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Do you have expression lines that refuse to fade, even when your face is at rest? If so, now may be the perfect time to start thinking about neuromodulators such as Dysport or Botox. A neuromodulator is an FDA-approved injectable that relaxes the targeted muscles and as a result will have you looking years younger and fresher within days.

Well known as one of the most effective wrinkle treatments on the market today, Botox, or botulinum toxin, is just one of many FDA-approved brands that do the same thing. Botox is a brand name just like Kleenex or Xerox, but all 4 FDA approved products in the US market work very similarly but differ in their molecular configurations and manufacturing, as well as slightly in actual function. Dysport, Xeomin, and Jeuveau are the other brand names for the injectable anti-wrinkle treatments. I have used all 4 types at the office since their inception but gravitate more towards Dysport for several reasons: Studies have shown that Dysport results “kick in” a little faster than Botox, Xeomin and Jeuveau, and tend to last a little longer. Also, you need a bit less product due to higher concentration of the actual active medication in the product, making it slightly more affordable over time. Lastly, I think Dysport, when done properly, tends to look more natural and softer, which has to do with it’s unique diffusion properties in adjacent tissues.

Use of all neuromodulators are skewing towards a younger population across the world. In fact, according to the American Society of Plastic Surgeons, more than 5 million Botox procedures were performed in 2019 alone, and although there is a significant growth in Botox injections in all age groups, this growth is more robust in the younger (20-35) population. One of the main drivers of this growth is the shift towards “preventative” Botox or Dysport injections in younger age groups, aka “prejuvenation”. This actually makes a lot of sense, as the facial wrinkles are much easier to treat before they are etched in and deep. In addition, there is a huge opportunity in the younger population to “retrain” the facial muscles. An expert injector can achieve this by shifting the energy from the “depressor” muscles, which are the muscles in the face and neck that pull the face and its structures down, to the “elevator” muscles, thus creating a beautiful lifting appearance in the entire face, creating a youthful and refreshed appearance.

In addition, it’s best to do these procedures around the time expression lines begin to appear, because once you have deep-set wrinkles and your skin is significantly thinner (50+ years), neurotoxins alone are not as effective, and often not sufficient, requiring additional treatments with lasers and fillers to erase or soften them.

Age isn't the only determining factor in deciding when to start treatment with neuromodulators. Over the years, dynamic rhytids (wrinkles that disappear when you’re no longer making any facial expressions), become static rhytids (wrinkles that remain on your face once you are no longer making facial expressions). However, this process happens much earlier in life in very expressive people. Although being very expressive is a personality trait, I have noticed that people in certain occupations such as accountants and teachers, tend to engage their facial muscles a lot more, creating etched-in lines much sooner in life. Similarly, those with an active outdoor lifestyle, tend to get static lines and wrinkles at a younger age not only due to sun damage but also repeated squinting in the sun. In these cases, Botox may not be sufficient to completely erase the wrinkles, however, Botox or Dysport can still reduce the depth of the static wrinkles and prevent them from becoming deeper, by minimizing muscle contraction in the treated area(s). As time goes by, and with repeated injections 3-4 times a year, many of these etched in lines will slowly fade away.

Keep reading to learn more about when is the right time to start these popular anti-aging injections!

By Dr. Neda Vanden Bosch

1. You Have Crow's Feet Around Your Eyes

One of the most compelling signs that the time is right for Dysport or Botox injections is crow's feet around your eyes. The skin around your eyes is very thin, so it is one of the first places to reveal the signs of aging. It is normal for temporary crow's feet to develop when you smile, but they should fade when you stop smiling. If they are a permanent fixture on your face, your muscles have been overworked to the point of creating etched in lines. Although you can try to treat it with creams or other treatments, neuromodulators such as Botox and Dysport are still the gold standard!

