According to the BotoxCosmetic® website, close to 12 million people have had Botox® treatments since its release in the United States in 2002. Botox® has become standard treatment for forehead wrinkles and is the centerpiece of virtually every aesthetic practice’s cosmetic offering.
An interesting phenomenon accompanies aging where Botox® alone becomes less effective in reducing wrinkles and lines and frequently leads to a lowered brow position. Many feel they have become “immune” to Botox. ® They attribute brow lowering to their body “fighting” the cumulative effects of Botox® as it tries to elevate the brows.
Atrophy of facial bones and fat typically begins at age thirty. As the aging process progresses, atrophy of the frontal (forehead) bone is evident as there is less antigravity support for the forehead. The body responds with more forehead muscle activity to lift the falling forehead. This, along with thinning of the skin, results in more visible forehead wrinkles. Using more Botox® initially may be effective; however, wrinkles caused by increased muscle activity are critical to maintaining brow position. Therefore Botox® actually leads to a lowered or aged brow position.
The correct way of treating the aging process and forehead wrinkles is to treat the cause—forehead atrophy. Fillers work well but do not slow the aging process and can be expensive due to the large area of the forehead. Fat grafting works; the stems cells in body fat slow the aging process, but the procedure is quite technique dependent. Today, another alternative is available.
Ulthera ®has been used successfully to elevate the brow position by tightening the forehead skin and muscle. It also increases the collagen content of the skin improving elasticity and reducing wrinkles during animation. Using Botox® between the eyebrows and for crow’s feet releases these muscles resulting in additional brow elevation.
This combination approach has given patients a dynamic duo that treats both the symptom and the cause of aging in the upper third of the face, cost effectively and with no downtime.