Frozen in Time, is Botox the Answer?

BY: Melissa Berman
April 2, 2022

A few years ago, I attended a performance at a theater in East Hampton, New York. It was an entertaining evening with an impressive cast, however, the standout memory I have is of Susan Lucci, at 71 years old, looking exactly the same as she did when I watched her on 'One Life to Live' during my high school years. How is that possible? My friend and I spent our post-theater cocktail time frantically googling Susan Lucci’s beauty secrets. It seemed to boil down to 2 things: pilates and Botox. We also factored in her long and happy marriage, but that’s a topic for another time.

a picture of a woman

A regular tool in the celebrity and mainstream beauty repertoire, Botox has received a fair share of negative reviews over the years; a key example being when Cameron Diaz went public denouncing it, saying it changed her face in a weird way.

Of course, Botox is no secret. In fact, it’s been approved as a cosmetic treatment since 2002. Botox is a brand name. The neurotoxin Botulinum type A is also the main ingredient of brands Dysport, Xeomin and Jeuveau. These neurotoxins work by disrupting the signal from your brain to your muscles that cause contraction. Normally, your brain sends electrical messages to your muscles so that they can contract and move. The electrical message is transmitted to the muscle by a substance called acetylcholine. When injected into specific areas, these cosmetic neurotoxins block the release of acetylcholine and, as a result, the muscle does not receive the message and does not contract. Reducing or stopping these contractions stops the skin from appearing wrinkled. Some refer to this as temporary muscle ‘paralysis’.

a woman's face with colored dots over it

In terms of effect, the holy grail with Botox is to erase years, in the form of wrinkles, in a way that looks natural. I spoke to two professionals who use Botox (and other neurotoxins) in their practice, about the pros and cons.

According to Theresa Pinson, a board certified nurse practitioner in Long Island, New York, and owner of Virtual Skin Spa “By temporarily relaxing these muscles, these neuromodulators improve the appearance of dynamic wrinkles.” Pinson says these treatments help the skin look visibly smoother, healthier and more youthful.

In case you’re wondering what makes a wrinkle dynamic, these are the wrinkles that are formed from repeated facial expressions such as smiling, frowning and raising eyebrows. By comparison, static wrinkles are marionette lines or nasolabial folds, which are not caused by facial movements, and therefore generally not the spots that are targeted with Botox.

Pinson recommends people begin to consider Botox “when they start to notice lines at rest between the brows, forehead or crow’s feet.”

Dr. Steven Hopping, a board certified, Washington, D.C. based, plastic surgeon, who has been using Botox for 20 years, notes that in 2021 over 4 million people received the muscle-relaxing treatment and calls it a “revolution in aesthetic medicine.” He adds that “Botox rejuvenation is often combined with soft tissue filler to enhance the aesthetic improvement.” When I asked him about the cons, he said there can be “temporary problems such as droopy eye or brow asymmetries.” These, he adds, “resolve as the Botox wears off but that can take weeks to months.”

Both Pinson and Hopping stress the importance of a highly experienced injector, who is familiar with facial anatomy. Pinson points out that there are recommended doses for the areas being treated. However, some patients may require more, or less. “A woman with a larger forehead will require a higher dose than a woman with a smaller one. This is why a thorough consultation, together with dynamic photos, is crucial.” She also has her clients come back for a two-week follow up – to compare results with the photos, and adjust if necessary.

I asked Pinson about reports of gradual muscle atrophy, associated with long-term use. “Botox reduces muscle contraction. Therefore, if it’s used on a regular basis, the muscles will not work for an extended period, and will undergo some atrophy.” she explained. Pinson doesn’t see this necessarily as an issue. “This may be a positive if the muscles in question are those you want to weaken, in order to smooth wrinkles. If the muscle that causes you to frown develops atrophy, then it would probably be beneficial.”

There are currently four brands of neurotoxins on the market, and the differences are very subtle. They all use Botulinum type A as their active ingredient. The proteins that are used in the formula, make for slightly different results.

● Botox carries a molecular weight of 900 kDa, and is formulated with protective proteins that some patients may develop an antibody against, over time. This could lessen the effectiveness of the treatment. The inactive ingredients in Botox include human albumin (i.e., plasma proteins) and sodium chloride. It’s good for all areas, especially small ones like crow’s feet.
o Onset is 3-5 days
o Results 3-4 months

● Dysport has the same molecular weight as Botox at its core, but the weight of the protective proteins in Dysport are not uniform, unlike those found in Botox. As a result, Dysport has a higher rate of diffusion, which makes it ideal for treating larger areas like foreheads.
o Onset 24 hours
o Results 3-4 months

● Xeomin is unique in that it does not use complexing proteins. Patients who show signs of resistance to Botox® and Dysport® may find success, due to the purified state of BoNT-A.
o Onset – 5-7 days
o Results – 3-4 months

● Jeuveau is the newest player in the market. It’s approved only for cosmetic use, has the same molecular weight as Botox, and both are formulated with human albumin and sodium chloride, offering similar results. Jeuveau, however, is priced at 20-30 percent less than Botox, because it’s newer, long-term safety and efficacy profiles have not yet been established
o Onset – 3-5 days
o Results – 3-6 months

I’ve never tried Botox, or any of the similar products myself, so I spoke to a friend who has. “My first two treatments went well”, Mary Jane told me. “But the third time, I went to a different place where he overdid the amount of Botox in my lips – and I couldn’t move my lips normally. I couldn’t even sip a martini!” she said. Since then, she’s decided to forego those types of treatments, and relies on a consistent, naturally-derived skincare routine. “I want to look my age. Good skincare is enough for me, I exfoliate 3 times a week, hydrate, and use serums.”

Pinson also mentions the importance of a solid skincare routine with quality products. “A daily skincare regimen is the foundation for maintaining a refreshed, youthful appearance. I always tell patients, I can relax your wrinkles with Botox, I can contour your cheeks and smooth out folds with fillers, but good skin quality is key.” She points out the four skin quality categories: skin tone evenness, skin surface evenness, skin firmness and skin glow. “Botox alone cannot achieve all of these.”

We are lucky to live in an era replete with bountiful options to help us feel good about how we look. Of course everything, especially beauty, is holistic. A healthy lifestyle, including nutrition, exercise, rest, skincare and making time for a rich inner life, are the foundation for an authentic glow. Treatments like Botox are just here to enhance an already beautiful you.

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