2. You Have Frown Lines

Do people often ask you if you're upset or angry? Even when you are relaxed? If so, those vertical lines between your eyebrows may be making you look angry. Frown lines are the lines between your eyebrows, often referred to as the 11’s since they resemble the number when you make a mad or pensive face. Another indicator may also be when you notice that your skin creases in these areas. Luckily, thanks to injectable muscle relaxants, like Botox or Dysport, these wrinkles don't have to be permanent. In fact, just five strategically placed injections can smooth your worry lines away and make you look friendlier, happier, and more approachable.

3. Your Eyelids Are Sagging

If your eyelids are sagging, there are several ways to lift them. Called a chemical brow lift, injection of a small dose of Botox or Dysport under the brow tail can relax the muscle that pulls the brow down, allowing the elevators of the brow to lift the brow much better, therefore minimizing sagging lids. It’s a real eye-opener! Many of my patients remark at how rested and approachable they look after.

4. You Have Horizontal Forehead Lines

Oftentimes people don’t even realize that their foreheads are aging them and sooner than they realize. They form by repeatedly making expressions just like the other areas and often appear as early as the mid to late 20s. Dysport and/or Botox injections can quickly and effectively take these away, but make sure you go to a reputable injector. This is an area that is easy to inject too much in, causing the whole forehead to drop. It’s an uncomfortable result, but luckily not lasting or damaging. I love injecting this area conservatively and my preference is for a natural looking, diminished movement type forehead, not completely frozen. When the forehead is completely “paralyzed” it tends to make the skin glassy looking and very unnatural. I always say it's better to come back more often and have a more natural look than to completely freeze the forehead and chance dropping the brow.

Other signs might include:

5. you’re looking to reduce the appearance of a “gummy smile”

A gummy smile is a term used to describe a person whose upper teeth and gums show prominently when they smile and laugh. Botox can be used to lower the upper lip, or to prevent it from rolling in and under as you smile, so that it covers more of the gum area. Most of the time this simply requires one or two injections right below the nose in a very carefully designated location, or 4 injections just above the upper lip depending on the type of gummy smile.

6. You have vertical lines around your lips

Those pesky vertical lines around the lips, especially the upper lip, are nobody’s favorite. Also called “smokers' lines” or “bar codes”, they can be caused by sun damage and age-related thinning of the skin, but the main reason we get these lines is the repeated pursing action of the lips. Therefore, smokers typically are known for these wrinkles, but they are very common and afflict most women in the aging process. Injection of 4-6 units of a neuromodulator at the lip border can significantly improve these lines. Once again, it’s best not to wait till they are etched in, at which point additional treatments such as fillers and lasers or chemical peels may be needed. A nice bonus of this procedure is that it creates a “lip flip”, making the upper lip poutier!

7. You have a mouth frown

Most people don't know that Botox and Dysport can be used very effectively in the lower face to create a more relaxed appearance and change your mouth frown “upside down”. This is an advanced application and should only be done by very experienced injectors. Age related volume loss in the lower face coupled with repeated contraction of hyperactive depressor muscles of the mouth and chin, creates the dreaded sad looking mouth and by breaking down the collagen and elastin in the skin, eventually creates wrinkles in the chin and marionettes. By injecting a small dose of neuromodulator in the tiny muscles that pull the mouth down, we can lift the droopy mouth corners and improve or eliminate the marionette lines.

8. You have a dimpled chin

The mentalis muscle is the main muscle of the chin, extending from the bottom of the central chin bone (mandible) to the crease under the lower lip, and along the way sending many attachments to the overlying skin, that can create a tethering effect on the skin akin to buttons on a sofa. Over time this tethering effect creates a porous, dimpled look to the skin. Patients who are born with a weak chin or have an overbite may have strain in this muscle at an early age, in order to keep their mouths closed. More commonly, age related volume loss and bony resorption creates constant contraction of the muscle, worsening dimpled chin. A few strategically placed injections of Botox in the chin area can relax the muscle in the chin and decrease or eliminate chin dimpling very effectively.

