What areas of the face do we treat with Botox and why?

Botox© (Botulinum toxin injections, now referred to as neuromodulator injections) can be administered in a number of different sites on the face and neck to relax the facial muscles.  The main areas treated with Botox© are found on the upper half of the face and in my opinion this is where the treatments work the best.  The three most common areas injected are:

1. The glabella complex to treat the vertical lines between the eyebrows.
2. The frontalis muscle to treat horizontal forehead headlines (frown lines).
3. The orbicularis oculi muscles to treat the crow’s feet beside the eyes.

If you have not had Botox© injections before then a good approach is to start with having one area treated, usually the main area of concern, and then treat an additional area if you are happy with the response.  By adopting this approach the results will be more subtle and friends and family will observe a gradual rejuvenating effect.  The most common area for initial treatment is the vertical frown lines between the eyebrows.  Good practice to be to have a two-week review after a patient’s initial treatment to ensure that the desired result has been achieved and that the patient is happy with the result.  At this review some fine tuning can be done. This initial treatment and review also allows the skilled Practitioner to create a ‘neuromodulator face map’ which documents the sites of the injections and the doses used which allows us to deliver more consistent results.

Apart from the three main areas treated on the upper face, other areas that can be treated with Botox© include the side of the upper nose to correct ‘bunny lines’, just below the nose to lift the tip of the nose (be warned – this is a painful injection point and the results are subtle), the mentalis muscle to soften dimpling on the chin and the depressor anguli oris muscle (DAO) which will elevate the corners of the mouth.  Injections can also be placed into the platysma muscle of the neck to soften vertical bands which in some people can be quite prominent.  These injection sites can all be more problematic than the standard three on the upper face.  Botox© can also be injected into the masseter muscle to slim down a square jaw if the masseter muscle is prominent.  This treatment is requested by female rather than male patients.

There are different viewpoints on how frequently Botox© injections should be performed.  Some patients are happy with a softening effect and so are content to have periods when the muscles are no longer blocked and will wait until they start to see their wrinkles develop again at rest before having a further treatment.  Other people, especially men, like to have a consistent appearance at all times and so as soon they notice movement coming back in the areas they have had treated, they will book to have a further treatment.  Younger patients, unless they have very defined wrinkles due to hyperactive muscles, tend to have Botox© injections less frequently while those in their 40’s and above tend to have treatments every 3 to 4 months.

You can find out more about Botox(c) treatments for the face here.

Dr Martin Wade, Dermatologist at London Real Skin.