Art of Anti-Aging

February 18, 2014

Botox®: Get Educated

The perks and risks of the popular anti-aging treatment

botox-dallasBotox® has been on the market for over 10 years and has become the go-to solution for smoothing wrinkles and achieving a youthful look. Along with competitors Dysport® and Xeomin®, Botox® belongs to a class of products called neurotoxins that work to reduce facial wrinkling and signs of aging. These treatments are short-term solutions to reducing wrinkles, yet they often prevent age lines from worsening and they can be an affordable option for improving appearance. While beneficial in many significant ways, neurotoxins also come with a certain set of risk factors that should be considered before treatment.

The Perks: Looking Younger

Injected from a tiny needle into muscles between the eyebrows, neurotoxins minimize the so-called “11” lines, or vertical lines between the eyebrows, that form when you are stressed or angry.  The results of injectable neurotoxins are visible in 3-4 days and, with routine maintenance, fine lines and wrinkles virtually disappear. In addition to minimizing wrinkles in the forehead, neurotoxins can also be used to improve wrinkles in the lower half of the face. Small wrinkles in the upper lip, often termed “smoker’s lines,” can be softened with a small amount of neurotoxin.  Four tiny shots across the top of the upper lip along the lip line can diminish the vertical lines and turn the lip up a little without making your lip look swollen.

Although neurotoxins are most commonly used to reduce facial wrinkles, they can also be utilized to modify the appearance of a down turned mouth. A muscle called the depressor angulari oris (DAO) that runs from the corner of the mouth down to the jaw can pull the corner of the mouth down, creating a down turned mouth.  By injecting a little neurotoxin into this muscle, you can stop the downward pull of the muscle and turn the corner of the mouth up, resulting in a pleasant smiling appearance, rather than a frown.

The Risks: A Not So Natural Look

Although neurotoxins can help create a younger appearance, there is a risk of side effects and it is important to know where to place the injections to achieve the desired effect. While injections can be used to smooth out wrinkles around the eyes, or Crows Feet, older women should be careful about using injections on the forehead.  The horizontal forehead lines are responsible for lifting the eyebrows, allowing you to show emotion.  If you paralyze the muscles responsible for lifting your eyebrows in order to smooth out forehead lines, your eyebrows will be lowered, resulting in a “Frankenstein,” or mean-looking forehead.

Additionally, you also have to be careful not to get the “Jack Nicholson” or “Joker” eyebrows, where the middle portion of the brow is lowered but the lateral portion is raised.   A little arch to the eyebrow looks good but you want to be careful to avoid the type of dramatic arch associated with a comic book villain. To keep a natural look, make sure you have an experienced injector performing your treatment.

Having an experienced injector perform is even more important when treating the lower half of the face. Here’s why: there is a muscle called the depressor labialis inferioris medial to the DAO. If this muscle is injected accidentally, you will not be able to lower the corresponding side of your lip and it will look like you’ve suffered nerve damage. Similarly, there can be some unwanted side effects when treating the upper lip.  While most people have no problems with this treatment, some will report muscle difficulty around their mouth. Reported issues have involved trouble saying words that start with B, P or R and issues brushing teeth, such as holding toothpaste in the mouth and spitting out toothpaste after brushing.

Weighing Your Options: Is Botox® right for you?

Since neurotoxins have a short term effect, complications will vanish after about three months. Although this is good news for negative effects, the positive results you experience will also fade after three to four months and treatment. As a result, treatment will need to be repeated to achieve the same effect.

While repeated treatments may seem costly, neurotoxins can be an affordable option for achieving a younger look. Even if your budget only allows for a twice a year treatment, neurotoxins will help prevent wrinkles from worsening and there will be some long-lasting improvement over time.  It is more beneficial to use less expensive skin care products and allocate the savings toward treatments like Botox®, Dysport® and Xeomin®,  which actually produce results.

For over ten years, thousands of people have been injected with neurotoxins and no serious health complications have been reported. Although some risks do exist, they are not long-lasting and can largely be prevented by expert injectors. Since everyone has unique concerns when it comes to our appearance, you should seek out an experienced physician who can help you determine the best course of treatment.


Rebecca L. Euwer, M.D.

Dr. Rebecca Euwer is a Board Certified Dermatologist, specializing in cosmetic dermatology. She has been in private practice for 23 years in Dallas, Texas. She is an associate professor at UT Southwestern. She has lectured and trained physicians locally and nationally on cosmetic procedures in Dermatology.