Thank you for your question. You submitted a question with one photo and
you describe in your question that you’ve done Botox™ for the first time and that
in one discussion with your physician, your physician had recommended, in addition to
doing the forehead which you want to do alone, the physician recommended you do the glabella
as well. And so you decide to just have the forehead done and you submitted a photo three
days after the procedure and you’re asking me if it looks normal.
Well, I can give you some guidance as to how to continue with doing Botox™ and understanding
the process a little bit. And it’s likely your doctor discussed this with you but this
is new for you so I think it is important to understand some basic ideas.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island
for over 20 years. In fact, my specialty of oculofacial plastic surgery was amongst the
first physicians using Botox™. So I’ve been using Botox™ for patients since 1993.
So to begin with, it’s very important to wrap your mind around this concept of how
Botox™ works. Very often people believe that Botox™ is a filler which it is not.
It may behave like a filler because of a net effect. And what Botox™ does for the areas
of your concern is basically improves the appearance of wrinkles. There are 2 types
of wrinkles: dynamic wrinkles and static wrinkles. Dynamic wrinkles are wrinkles that occur when
you activate muscles. Static wrinkles are wrinkles that occur regardless of muscle activity
that are present at rest.
What Botox™ does is it relaxes muscles and so when you talk about the forehead with the
glabella, you are actually looking at 2 different sets of muscles. The forehead muscles that
you want to smoothen is the muscle that lifts the eyebrows. The muscle is called frontalis
muscle. In the photo you submitted, it appears that you have some movement of the frontalis
muscle in the lower part and the upper part looks relatively smooth. Essentially, it is
reasonable to understand that this is likely the area that your doctor injected and limited
the area as the doctor gets closer to the eyebrow. There is a basis for that. The glabella
which is the area where the frown lines are is often done in combination to help rejuvenate
the forehead, let’s say in an aesthetic unit, an area where you want to improve the
horizontal lines as well as the vertical lines and number 11 lines.
So assuming that your doctor expressed to you their concern that it may look unnatural
or not in harmony, so understanding that it is very important that you appreciate what
is the timeline for the effects of Botox™, yes, you can start seeing changes as early
as 24 to 48 hours. But in my practice, I have people come back in 2 weeks. Clinical studies
have shown that the peak of effect can be around 2 weeks so that is when I determine
the effectiveness of a Botox™ and whether there is indication for enhancement.
Another important element of this is the importance of what is causing the horizontal lines to
form. Very often people raise their eyebrows very aggressively because they have drooping
brows and because they have extra skin over their eyes called dermatochalasis. So unconsciously,
people will reflexively raise their eyebrows and while raising their eyebrows, they are
forming horizontal lines so the practitioner is in a challenge. Very often, since we don’t
see the rest of your face, it’s just something that I’m just giving you some information
about.
Essentially, you do not want to do Botox™ so aggressively that the forehead completely
relaxes that the brows drop nor do you want necessarily to have the completely smooth
forehead because that itself can sometimes not fit the rest of the face especially when
you’re looking at the area of isolation. So, allow yourself some time to evaluate the
result. Visit your doctor or contact your doctor in about 2 weeks for reevaluation from
the time of your injection. Learn more about this and I would stress strongly that you
find a doctor that you are comfortable with and that you feel can work with you as you
continue your journey into doing this in a more consistent basis.
So I hope that was helpful, I wish you the best of luck and thank you for your question.