BoTox/Dysport injections are the most common nonsurgical cosmetic procedure performed in the United States. Yet the effects are pretty subtle compared with some other procedures, and the most common objection I hear to the procedure is that, “BoTox lasts only a few months and I want something permanent.” Here are a few things you may want to know about BoTox/Dysport – and if you want to skip down, I’m saving the best for last.
It's the only game in townRight now, there just isn’t anything else other than some form of Botulinum A (BoTox and Dysport being the most commonly used in the USA) that is going to relax your muscles other than cutting them. There may be other things going on in a face requiring other procedures, but if it’s muscle movement that’s contributing to something you don’t like (like frown lines between your brows), basically the only way to treat those muscles is BoTox/Dysport.
The more the betterThis isn’t about big doses; it’s about repetition. Certainly one BoTox session can be helpful for a special event, but the real beauty of how it works is in keeping to a schedule and repeating the injections so the muscles don’t have the ability to regain their strength. Indeed, this may be every few months for a year or two, but just as with any other muscle we work out in the body, if it remains unexercised long enough, it will undergo “disuse atrophy”, a good thing for muscles whose only purpose in life is to pull our faces down and in. As this atrophy happens, and I have seen this over and over in my 20+ years of giving BoTox, the BoTox doesn’t have as much of a battle to fight and often we eventually can reduce the effective dosage and/or significantly extend the time between treatments.
And the other side of that coin?With certain parts of the face, the muscles that pull the face down have opposite muscles that pull the face up – the “happy” muscles. As the muscles we treat get weaker over time, the happy muscles no longer have the “sad, angry” muscles working against them, and the happy muscles contract more and get stronger. At some point that area of the face just gets a bit of a lift that the single session of BoTox would never have been able to achieve. This is particularly amazing at the corners of the mouth!
Our brains get the hintWith the exception of the part of the closing muscle of the eyelids (the orbicularis oculi) that contracts with a natural smile, the facial muscles that we treat with BoTox/Dysport have voluntary and habitual components to them. This means that if we treat a muscle and keep it relaxed long enough, our brains tend to forget that contracting that muscle is part of our repertoire and we tend not to use it as much. Again, this is something that happens over time and is a side effect of BoTox/Dysport that often eventuates in needing less and/or extending the time between injections.
It's often effective for depression and anxietyDid you know that researchers have found that when someone holds a pencil in their teeth, forcing a sort of smile, they find cartoons to be funnier? And when a person is asked to put on a frown they rate photographs more negatively? That is because of a link between facial muscles and nerve pathways through the “emotion” part of our brain that then affects our mood. This evidence supports the idea that “the emotion follows the expression”. Indeed, research has shown that BoTox/Dysport placed in the frown muscles (the corrugator muscles) between the eyebrows compares in effectiveness with anti-depressant medications in treating depression. You can try this yourself. Sit quietly, relax your face and put on a little smile. Holding this relaxed expression is incompatible with negative thoughts. If they bubble up, your face will tighten and the smile goes away. Those of you who meditate know all about this. If you’re interested, a short and excellent article with this research information appears in Aesthetic Surgery Journal (35) 6, page 759 and is by Dr. Steven Dayan.
Oculofacial Plastic Surgeon, Sarasota, Florida
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