Today we are going to talk about the finer points of Botox® treatments, and why so many injectors of Botox® do it wrong. Botox® treatments are great for softening smile and frown lines, and when used by an expert it can even be used to create a brow lift effect. Many different types of medical professionals can inject Botox® legally, but most Botox® practitioners don’t have an extensive base of knowledge regarding facial anatomy, or of the effects of Botox® on the body. This can lead to their patients experiencing irregular results.
- One example of a mistake often made involves forehead lines. Many patients don’t like forehead lines, but they are often an example of an effect rather that of a cause. Let me explain. Forehead lines frequently appear when our brows start to fall into the eyelid space. This can happen with age and with sun exposure. When the brows are relaxed they fall into the eyelid space but the brain subconsciously pulls them up with the forehead muscle (called the frontalis muscle). When an Botox® injector without proper training primarily treats the forehead lines, the effect is a relaxation of the frontalis muscle and a descent of the brows into the eyelid space. This results in a new heaviness above the upper lids, which is usually the last thing a patient would expect from a cosmetic Botox® treatment.
The best way to inject Botox® in theses circumstances is to treat the muscles that pull the brows down first. This results in the brows rising naturally. Only after these muscles are treated can some Botox® be placed in the high parts of the forehead. The middle of the forehead needs to be left untreated so that the brows don’t fall after treatment.
- The second mistake Botox® injectors frequently make is not injecting enough units to get a complete result. By undertreating patients, they provide incomplete results that don’t last as long as they should. This results in frustrated patients.
- The third mistake Botox® injectors make involves diluting the Botox® with more saline than necessary. While one injector might mix the Botox® (which is freeze dried) with 1 cc of saline, another might use 2-4 ccs. Both can be injected, but the one using the higher dilution and more saline can result in large swellings in the areas where the injection was administered, and the extra liquid allows the units to move around more. This can result in the Botox® affecting unexpected areas. This is one reason that many injectors don’t completely inject the corrugator (frown) muscles which cause vertical lines between the brows. They worry that injecting the full muscle will result in Botox® drifting into the eyelid-lifting muscle. This could cause the eyelid to droop after the Botox® treatment. If these injectors understood that using concentrated Botox® with less dilution would allow them to safely treat the full corrugator muscle, they could offer their patients better results.
- The fourth mistake that Botox® injectors make is that they don’t use magnifying loupes when administering injections. There are many blood vessels just below the skin surface in the areas where Botox® is injected. Hitting these vessels results in bruising for up to 2 weeks after treatment. Patients don’t want to have bruising. By using good overhead lighting and magnifying glasses, it’s possible to see these vessels and inject between them, treating specific areas and getting great results, usually with no bruising. I call this technique “walking between the raindrops”.
These are the four mistakes practitioners make with Botox® treatments. To get the best results, seek out injectors who use the least amount of dilution with their Botox®, who know facial anatomy, and who use magnifying loupes and good lighting when injecting. Injectors who follow these key steps are usually the best people to see for Botox® treatments.