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There’s a lot more to Botox than meets the eye. We say this because the eyes are typically what most people think of when they think of Botox injections. The truth is that Botox can be used in many different places on the face to smooth lines, shape, and lift. At Celibre Medical, our injectors are trained in the most advanced, artful ways to inject Botox. This allows us the ability to provide you with outstanding injection results that not only make you look younger but also more naturally beautiful.
First things first though. Botox is not botulism. It is a highly purified protein that is FDA-approved for cosmetic injections. It is derived from Clostridium botulinum bacterium, but it is created in a strictly controlled, laboratory setting which assures you’re receiving a safe and effective product when purchased directly from the U.S. manufacturer, Allergan.
Botox works by relaxing the specific muscle that it’s injected into. It binds to receptors on the muscles that are normally stimulated by the signal molecule acetylcholine. When bound to Botox, these receptors essentially become blocked and the muscle stays relaxed, unable to contract. Of course, as our bodies regenerate, this effect wears off as new, unblocked receptors form on the muscle. When this happens, you’ll slowly start to see muscle contractions return. In full effect, Botox makes the skin over the treated muscles appear smooth and lines caused by their contractions that pull on the skin simply disappear.
Botox can shape the face by selectively relaxing certain muscles that are causing unwanted changes. By shifting the “balance of power” so to speak, Botox allows us to make other muscles work more efficiently at lifting and can help temporarily reverse signs of age.
Here is a brief description of the facial areas that can be treated with Botox and what it can do for each:
The little frown lines between the eyebrows are the bread and butter of Botox. Also known as “the elevens”, we get them from repeated contractions of a group of three separate muscles (the eyebrow depressors) in the area above and between the eyes. They all contract together, pulling the inner eyebrows down and in, creating a scowl or “frowning” appearance. Carefully injecting each of these three muscles melts away that sour, unhappy appearance and beautifully smooths the skin between the eyes.
Remember how we talked about that “balance” in the section above? When the frown lines are relaxed, the forehead muscle can lift the inner part of the eyebrows up…this is one of the ways that Botox can be used to reshape the brows and open up the eyes.
Botox for frown lines around the mouth
A telltale sign of age, crow’s feet are the lines that extend from the outer edge of the eye. They are caused by the contraction of the purse-string-like muscle that encircles the eye called the orbicularis oculi. This muscle allows us to blink or squeeze our eyelids shut, and it also contracts when we smile, which is what most people dislike! This is the second FDA-approved use for Botox Cosmetic. When carefully injected into the outer portion of this muscle, it will relax, softening the lines or making them disappear altogether with contraction. But don’t think that’s it—Botox is regularly used in many different areas to shape the face and soften lines. Even though these may be “off-label” (another term for not FDA-approved), they are widely requested and performed. As a result, when done by a knowledgeable, experienced injector, they’re considered very safe and effective.
Ever wondered if there was a way to get a brow lift without surgery? Well, there is! If you remember the orbicularis oculi muscle as described above, it encircles the eye and pulls the outer edge of the eyebrow down. This can make you look tired and make your eyelids feel heavy. Just a small amount of Botox injected into the muscle at the tail/outer edge of the brow relaxes this pull and can literally lift the brow up. Especially when combined with treatment of the elevens, this simple, easy procedure can be as effective as surgery for some people! Injections here can also help arch and shape your brow back to what it used to be years ago, or give you a new, sophisticated look if you’ve never liked the shape of your eyebrows.
Are you looking permanently surprised? If you’ve started noticing deeper horizontal lines across your forehead, then Botox may be the answer for you. Your forehead muscle is called the frontalis. Everyone has a bit differently shaped frontalis, so careful evaluation by your injector is necessary if you want treatment for forehead lines. Now, a really important piece of information here: your frontalis is the only muscle that lifts your eyebrows up. So, what happens if you get too much or the wrong dose of Botox here? You can end up with uneven eyebrows, flat brows, or worse yet, lowered brows like a Cro-Magnon! So, be very careful who you chose to inject you here. A good rule of thumb is to also treat (a bit heavier) the eyebrow depressors (remember the “balance of power”?) otherwise, you could end up looking worse-off than you started.
