Expression lines and creases of the forehead and around the eyes are the result of the repetitive contractions of facial muscles and changes in the skin over time. The nerve impulses that stimulate muscle contraction in these problem areas can be selectively controlled by neuromodulators such as Botox®, Dysport®, and Xeomin®. A smoother, more youthful appearance results as skin lines and wrinkles visibly diminish following the treatment.
Botox Cosmetic provides a non-surgical way of reversing some of the visible signs of aging. The treatment is simple with minimal discomfort, requires only a few minutes, and you can immediately resume normal activities. Very precise injections are made into the areas selected for treatment. The results will be apparent in a few days with continued smoothing of the skin occurring for a few weeks after the first treatment. Side effects are rare.
Botox Cosmetic is extremely safe and has over 15 years of success in treating a variety of medical conditions such as chronic migraines and TMJ in addition to its cosmetic use. You will still be able to laugh, smile, or frown, but without the wrinkles. The duration of effect is from four to six months. Long-term maintenance of smooth skin can be achieved by adhering to regular treatment intervals.
Daxxify is a new, longer-lasting alternative to BOTOX® Cosmetic. It has been FDA-approved based on extensive clinical studies that showed its efficacy to be up to 2-3 months longer than BOTOX® Cosmetic in most patients. Some patients were seen to benefit from Daxxify for up to 9 months following treatment. The neuromodulator is the same in both formulations but the important difference is that Daxxify uses a stabilizing membrane of peptides that were specifically created to bind securely to the nerve receptors in targeted muscles. The chemical signals for muscle contraction that are responsible for producing wrinkles are thereby blocked for an extended period of time. As a result, the muscle relaxes and the skin stays smoother with fewer treatments. Daxxify is typically used for the vertical frown lines, forehead creases, and crow’s feet around the eyes but can also be used to soften muscle bands in the neck, smooth chin irregularities, and decrease prominent masseter muscles of the jawline.
Dysport differs at the molecular level from Botox Cosmetic but has a very similar mode of action on the wrinkle producing muscles of the face. It has fewer proteins attached to botulinum toxin A, the active biologic component, and, therefore, is a smaller size molecule. It is felt that this smaller size may enable it to spread more widely and also possibly take effect more rapidly. The outcome and longevity of the benefits from each product are very similar with both Dysport and Botox Cosmetic providing a non-surgical alternative to reversing some of the visible signs of aging. Maintenance requires two to three treatments annually.
Xeomin differs from Botox Cosmetic and Dysport in that it does not have any additional proteins attached to the native toxin. Although an immune reaction to these proteins is extremely rare, the possibility of such a response by the body is eliminated when Xeomin is used. That is why some have coined the term “pure-tox” to describe its protein-free formulation. The results achieved with Xeomin compare favorably with both Botox Cosmetic and Dysport.
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Botox Cosmetic smooths facial lines and wrinkles by decreasing the repetitive muscle contraction that is their underlying cause. Lines that are created by muscle contraction which remain present at rest even when the muscle is relaxed are due to changes in skin quality with the aging process. Dr. Forley’s understanding of facial anatomy and experience enables him to selectively treat portions of the wrinkle producing muscles while preserving facial expression. This allows the skin lines and wrinkles to gradually diminish resulting in a natural, more youthful appearance without the frozen look of indiscriminate use of this neuromodulator.
Patients often forget what their facial wrinkles looked like before they started treatments with Botox Cosmetic, Dysport, or Xeomin. The same repetitive muscle contraction that originally created the lines will result in the gradual return of the wrinkles when neuromodulators are discontinued. If the wrinkles that return truly appear worse to you, it is more than likely that the skin itself has continued to age and will be less able to resist the creation of wrinkles in response to the muscle activity that is now present. The good news is that the skin will return to its smoother appearance when you resume neuromodulator treatments.
It is not uncommon for the muscles of animation that have been treated with Botox, Dysport, or Xeomin to resume their ability to contract and produce wrinkles in stages as the effect of the neuromodulator gradually wears off. The amount of neuromodulator that binds to the receptors following a treatment is variable. This enables some parts of the muscle to become active sooner than other parts once their receptors are able to receive signals from the brain to contract. If treatment is administered at the earliest stages, the receptors that remain blocked will not benefit from the neuromodulator injected and those muscles will resume contracting over the coming weeks. This results in either the perception that the recent neuromodulator treatment didn’t work or an increased frequency of treatments to keep up with the stages of muscle re-activation. Dr. Forley will be able to guide you as to the best time to re-treat your muscles of animation to achieve optimal results and keep the frequency of your treatment intervals at 4-6 months.
Aesthetic surgical procedures have many beneficial effects but they generally do not replace neuromodulators as a treatment for wrinkles except for a few scenarios. Patients will often compensate for a low lying brow or excessive heaviness of the upper eyelids by contracting the frontalis muscle of the forehead. They feel relief as the brow elevates but this repetitive movement gradually results in wrinkles that extend across their forehead even at rest. A brow lift or upper eyelid surgery will decrease the impulse to contract the frontalis muscle and may gradually result in a smoother forehead appearance. These procedures can also be combined with a partial excision of the corrugator frown muscle to produce a long term reduction of the “elevens” between the brows. However, in some cases neuromodulators may still be needed due to persistent muscle contraction with facial animation despite the surgery and possible regrowth of the corrugator muscle.
Neuromodulators are very effective at producing a relaxation of the wrinkle producing muscles of the upper third of the face resulting in a smoother appearance of the overlying skin. However, the frontalis muscle of the forehead is responsible for elevating the brows and it is important to maintain some of its function to avoid a droop or descent of the forehead. This can create an undesirable heavy, hooded appearance. Some patients are more at risk for this result than others depending on their natural brow position and underlying bony anatomy. Dr. Forley will discuss with you the optimal pattern of neuromodulator treatment in your forehead to achieve the most natural, wrinkle-free result. In some patients, maintaining a low level of muscle contraction of the lower forehead is a necessary tradeoff to keep the brow from drooping following the treatment.
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UK-based Tatler discussed Dr. Forley in its 2008 Beauty and Cosmetic Surgery Guide as one of the "A-list of cosmetic surgeons"..."who are at the top of their game"...and whose "innovations are shaping the art of cosmetic surgery around the world." It was noted that Dr. Forley’s "discreet Upper East Side clinic is perfect for women and men in search of minimally invasive natural-looking surgery.
Julia Reed writes that Dr. Forley, "disarms me by asking what I might like to have done. Nothing, I say, sure that I mean it. And then he shows me before and after books of tiny little neck lifts, subtle browlifts involving tiny little incisions well hidden within the hairline. In ten years, he assures me, I’ll be thinking about it. I actually like him. And I fear he may be right."
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