Thank you for your question.
You've submitted some photos and you're asking if you should have that many wrinkles when
you squint.
You describe having a lot of wrinkles when you scrunch your face, and the question of
course is do you need more Botox.
Well, let's analyze the facial movements to get a better sense of which muscles are being
affected, and take it from there.
To give you a little bit of my background, I'm a Board-certified cosmetic surgeon and
a Fellowship-trained oculofacial plastic surgeon.
Just as an aside, oculofacial plastic surgeons where one of the first, along with neurologists,
to use Botox or botulinum toxin.
Originally, this was a drug for facial spasms and neurologic conditions, so I've been treating
patients with botulinum toxin since 1993.
I've been in practice for over 20 years in Manhattan and Long Island, so I certainly
have a lot of experience with this drug.
So let's start with just defining the lines around the eyes, which seems to be the focal
point of your question, to understand what we do when we inject the Crow's Feet lines,
or the lines around the eyes.
Those lines are the result of the actions of a muscle called the obicularis oculi muscle.
This muscle is like a circular muscle, and when you squint, that muscle is activated.
Now there is an important distinction to be made here—when you smile, or as you describe
“scrunch your face”, the cheeks go upward.
Now when the cheeks go upward, there is a vertical movement of the soft tissue in the
face, and that can contribute to the lines around the eyes.
I always describe it to my patients as like an accordion effect.
So when a patient of mine has a question like yours, I first have them relax their face,
and I ask them to squint without moving their cheeks.
Because what you want to do is isolate the area around the eyes, because that's the only
area of muscle that's being treated when you're trying to assess the Crow’s Feet lines.
No matter what happens with that activity, and the treatment, the physical movement of
the cheek will still cause this compressive effect and create lines.
So when I tell patients then to squint their eyes, and they don't see the lines form, they
understand.
So, try to do this for yourself.
If you squint your eyes and you don't see those lines, then chances are the Botox in
that area has been adequately successful in reducing the activity in that area.
I think again that this type of question, since you didn't specify exactly where you
had the Botox injected, I would say that, at least around the eyes, if you can see that
kind of result when you’re squinting without cheek movement, without facial movement, and
you don't see lines, then most likely the Botox is working as intended.
As always, I always recommend to patients who ask these questions to meet with the original
doctor who performed the procedure.
I think that a routine, and it might be already a part of your relationship with your doctor,
in our practice what we do is we tell our patients, whether we do Botox or injectable
fillers, we always have our patients come back in about 2 weeks.
Clinical studies have already demonstrated that the peak effect of Botox is around 2
weeks, so that's usually the best window to see if there's a need enhance the results,
and to test the effects and see how satisfied are patients are with their results.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.