To Botox or Not to Botox? That is the Question.

I have just had the pleasure of attending the Australasian Society of Aesthetic Plastic Surgeons meeting in Sydney.

Over four days a number of experts from Australasia and the world presented their techniques and philosophies for non-surgical cosmetic procedures. Two main ideas were discussed, the use of neuromodulators (Botox and Dysport) and fillers (Restylane and Juvederm).

Botox is well known to many, Dysport effectively has the same mode of action for temporarily weakening facial muscles. Both Botox and Dysport have been used traditionally to reduce facial lines and creases, to smooth the skin and make a younger appearing face.

What has been overdone is excessive application to the forehead, crows feet and between the eyebrows which results in a very unnatural, not at all youthful, paralyzed face with abnormal smile and often splayed apart eyebrows. Look at celebrities in the magazines or better still for a dynamic demonstration watch out for an aging female TV news anchor who cannot animate appropriately.

The same problem has occurred with fillers, overuse in specific areas has, for example, lead to obvious trout lips. Thankfully both botox/Dysport and Restylane/Juvederm are temporary agents and wear off after 4-6 months and 8-12 months respectively.

Fat grafting is an exciting and now proven technique for facial rejuvenation, it has the benefit of being permanent but accordingly must be performed by an experienced Plastic Surgeon. The theme of the meeting was using these agents intelligently, applying them to specific structures, with a view to a balanced and individual approach. On the first day of the meeting I attended the Masterclass, a select small group aimed at facial anatomy and live demonstrations of injections. The content was fantastic but what really stood out was the difference in anatomical knowledge between the surgeons and non-surgeons.

The surgeons were extremely comfortable and competent with their anatomy whereas the non-surgeons were really seeing this for the first time.

Herein lies a problem, most botox and fillers are being injected by non-surgeons, effectively GPs who have completed a weekend course or two and are then deemed competent by the drug company marketing the product. Not surprising then that the products are often used in a less than ideal manner. Patients who are attended by such practitioners are only offered botox or fillers, these patients do not get the benefit of being assessed by a Plastic Surgeon who has both non-surgical and surgical techniques available - these patients will get a complete individualized management plan that may be purely non-surgical, surgical or may include both.

Facial rejuvenation should be the goal of botox and fillers, not creating a different facial appearance. A good idea is to look at a photo of yourself 5-15 years ago and hold it next to your face as you look in the mirror. What do you see and desire? Regaining the youthful characteristics takes an artist's eye and a surgeon's knowledge and steady hand. Botox and fillers certainly have a place in cosmetic surgery but must be applied by an intelligent practitioner who understands how faces are constructed and how they move dynamically. A little botox here and there, some filler there and here will work wonders if applied in a balanced manner. As the face ages the skin changes, the face loses bulk and is affected by gravity. Traditionally facelifts and the like pulled back the aged and drooped skin but did nothing to address the loss of volume in the face.

Now the combination of surgery, fillers and botox has really provided Plastic Surgeons with the complete package for facial rejuvenation. In your goal of facial rejuvenation, carefully choose a practitioner who has the full armamentarium of surgical and non-surgical techniques to assess and address your individual characteristics.