In my Chicago area office, I see many women who have used botox repeatedly over the years. They often have flat foreheads and abnormally shiny skin from muscular atrophy.
Often their eyebrows are too high on the foreheads giving them a look I affectionately call “Mrs. Surprise”.
The question is; is this the necessary outcome after using years of botox? And the answer is; it doesn’t have to be.
Training courses for physicians often focus on the marketing and financial aspects of learning a new technique. The plastic surgeon I initially heard speak about botox had a frozen expression and stated he used a whole vial (100 units) in each of his patients face. He was supposedly excited about the topic but I couldn’t tell. He spoke about getting the patients “hooked” on their freshly ironed face and returning every three months for their eight hundred to twelve hundred dollar treatment.
I don’t love my “elevens” but I can tell you that weakening the muscles (by using less botox per area) as opposed to paralyzing them is a better way to go in the longterm. This isn’t the norm as it is not how we’re taught in training courses, and it’s not a good business model, since we charge per unit of botox. And, to be fair, there are many patients who want their face immobilized.
I encourage my patients to sit down with me and talk about expectations, short and longterm. This way I can explain that weakening the musculature that causes excessive wrinkling is often a better option than completely paralyzing facial expressions. Besides, next time you’re feeling something, don’t you want others to know it.