The goal of a Botox or Dysport injection is to diminish the appearance of wrinkles and to not look “Frozen”. To achieve this goal, the placement of Botox and Dysport requires insight, foresight, and an artful appreciation of a persons’ face. These skills are achieved by having years of experience with these products and by having undergone a fellowship in facial plastic surgery. The ideal outcomes for Botox and Dysport injections are different for different sections of the face. Some areas of the face you don’t want the muscles to move at all. But there are some areas of the face where you need the muscles to still move a little bit to keep a natural appearance. The difference between not moving at all and moving a little bit is determined by how much Botox or Dysport is injected and the technique of the injection. It is important to realize that the dose of Botox and Dysport is tailored to an individual. To better tailor the Botox or Dysport injection, a follow up visit is usually scheduled 2 weeks after the first injection. The most important thing to realize is that the technique of the injection has a very big impact on the results. Often times, the better the technique, the less product you need, and the less money you need to spend to get great results.
Botox or Dysport Injection for Wrinkles of the Glabella
The area between the eyebrows and at the top of the nose is called the glabella. The muscles in this area are called the procerus (which causes the horizontal wrinkles at the top of the nose) and the corrugators (which causes the “elevens” or vertical wrinkles between the eyebrows). These muscles contract when you squint. For the glabella you really don’t want any movement. No one will notice that you are unable to move these muscles. The amount of Botox injected in this area usually ranges from 12 units to 24 units. My usual starting dose in the glabella is 18 units of Botox. The amount of Dysport I use in the glabella ranges from 30 units to 60 units, with the starting dose usually at 45 units.
Botox or Dysport Injection for Wrinkles of the Crow’s Feet
The second area that you do not want any movement in is the crow’s feet. The crow’s feet are the wrinkles that radiate out from the outside corners of the eyes when you smile or squint. The dose of Botox used in the crow’s feet is usually 12 units per side, and the dose of Dysport used in the crow’s feet is usually 30 units per side. When patients have very small or early crow’s feet, lower doses can be used. Sometimes patients are afraid that injecting the crow’s feet will affect their smile. Botox or Dysport injections into the crow’s feet does not affect your smile and no one will notice that you don’t have crow’s feet when you smile or squint.
Botox or Dysport Injection for Wrinkles of the Forehead
There are always exceptions, but the majority of patients want to soften the wrinkles of the forehead, and maintain the ability to raise up their eyebrows. To achieve this goal, a smaller dose of Botox or Dysport is used in the forehead. I usually use about 8 units of Botox and about 20 units of Dysport in the forehead. There are several factors that determine how much product is needed for the forehead. Strong forehead muscles (frontalis muscles) or large foreheads usually require higher doses of Botox or Dysport. Again, injection technique is very important in improving the forehead wrinkles and maintaining a natural appearance. When using such small doses in the forehead, patients need to realize that it will not last as long when compared to putting large doses in the forehead. My experience has been that patients much prefer to use smaller forehead doses and come back more frequently, than to use a big dose that may last longer but makes them feel heavy. Using smaller doses does not cost more money, since you only pay for the amount you use.
There are some patients that are not candidates for Botox or Dysport injections of their foreheads. These patients have very saggy or heavy eyebrows and they reflexively use their forehead muscles to lift up their eyebrows. When they excessively use their forehead muscles to correct their eyebrow ptosis (heavy eyebrows) they tend to have very deep wrinkles of their forehead. These patients are very dependent on their forehead muscles to keep their eyebrows up, and if you even use the tiniest amount of Botox or Dysport, they will feel heavy and may not be able to lift up their eyebrows. For these patients, the best treatment for both the wrinkles of the forehead and their heavy eyebrows is a surgical browlift.
Botox or Dysport Injection for Wrinkles of the Upper White Lip
The other area where you want to soften wrinkles and maintain muscular movement is the upper white lip. Patients who see wrinkles in the upper white lip when they purse their lips are candidates for a very small dose of Botox or Dysport. The muscle underneath the white lip is the orbicularis oris muscle. This muscle is important in puckering, whistling, or drinking out of a straw, so it is very important that this muscle can still function. The goal of the Botox or Dysport injection is to soften the wrinkles of the upper white lip by weakening a small portion of the muscle with very small amounts of Botox (4 units) or Dysport (10 units). Again, using smaller doses does not cost more money, since you only pay for the amount you use.