One of the biggest concerns that patients who have never had a neurotoxin injection have is that they will no longer be able to make any facial expressions, giving them a mask-like appearance. The idea, of course, behind Botox®/Dysport®/Xeomin® injections is to target specific muscles of facial expression and reduce or eliminate their ability to function and, therefore, decrease the lines on the face created by muscle contraction.
Many patients are looking for as complete paralysis of the muscles that they are concerned about as possible to allow no motion at all and completely eliminate the lines. In these cases, the patient will not be able to have any form of facial expression in that specific area. It is possible, of course, that some of the injected product will spread out of the intended area into adjacent muscles resulting in decreased expression in that area as well. The most common example of this is when the brow muscles ('elevens') are injected and some of the drug gets into the frontalis muscle that pulls the eyebrows upward resulting in transverse lines on the forehead. In these cases, there will be some loss of the lower frontalis muscle function and the ability to elevate the brows will be reduced resulting in less facial animation in the lower forehead. Usually this is very limited in nature.
Limiting the Injection
Patients who would like to keep some form of expression in the muscles that are being treated can ask their injector for less product. As a result, the muscles will still have some ability to contract; they will keep some facial expression in that area but their lines will not normally be completely eliminated. Some patients have muscles that are so powerful that, regardless of how much neurotoxin is used, they will always have some motion.
The most common area to adjust the amount injected and position of the product is the forehead. Neurotoxin injections that result in complete paralysis of the forehead will generally result in drooping brows. This is generally not a desired result, particularly in those who already have a low brow to begin with. Limiting injections to the upper forehead will usually leave some lower brow motion to prevent too much brow depression but will not eliminate the lower forehead lines.
More Areas = Less Expression
The more areas a patient has treated, the more muscles will be affected and the less facial expression they will have. To avoid affecting the muscles which affect a person’s ability to smile, the majority of Botox®/Dysport®/Xeomin® injections are done in the upper half of the face around the eyes, brow and forehead.
The better the knowledge, experience and skill your injector has, the better your result will be. In Columbus, Ohio, there are a lot of physicians who delegate neurotoxin injections to a ‘trained injector.’ That’s like saying; “I don’t have time for you. You’re not important enough for me to do your injections so I’ll have my assistant do it.” I would go elsewhere.