A frown, crow’s feet and forehead horizontal lines are mainly caused by muscle contraction. In the forehead, there are elevators and depressors and their balance action contributes to various forehead expressions.
It blocks the release of neurotransmitters and in turn, prevents muscle contraction. Therefore any Botox anti-ageing injection technique used in facial rejuvenation should take into account obtaining a balanced function between elevators and depressors.
The patient needs to be counselled and advised of the concept of balanced muscle action when they attend for the initial Botox consultation. The concept of one side, two side injections which are popularised in the media should be discouraged if one wants to obtain a natural looking rejuvenation.
We do advise our patients on the anatomy, the effect of Botox as well as its limitations alone in removing all the lines.
Botox also has another function where the ‘P’ substance release is prevented and thus plays a role in the pain pathway. This action and the ability to prevent muscle contraction both help to control some frontal migraine as well as facial pain. A careful history is essential, therefore, prior to Botox injection.