Botox: Understanding Balance

One of the most common things that I hear when I am working on a new patient for Botox is either “Don’t give me those Spock eyes” or “Don’t make me look too frozen.”  Although Botox has become one of the most commoditized items in the cosmetic world, I believe that by delivering quality (more natural results that appear more aesthetically rejuvenative) and value (that lasts longer and helps to promote better long-term skin healing) then Botox can help define one’s cosmetic practice.  For example, I have a gentleman that flies in from Hong Kong every three months just for me to do his Botox and then he flies right back out to go home.  I have another individual who flies in from New York to get Botox even though his significant other offers him free Botox treatments.

Is Botox just about wrinkle reduction?  In short, no.  One must take a step back and understand how injecting Botox in one muscle can have favorable or unfavorable results in surrounding muscles.  The frontalis muscle of one’s forehead is the only elevator of the forehead.  If one just blocks the frontalis muscle, there is a good chance that all the depressor muscles will pull the brow downward unopposed.  This is why I am very careful not to just treat one’s forehead muscles even if that is the only area of wrinkles.  In fact, if there are many more wrinkles in the forehead I have to be extremely careful not to over inject it since wrinkles in the forehead signal to me that someone is trying to lift one’s brows a lot and knocking that ability out and further lowering the brows could make someone quite angry at me.

Conversely, if I inject only the depressor muscles like the frowning muscles (the corrugator and procerus muscle) and the smiling muscles (the orbicularis oculi), sometimes the sides of the eyebrows can lift too much and cause a Spock-like or Jack Nicholson-like effect.  Treating a small degree in the forehead can help balance the result.  When I see a patient I put together all the things that I see:  how bad the habits of movement are, where the brow and eyelid position sits, and other anatomic features along with what a patient desires.  I do this when coming up with a game plan on how I will help a patient look better in a balanced and natural way.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8188. To Learn more about Dr Lams’ plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forum