9. you’re looking to shrink or soften your jawline

The masseter muscle, which is used for chewing and grinding of the teeth, can be fuller in some people and even enlarged in patients who grind their teeth. Botox or Dysport can be injected into these muscles to soften the jawline, creating a soft, feminine look, as opposed to an unappealing androgenous in women. In fact, using Botox for the masseter to soften a square jaw in women is the number one use of Botox in Asia, particularly in South Korea. When used properly, the cosmetic results are astonishing, elongating the lower face and making a square jaw or square face more heart-shaped or oval, and the whole face leaner. This procedure involves a thorough understanding of the anatomy of the lower face and should be undertaken only by very proficient injectors in treating the lower face with neuromodulators. A huge benefit of this treatment is elimination of teeth clenching, with resulting improvement f TMJ issues, dentition problems and even cracked teeth, headache and neck pain.

10. You have neck wrinkles and jowls

As we age, the vertical muscles in the neck, aka platysma bands, are cord-like muscles connecting the jawline to the chest, often with many anatomical variations, and extend up in the lower face or way down into the chest wall. Regardless, they all become more prominent with age, and more visible due to thinning of the skin and volume loss in the neck. Their repeated contraction causes wrinkles, lines, crepey skin, and contributes to jowls by pulling down on the jawline. Fortunately, Botox helps relax these hyperactive muscles which provide the neck with a more youthful and smoother appearance over time, while improving the jowls. Infact, injecting Botox or Dysport along the Jawline and upper neck is called “Nefertiti lift”, named after the Egyptian queen, known for her beautiful neck and tight jaw line!

At the End of the Day, It’s an Art Form

Botox and/or Dysport are truly a customizable treatment which, for me, is what keeps it so interesting. Each patient is unique with unique facial features and their dosage and placement should precisely match their individual needs. Therefore, it’s important to go to an expert injector with years of experience, and deep understanding of anatomy and complex muscle interactions of the face! Once you see and feel the difference, you will never go back to a formulaic approach commonly used at many offices where the injector is not as artistic or knowledgeable about these complex topics.

In addition to the above-mentioned possible treatment areas with Botox and/or Dysport, we can treat a host of other things with these products. From decreasing underarm sweating and correcting facial asymmetry, to improving acne, decreasing pore size and improving skin texture, there is really a plethora of other treatments that my patients love. To read more about that visit my blog about all the other areas this wonderful product can “enhance” here.

Learn More at Your Complimentary Consultation

If you've noticed any of the signs and are interested in learning more or starting Dysport or Botox treatments, contact us today at VBoutique Aesthetics & Wellness in Lake Worth, FL to schedule your initial complimentary consultation

with Dr. V.

Meet Dr. Vanden Bosch!

Dr. V - Neda Vanden Bosch is the primary cosmetic physician at VBoutique. She is an accomplished physician with extensive training and experience with dermal fillers, collagen stimulators, laser and radiofrequency treatment, as well as skin care. Dr. V is licensed in 10 states. She is board certified by the American Board of Radiology.

Dr. V combines her artistry and deep understanding of facial aging with expert technique, and a variety of cutting edge laser devices to craft individual treatment plans for facial rejuvenation and body contouring. She also has exclusive access to the latest and most innovative aesthetic treatments available in the United States.

She is a highly-trained physician and sought after injector of dermal fillers and neurotoxins. With 10 years of experience in aesthetic medicine, she is a faculty member of the prestigious Galderma Injection Training Network (GAIN) and trains physicians how to perform cosmetic procedures. Dr. V was recently named to Galderma's Top 100 Injectors.

​Dr. V has treated thousands of patients with injectables and has numerous of hours of experience perfecting specialized injection placement to correct facial volume loss and facial asymmetries. Preciseness with a woman's deft touch means the best and longest lasting results from volume replacement treatments.

Merz Aesthetics recognizes her as a highly regarded "Elite Provider" of Radiesse and Belotero dermal fillers, as well as neuromodulators. Dr. V is a participating physician in Allergan's Brilliant Distinctions Program for its Botox, Juvederm and Latisse products, and Galderma’s “Aspire Rewards” Program.

Most recently, Dr. V was named a "Top Doctor" by online, aesthetic and cosmetic treatment community This recognition is awarded to less than 10% of doctors on the website.


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