The Line…

I think I first noticed it when I was 25.

It started as a faint wrinkle in between my eyebrows. At first, I thought, oh, whatever. It gives me character. It shows I’m expressive. It’s a sign of maturity. And then it got deeper. And stopped appearing just when I furrowed my eyebrows; it had made a permanent home on my otherwise unlined face. That was it for me.

Luckily, as a dermatologist, I’m equipped to deal with such matters. So let’s talk about these little (or not so little) lines that find a place on our faces, whether they’re welcome or not. Wrinkles on the forehead, between the eyebrows (glabella), and around the eyes (crow’s feet) are caused by the movement of muscle. We activate these muscles when we make facial expressions: lifting our eyebrows, furrowing our brow, and squinting our eyes. Over time and with repeated movements, the wrinkles can become more pronounced. Botulinum toxin type A can be injected to relax these lines.

A little history: in 1987, Botulinum toxin type A was approved by the FDA (Food and Drug Administration) for the use of blepharospasm (spasm of the eyelids). Patients began to notice smoothing of their wrinkles as a pleasant side effect of the treatment. Dr. Jean Carruthers, an ophthamologist, and Dr. Alastair Carruthers, a dermatologist, began studies and reported botulinum toxin type A as a cosmetic treatment for frown lines in 1992. More and more physicians began injecting patients, more studies were conducted, and Onabotulinum toxin, or Botox, was approved by the FDA for the treatment of glabellar frown lines ten years later.

So how does it work? In a nutshell, it temporarily stops muscle contraction by blocking the release of a chemical needed for the nerve and muscle in that area to communicate. No communication, no contraction, and subsequently, no lines. The product is injected in the specific area with a very thin needle, causing very little to no discomfort. The effect is usually noticeable in about a week, and lasts about 3 months, after which the muscle can move again, and the lines will usually return.

In April 2009, another botulinum toxin type A was approved by the FDA for the treatment of glabellar frown lines: Abobotulinum toxin A, or Dysport. Both Botox and Dysport are excellent products. There are subtle differences between them, which may include how soon they start working and how long they last.

While these treatments are effective, they are not for everyone. Women who are pregnant or nursing should not be injected. People with specific neurological diseases or on certain medication may not be candidates. The most important thing, as with any injectable procedure, is to have a board certified physician perform the injections, such as dermatologists, plastic surgeons, and ophthalmologists.

My upper face is currently smooth from my last treatment. Now on to those parentheses around the mouth…

Donna Bilu Martin, MD is a board certified Dermatologist at South Beach Dermatology.

This post is not intended to be used for the purpose of medical diagnosis or treatment in any shape or form. Accordingly, any information contained within should not be construed as medical advice, evaluation, or consultation and should never be considered a replacement for a formal evaluation by a physician in the office. Therefore, the information and correspondence that is involved with this weblog does not constitute a formal doctor-patient relationship. Explanation of off-label services and/or products that are mentioned herein does not reflect an endorsement nor promotion and should not be construed as such.




2 thoughts on “The Line…

  1. Love the article, thank you! I did want to hear more on her opinion or why maybe not to inject?! Pros & Cons? Also, is 26 too young to start prevent 1st wrinkle?? -stef xo

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