getting rid of 'angry face': what you should know about botox and dermal fillers

while both botox and ha can be used to address common concerns such as lines and saggy skin, understanding how the face ages can help you choose which treatment is best for you.

by frances krawiec

jan 6 2022

5 minute read

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getting rid of 'angry face': what you should know about botox and dermal fillers

expertise that aligns with the goals of the patient is key to getting the best possible results from botox and dermal fillers. getty

botulinum neurotoxin (botox) and hyaluronic acid (ha) injectable dermal fillers are now considered mainstay treatments for skin anti-aging prevention and correction strategies. however, while both botox and ha can be used to address common concerns with lines, sagginess, negative social cues (angry face), and undesirable contours, loss of proportions and balance, it’s important to understand how the face ages before choosing either or both of these treatments.

the human face

the human face is a complex interconnection of layers, structures and important functions that are integral to skin integrity and how the face ages. facial aging is a predictable process that begins in a person’s early 20s and is influenced by genetic, environmental, and biological forces. intrinsic aging results from changes to bone, ligaments, deep and superficial skin layers, fat pads, muscle activity, and collagen development and breakdown. common important environmental factors such as solar exposure and use of smoking products, as well as a poor diet

fat pads. there are multiple deep and superficial fat pads, and with age, they atrophy, leading to decreasing volume, impacting the surrounding tissue, ligament tone and structure.

facial bones. facial bones recede, particularly the orbital bone and the maxilla, contributing to changes in the mid-face and cheeks and the under-eye region. thus, proportions and angles change.

changes to skin layers. chronological age has been well correlated with skin age given increasing evidence of wrinkles, decreasing elasticity and thickness of skin, and flattening of the skin layers. reduced hyaluronic acid, a water regulator for the skin, manifests itself as dry sensitive skin.

collagen breakdown. the physical structure of the skin is highly impacted by increasingly impaired collagen formation and function. as the years pass, fragmented collagen accumulates owing to the lack of tensile strength of the skin. various muscle contractions become largely overactive due to the lack of structure and need to maintain facial expression. as a result, once lines from expressions that used to be temporary become wrinkles much like scars with age.

external factors. damage from factors such as sun damage, smoking and an unhealthy diet will cause a negative, but synergistic, worsening of the signs of aging.

tackling the signs of aging with dermal fillers

dermal fillers can be used to treat skin quality, volume, and provide support for underlying structures while considering the aesthetic features of the face. younger patients are often are interested in dermal filler treatments for slimming, chin projection, jaw and cheekbone contouring. other patients may be looking for filler treatments to address the signs of aging, alleviating heaviness, sagginess or help with full-face shaping to reestablish softer features and regain a more youthful healthy appearance.

hyaluronic acid is a naturally occurring molecule and is most abundant in the skin. in the human body, ha, among other functions, is important for filling spaces, maintaining the hydration and lubrication of the skin, as well as stimulating fibroblasts (cells that form connective tissues) for collagen development. however, natural ha degrades relatively quickly in the human body, only lasting approximately 24 hours. on the other hand, ha dermal fillers, produced by bacterial fermentation, have undergone a process that reduces the speed at which they breakdown. in fact, injectable dermal fillers can last a few months to a year, or longer.

fifty-three-year-old woman before and after treatment following md codes. (springerlink)

while the elastic and hydrating quality of ha fillers gives them a gel-like quality, individual filler products differ on the degree of stiffness and cohesiveness. the variation in the type of filler is necessary in order to achieve the differing desired outcomes typically related to volumizing, lifting, contouring, and boosting the skin, as well as texture improvement. in other words, filler products are adapted to address specific concerns.

in addition, the outcome is highly influenced by the approach to the face, anatomical location and the injecting technique. one approach to facial ha dermal fillers is known as the “md codes” developed by dr. mauricio de maio , which is a set of guidelines to follow when injecting ha. this methodological and systematic approach takes into account emotional messages, facial shape, anatomical landmarks, type of product, and location to be placed while using a universal language of codes. but there are many excellent approaches to optimizing the natural appearance of facial aesthetic outcomes, and not every patient will benefit from the same approach.

filler injections must also take into consideration underlying structures such as bone, ligaments and deep fat pads. understanding the aesthetic ratios of face, facial balancing, ideal angles and proportions is important, as well as recognizing the differences in filler products, the patient’s health, skin quality, and intrinsic and extrinsic aging factors is critical to optimize results, while maintaining utmost safety for the patient. there are some common potential adverse events like swelling bruising, and inflammation as well very rare risk of more serious complications which of course would be addressed during your consultation.

beating the signs of aging with botox

botulinum toxin injections, on the other hand, has no effect on skin texture, but rather, they impact the facial lines and wrinkles created by muscle activity. all neurotoxins intended for cosmetic purposes contain botulinum toxin — which is produced from the bacterium clostridium botulinum. the neurotoxin causes relaxation by blocking the nerve signals to the muscle. once injected into the intended muscle, it begins to take effect over one to four days, with the full effect resulting by two weeks. while neurotoxin is not reversible, it does wear off, lasting typically around three to four months — depending on the dose.

botox was first approved for medical use in dermatology, but is now used to treat various health conditions, such as migraine, lazy eye and overactive bladder . in 1992, botox was introduced for its aesthetic benefit of relaxing dynamic lines. currently, in canada, there are four neurotoxins approved for cosmetic use including botox, dysport, xeomin, and nuceiva. while there are some differences between the toxins, they are usually not noticeable to the patient, and can be explained by a medical practitioner.

neurotoxins have become increasingly popular for softening negative messages of the face, treating and preventing wrinkles, and improving the symmetry of structures related to muscles. but in medical aesthetics, neurotoxins have other benefits as well, such as the ability to reduce sweating (hyperhidrosis), improve vascular abnormalities, (rosacea), oil production in acne vulgaris, all-important to aesthetic results. since botox a is used at low doses and wears off, it is considered to be a very safe cosmetic injectable. however, like fillers, there are some potential adverse effects including bruising, headaches (lasting two to four weeks), double or blurred vision, and rarely, rarely, eyelid and brow dropping (ptosis). neurotoxin treatments tend to be straight forward, but since muscles are layered and opposing and not always symmetrical in strength or position, injections must be tailored to prevent adverse events and undesirable outcomes.

getting the best results

although botox and ha dermal fillers are increasingly sought out as a treatment option to reduce the signs of aging, the complexity of facial structures, along with individual aging and genetic characteristics, highlight the importance of seeking out a skilled and knowledgeable medical practitioner. expertise that aligns with the goals of the patient is key to getting the best possible results from these treatments.

frances krawiec is a nurse practitioner at preventous collaborative health and preventous cosmetic medicine.

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getting rid of 'angry face': what you should know about botox and dermal fillers