Say what? We know it sounds funny, but some people crinkle or wrinkle at the sides of their noses when they smile or talk. Over time, these little lines can permanently stay, which doesn’t look good. There is a small muscle called the nasalis on either side of the nasal bridge or nasal radix. When it contracts, it pulls on the skin covering the nose in this area, creating bunny lines. Just a small amount of Botox Cosmetic delivered in the right place here can make a big difference, but your injector needs to have an eye for these lines and make sure it’s placed in just the right spot to work well!
Have you noticed little vertical lines above your upper lip that act as a sponge for your lipstick? Maybe you don’t smoke, but you drink with straws or purse your lips often? All these activities cause pesky smoker’s lines, and no matter why you have them, we’re sure you’d rather not look at them in the mirror every day! Botox can help. The muscle that encircles the mouth works a lot like the one that encircles the eye: like a purse string. Its name is the orbicularis oris. The difference here is that we need this muscle to speak properly and make natural facial expressions. Very small amounts of Botox, carefully injected into the strongest parts can make those lines soften and/or disappear while still maintaining natural function. Here’s another bonus: when the upper part of this circular muscle is relaxed, it causes the upper lip to roll slightly towards the nose (lip eversion). The translation is that your upper lip will look fuller and bigger making that lipstick or gloss look even better! We’ll often use a dermal filler such as Restylane or Juvederm in conjunction with this treatment to give you the very most natural, soft, and full lips possible.
We’ve talked about frown lines, but what about a mouth frown? Go ahead, make a frown. Do you feel those muscles pulling the corners of your mouth down on either side of your chin? Those are your DAOs or depressor anguli oris muscles. In some people, these muscles are overly active, creating a permanent mouth frown or downward angle at the corners of the mouth. This creates an unhappy and old woman (or man) look that can also lead to skin creases in this area too. Fillers are usually the first choice to treat this, but although they help the creases, they don’t improve the “look” of the mouth frown. Fillers can also bunch up and create a heavy look around the mouth in this area, so they are not always the best answer. An astute injector understands this. By looking at your unique facial expressions and watching you talk, he or she can help you decide if Botox is a better choice. Again, the careful injection can create a straight mouth or a slightly upturned one (don’t worry, you’ll be as happy as you look!) See our before and after pictures here on this technique to better understand how it helps.
This one is like it sounds—a bumpy chin. What’s the reason for this? You guess it…an overactive muscle in your chin area. It’s called the mentalis muscle. Again, this one isn’t a problem for everyone, but for some, this muscle stays in a state of permanent contraction which makes the skin look uneven and bumpy like an orange peel. Botox Cosmetic in the mentalis muscle causes it to relax, softening and smoothing out the skin on the chin.
We’ve covered a lot of ground here. We hope we’ve given you some good information about just how versatile and useful Botox Cosmetic injections can be when it comes to helping you achieve smoother skin and more youthful features. The procedures we’ve discussed as “off-label” are considered advanced techniques that require further training and advanced knowledge of facial anatomy to get right. Don’t think that because someone “does Botox” they understand the nuance and skill necessary to perform all these injections. Make sure your injector has advanced training and experience with Botox. Ask questions and be an advocate for yourself.
Here at Celibre Medical Corporation, our injectors undergo rigorous training. We attend regular conferences, and workshops and stay up on the cosmetic research journals to make sure we are up-to-date on all the latest and most advanced uses of Botox Cosmetic. Our goal isn’t to use them indiscriminately on everyone. We take pride in providing you with a very specific, individualized treatment plan that best suits you. Our aim is to help you look naturally younger, more refreshed, and beautiful with Botox, not fake, expressionless, or strange. When used appropriately, Botox can be a powerful secret weapon in the fight against age. Make sure your injector is on the same page as you and has advanced “weapons” training. To learn more about Celibre Injections, please visit celibre.com/wrinkles. More Botox Injections before and after photos
Lori Ishii Haney
RN, MEP-C, CMLSO