Without seeing you for a face to face consultation, it’s hard to advise you fully but it sounds like you have resting lines (lines when you aren’t moving your face). Botox can sometimes soften these lines after a few treatments, however it’s designed to treat dynamic lines (lines that occur on facial movement) and prevent static lines getting worse rather than marking resting lines better. This is because Botox works to soften movement in the muscles of the face over which the skin lies rather than addressing the wrinkles directly. When we are young, the muscles moving the skin doesn't cause any wrinkles because we have good elasticity and support from collagen and elastin. As this diminishes with age, the skin starts to become less elastic and plump and so the repeated movement causes furrows (wrinkles) to form. Generally if someone has static wrinkles, it might mean that addressing the skin itself and replacing some of the structural support lost with age might be of more use. I would advise that you try some skin rejuvenation treatments such as CO2 laser or a course of chemical peels and micro needling to address your static lines. These interventions look to help your body produce more collagen and elastin and so reduce lines by supporting the skin itself and in doing so making the surface of the skin appear smoother.
Botox can be injected into different muscles of the face for different reasons. To reduce wrinkles, it is usually placed in the forehead, glabellar (muscles that move to create frown lines) and around the eyes to address crow’s feet. Botox is really helpful at diminishing dynamic lines (present upon facial movement) and preventing worsening of static lines (present at rest). Botox isn’t good at reducing lines that are present at rest (some find that resting lines soften after a few treatments but most don’t see much difference). This is because Botox works to soften movement in the muscles of the face over which the skin lies rather than addressing the wrinkles directly. When we are young, the muscles moving the skin do not cause any wrinkles because we have good elasticity and support from collagen and elastin. As this diminishes with age, the skin starts to become less elastic and plump and so the repeated movement causes furrows (wrinkles) to form. Generally if someone has wrinkles all over the face, it might mean that addressing the skin itself and replacing some of the structural support lost with age might be of more use. Replacing volume loss and supporting the skin with use of soft tissue fillers may be more appropriate as well as other skin rejuvenation treatments such as laser and deep chemical peels. Failing that, if the skin is very lax and wrinkles severe, surgical intervention might be worth considering. Without seeing you it’s hard to answer this in an accurate and tailored way but I hope this helps none-the-less.
I advise my patients not to do vigorous excerice for 6 hours post injection, this is not because it decreases the results but theoretically increased blood flow into the muscles where Botox is injected, may shift the molecules of botulinum to other areas. This may result in the migration of the botox and cause unwanted effects on unintended muscles. There is a school of thought that people who exercise more tend to have a shorter duration of action of Botox than those that don’t exercise. This is largely anecdotal though, I’m not aware of any scientific studies that prove this. Don’t forget though that exercise in the right amounts is good for your health and therefore your skin will benefit from it and you will notice a positive difference in your skin if you live a healthy lifestyle as well as if you use Botox.
In the face, Botox works by blocking nerve messenger receptors in the muscles in the area it is injected into. As a result it takes 2-3 weeks to take full effect and in most people will last 3-4 months, which is how long it takes for your nerves to grow new unblocked receptors. You’re right in saying that it can vary in duration from person to person and there’s currently not a lot of scientific evidence to explain why. My experience suggests that people who exercise a lot, people who smoke and people that spend a lot of time in the sun (or don’t wear a good spf) tend to see the effects of their Botox diminish faster. Quite a few other doctors feel there are genetic reasons for variable response, and I think it’s logical to suggest they might be but to date there is no definitive science behind that assumption. Botox can also be used in other areas of the body e.g. armpits for sweating which tends to last a month or two longer and again can vary in duration from person to person.
Hi Charlotte – firstly thank you for the question and photograph. I can see there is some volume loss to the lower face (as you’ve described) and there a few options to restore this. I would probably recommend a combination of skin treatments and filler. Filler would be an option that provides immediate results. The type of filler I would use would last 9 months to a year but if used in combination with skin treatments, this would likely last longer. Without examining you face to face is difficult to predict totally treatment cost, i would recommend booking a consultation with a Doctor who can advise you further. I hope this helps. Dr Catharine Denning
