Facial Rejuvenation: Botox

The beauty of the facial ageing process is that we transform from the strength and vitality expressed by the young face, to the trustworthiness and credibility reflective of accumulated life experience and loss of naivety which is often described as ‘’character’’. The difficulty of plastic, reconstructive and aesthetic medicine and surgery is to strike an optimal balance between these two extremes, while making sure it fits the actual age of the patient.

Although not immediately obvious upon first glance, the human face is controlled by 43 different muscles. The majority of these are directly attached to our skin and innervated by a single nerve named the facial nerve. Its many different branches allow for selective activation of individual muscles, on their own or in any imaginable combination. This explains the extensive number of emotions we are able to communicate through our facial expressions and provides the basic explanation for the old adage “The face is the mirror of the soul”.

In addition to our emotions, another important driver of facial muscle activity is compensation for loss of elasticity and thickness of our skin, which progresses over time under the influence of intrinsic (genetic) and extrinsic (diet, sunlight, trauma, sleep deprivation) factors. For example, ageing may cause sagging of skin around the eyes which may induce overactivation of forehead musculature to decrease the resultant obstruction of our visual field. Our emotions, ageing and compensational activity are the three factors that combine to determine the relative activity of our facial muscles in different parts of the facial skin. The result is that different areas of our facial skin are subject to different degrees of tractional force at different points in time.

Both the amount and direction of tractional force accumulated over time are the main determinants of the location and depth of skin creases in the human face. These dynamic skin creases are defined by their prominence being dependent on the activity of the underlying muscle. Static and usually finer skin creases, on the other hand, are not significantly influenced by muscle activation. From an aesthetic perspective, the dynamic skin creases are the ones which give character to our face, for they communicate our emotional state and history to our surrounding audience. Although this can be a hugely important asset in human interaction, it can also affect our well-being negatively if our face communicates emotions we would like to keep to ourselves, or information regarding our age which we may all like to disguise to a variable degree at different points in time. 

BOTOX (Botulinium Toxin) is a natural agent which decreases activation of muscles in a temporary (~ 3 – 6 months) and completely reversible fashion. This characteristic makes it hugely effective in modulating the emotional balance and history expressed by our facial muscles. However, this balance is very precarious, and it takes great skill, pharmaceutical and anatomical knowledge to adequately deposit the correct amounts of BOTOX into the correct muscles, in order to obtain the optimal and highly variable balance for each individual patient. In recent years, the availability of BOTOX treatment has skyrocketed, with an array of practitioners offering a large variety of different types of treatments which can vary significantly in effectiveness, complication rate, price, and patient satisfaction. At ANDSURGEONS, we strive to optimize the quality of BOTOX treatments by making sure your procedure is only performed by facial plastic surgeons. This means you can rest assured that your practioner has the necessary anatomical, medical, and pharmaceutical knowledge, as well as the practical surgical skill and experience to advise, treat and follow you, and deal with post-treatment problems should they arise.