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The Straits Times
Mind Your Body | Health Help | Doc Talk By Dr Jean Ho
July, 2010

Article
Erasing Frowns, Gaining Friends .......


Wear a smile and have friends, wear a scowl and have wrinkles.
By George Eliot

A psychologist friend shared with me an interesting finding last Christmas, over roast chicken and our neighbour’s scrumptious sheperd’s pie.

We had launched into a hearty discussion about botulinum toxin treatment (commonly referred to by the trade name ”Botox”) and its psychological effects.

“Do you know that botox can treat depression?” said my friend



Hmm, I have suspected that for some time. Patients, following their first treatment with botulinum toxin, reported that they felt better than they had in a long while.

“There is research, which showed that patients who had treatments to their frown lines were able to maintain a positive mood more easily, compared to patients who did not have the treatments,” she added, citing the study findings.

Also these findings were independent of whether the patients in the study were deemed attractive or otherwise.

Botulinum toxin is administered to muscles which control facial expression, to relax them. The most popular application is in the treatment of frown muscles. These muscles draw the eyebrows together into a scowl. The frown muscles are important in the expression of sadness, fear and frustration.

Therefore a smoother forehead translates into a happier state of mind, the study concluded.

Be it a grimace, a squint, a pout or grin. Years of animation cause the skin to fold repeatedly, giving us the distinctive frown lines, crow’s feet or forehead lines.

In younger patients, these lines convey an appearance of age, fatigue and frustration.

Over the passage of time, the wrinkles become permanently etched into the skin. Sun exposure and smoking compound the problem, causing loss of skin elasticity, pigmentation and coarse pores. In older patients, the skin looks worn and weathered.

The use of botulinum toxin has emerged as an indispensable tool for rejuvenating the aging face.

“But, I am not sure if I want that poison injected into my body,” she, like some patients, remain wary.

The history of botulinum toxin has evolved from an archaic disease contracted from eating contaminated meats and vegetables, to something that is discussed over cappuccino and cocktail parties.

Medical use of the toxin started around the 1970s when doctors used it to treat squints and overactive eye muscles. The use was expanded to treat facial wrinkles in 1990s. When administered under expert hands, it was found to be safe and effective. The fact is that the dosage used in cosmetic treatments is too miniscule to be of any hazard to the person.

‘’But I have to keep coming back for repeat treatments, right?”

Botulinum toxin relaxes the muscles. Due to the regenerative potential of our tissues, the effect of the toxin wears off after period of 4 to 6 months and muscle activity is regained. Wait, there is more to it.

Patients who returned for repeat treatments could do so at longer time intervals and required less dosage than before. The improvement in facial lines also persisted for as long as 1 year after the last treatment.

“I don’t want to look and feel stiff after the injection.”

This is where the maxim “less is more” comes in. The strategy is to avoid overtreatment, so that the patient still retains some activity of facial expression. Also a precise technique will ensure that only the offending muscles are targeted, sparing the rest.

In fact, when properly applied, the treatment “opens” up the eyes, making the patient look more alert and engaging.

“I am 38, am I too young to consider starting treatment?’’

To experience the maximum benefit from botulinum toxin injections, it is desirable to begin treatment earlier than later, before permanent signs of aging set in.

Apart from erasing frown lines, botulinum toxin can be used to smooth out a dimply chin, eliminate crow’s feet, slim down square jaws, and upturn the corners of a droopy mouth.

It is also an integral component of most rejuvenation programmes. For example, botulinum toxin combined with the use of fillers plump up facial crevices, restoring the youthful contours of the face. It also complements skin tightening procedures or chemical peels to provide more long-lasting uplifting results.

The present study has added a new dimension to the list of perceived benefits. The face is a vital organ of communication. Botulinum toxin treatment, in limiting certain negative expressions, will no doubt have a potentially beneficial psychological effect on the patient.

“So would you consider the treatment for yourself?” I asked, teasingly.

She scrunched up her face, as if deep in thought. Fingering the deepening crease between of her brow, “I think I would need it sooner than later.”

 

Dr Jean Ho is a consultant dermatologist with special interests in paediatric dermatology and laser surgery. She practises at Mount Elizabeth Medical Centre.

jeanho@drjeanho.com

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