal takes 2-3 weeks. Lid droop can usually be avoided by proper injection technique.
Headache and flu like syndrome can also occur in some patients, but this is unusual, occurring in less than 2% of patients.
Where Should I Go For Treatment?
You should consult a board certified physician who is experienced in facial aesthetics and facial rejuvenation procedures. Unfortunately many people assume that these injections are easy to do and many doctors and nurses with no formal training in facial aesthetics and facial rejuvenation procedures do these injections.
Your doctor needs to understand how the facial muscles work and what is causing the aging change that you want to correct. Technique is very important if you are going to achieve a good result.
Board certified Plastic Surgeons and Dermatologists are the most highly trained and expert doctors in these techniques. I suggest that you consult one of these board certified specialists. Personally I would avoid having these injections in a Spa, at a party, or by a non physician.
What Do Injections Cost?
These injections are priced according to the amount of Botox used, which is described in International Units (IU).
A typical treatment can use 25 to 50 IU's. I can usually do the forehead lift with 25 IU's. This can cost between $ 325- $ 500. You will likely pay more to have an experienced board certified expert do your treatment, but I believe you get what you pay for.
Prices vary from $ 13 to $ 20 per IU, depending on the number of areas treated and the number of units used. The more IU's used and the larger number of areas treated, the less the per unit charge.
Be wary of low priced injections. Some unscrupulous providers dilute the material and lower the price. If this happens to you your treatment will be less effective and will not last as long.
Ask your doctor how the dilution is done. There should be 2.5 IU's in each 0.1cc of solution, so a 1 cc syringe should contain 25 IU's.
Ask the questions and make sure you are getting what you pay for.