The most popular cosmetic procedure is injection of botulinum toxin, the first and most well known of which is Botox® Cosmetic.
Botox was used to treat a number of conditions where muscles were contracting in ways that were undesired, such is in certain eye conditions, neck stiffness, and congenital muscle disorders. The application of this treatment to remove facial expression lines launched the most popular cosmetic treatment of all time. Other brands of botulinum toxin include Dysport® and Xeomin®.
Where is botulinum toxin most commonly used for smoothing out wrinkles?
Generally, Botox® is used on the upper face. The first question to consider, is “how does aging affect our skin?”. The real question is “How does sun-damage affect our skin?”. If one looks at facial skin and compares it to our bottoms, it’s easy to see the effects of long-term sun-exposure compared to where the sun doesn’t shine. Fine lines, wrinkles and enlarged pores as well as pigmentary changes and redness are the 5 key signs of skin aging. We get furrows where our facial muscles attach to our skin. They are not from which side of our faces we sleep on, or from simple chronological aging. The sun is the main culprit and accounts for 90% of the signs we ascribe to skin aging, with a 10% assist from smoking in those who smoke. Young kids move their facial muscles as much as older adults, but we don’t see the places where the muscles attach in kids. The furrows of our foreheads, between our eyes, and our smile lines are all from muscle movement of the muscles underlying our skin and where they attach.
Why don’t we see these lines in kids? It’s because their skin has not yet had damage to the collagen and elastic fibers that make up healthy skin. In sun-damaged skin, we develop abnormal elastic fibers that replace the normal collagen-rich layers of our skin. When this happens, we are able to see facial expression lines in our skin.
The lines above the bridge of our nose, the ‘dreaded 11s’, or 111s or 1 that makes us look overly serious or stern are great examples of lines that can be treated with Botox®. The other most commonly-treated area is the forehead, where longitudinal lines can make us look tired or serious. Smile lines around the eyes are also very commonly treated with Botox®. Generally, Botox® and other botulinum toxins are used most commonly on the upper face. Less commonly-treated areas are the lines above the lip (too much toxin here can make a smile uneven), or the jowls to reduce the appearance of a large chewing muscle. Botulinum toxin is also commonly used to treat excess sweating of the underarms, hands and feet.