The dos and don'ts of BOtOX
There's a bit more to Botox than meets the eye. The teaching today for both the surgical and non-surgical approach to a patient is along two broad principles: firstly, the end result should look natural, and secondly, the treatment plan should be tailor made to suit the individual.
The distinction between wrinkle effacement and facial shaping is critical. Foremost, a thorough understanding of the underlying musculature and the physiologic interactions of the muscles is critical to success. A completely symmetrical face is rare, and some faces are more asymmetrical than others, so it's important to consider the impact of treatment to both sides of the face. To change or lose that expression can have serious Consequences. It's thus an essential part of the consultation to look carefully at the patient's individual anatomical and personal characteristics - when their face is at rest and when it is smiling, contracting, laughing, frowning, tensed or relaxed. Only in this way can we be sure that the specific treatment recommendations we're making are appropriate for each patient.
The right balance When injecting Botox, we need to be aware of the muscle balance of the face. Some muscles are elevators, like the frontalis. When contracted, they pull tissue upwards and lift the brow towards the hairline. Other muscles are 'depressors', such as the corrugators, procerus and depressor supercilli. They pull tissue downwards when they contract. When changing the activity of an elevator, we must take the effect on the corresponding depressor muscles into account. Likewise, when injecting depressor muscles, it's important to consider the effects on corresponding elevator muscles. If not, sections of the face can pull down instead of up, or vice versa. Consider treatment to the upper face. With age, muscles initially lengthen, but reactive hyper-tonic contraction leads to subsequent shortening. In the inner zone, the position of the head of the eyebrows depends on the balance between the elevatory frontalis muscle and the depressor corrugator muscle and to a lesser extent, the procerus and depressor supercilli. As the muscles shorten with age, the powerful depressor muscles tend to outpull the frontalis muscle, so the head of the eyebrow is likely to drop, with folding of the inner part of the eyelid. In the middle zone, the position of the body of the eyebrow depends on the balance between the elevatory effects of the frontalis muscle and the depressor effects of the orbicularis muscle. In this zone, the shortening of the frontalis muscle with age tends to be more forceful than the depressor action of the orbicularis, so there is often a lifting ofthe middle of the eyebrow.
In the outer zone, the position of the tail of the eyebrow depends mainly on the activity of the orbicularis muscle, because only a few fibres of the frontalis muscle extend to this part of the eyebrow. With age, the orbicularis muscle will increasingly pull the corner of the eyelid downwards, but this can be corrected by simply injecting Botox into the orbicularis, so the tail of the eyebrow is raised, thus widening the eye. ：
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