Botox and Dysport: How To Avoid the Porcelain Doll Look

Here in San Diego, a common question I get as a Plastic Surgeon is: “What do I do about these wrinkles around my eyes?” The first thing I say is: “Those aren’t wrinkles. They are called ‘smile lines'”. The lesson I learned here is that the word “wrinkle” evokes quite an emotional response and is usually synonymous with “are you saying I look old?!!”. But its important to understand that those wrinkles are not just about aging… they are about expression! We wouldn’t be human if we could not express ourselves. For this reason, many performers or actresses that I have encountered over the years in my practice shun the idea of any treatment or injection that will impede their ability to express themselves.

But fear not! There is a way to reap the benefits of neuromodulator injections (i.e. Botox Cosmetic or Dysport) without looking like a porcelain doll or appearing “paralyzed”. The key lies in having your plastic surgeon inject strategically!

A common anatomic location where this is of critical importance is around the eyebrow and crow’s feet region. When injecting a neuromodulator in this area, I try to avoid injection just above the eyebrow. This can completely stop movement of the eyebrow. Most of my patients who are looking to improve their forehead wrinkles still want some animation and expression. If Botox or Dysport is injected in this region, the brow can flatten, become less expressive and accentuate excess upper eyelid skin. It is possible to treat the wrinkles by injecting in the middle of the forehead or near the hairline, but avoiding injection just above the eyebrows will ensure that your friends know you are still moving and alive!crows feet

Another little secret lies in the crow’s feet region. When the crow’s feet are strategically injected, the muscles that pull down the corners of the eyebrow are temporarily weakened. When this occurs, we can remarkably achieve a “chemical browlift” which raises the corner of the eyebrow. However, this only works if your plastic surgeon avoids injection above the eyebrow as we discussed above.

Sometimes, there is a tendency for doctors to inject a neuromodulator in the area of the upper cheek just below the crow’s feet region. This should be approached with caution. The issue lies in what this can do to the shape of your face during smiling. When these muscles are temporarily weakened, this can cause an unnatural, flattened appearance of the upper cheek during expression. For myself and many of my patients, this is a sign of looking “overdone”.

Neuromodulators such as Botox and Dysport are some of the best anti-aging products out there. But the secret here: “less is more”. If you desire improvement in smile lines (ok….wrinkles), but still want to maintain your ability to express yourself, strategic use of neuromodulators can very much achieve this. Give us a call, I’ll be happy to show you during our consultation!

Salvatore J. Pacella, M.D., M.B.A., F.A.C.S.