Botox relaxes smaller wrinkles

Every time we make a movement with the upper face, a crease is made in the skin.  When we are young the crease goes away when we relax the muscle.  Over time that creases get deep, and are visible even when the muscle is relaxed.

Your creases may be so deep that simply relaxing the muscle isn't enough.  It may take months or years of having Botox to keep the muscle relaxed, fillers to replace lost volume, retinoid creams to improve the skin texture, and laser rejuvenation, in order to see the lines go away.  It is also important to be sure you are getting enough Botox- if you are getting too little you won't get a fully relaxed muscle.  And as soon as you notice movement returning, get your next Botox treatment to prevent the lines from getting deeper.

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This is a great question. Botox works by paralyzing the underlying muscles, which prevents the formation of wrinkles by preventing the muscle from bunching up the overlying skin. For mild wrinkles at rest and wrinkles that are only visible when you contract your forehead or orbicularis (the muscle causing crow's feet), Botox is very effective.

For deeper wrinkles that are present even at rest, Botox is less effective. This is because over years of the constant stress on the skin which causes the wrinkles, the dermis of the skin atrophies (weakens) and a permanent wrinkle is formed. So, even if the underlying muscle is paralyzed, the skin still has wrinkles from the dermal atrophy.

For these wrinkles, you may need a dermal filler to support the overlying dermis. Alternatively, you may need surgery to "lift" the forehead and lateral temporal (above the crow's feet) area to smooth out the wrinkles.

I hope this is helpful. David Shafer, MD New York City

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Botox relaxes the muscles, but your lines and folds are probably etched in your skin. In addition to Botox, you probably need to smooth these folds with fillers like Juvederm. If fillers don't help enough, the next thing to try is laser resufacing. This can be either superficial or deep resurfacing and I use the Contour or Profile laser manufactured by Sciton.

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