The Changing Face of Botox

With Botox being the most requested cosmetic procedure in the world, its stigma of ‘plastic’ has subsided and has become a popular refresher for many women’s beauty regimes. Moving away from the overdone look, small tweaks are made that look unnoticeable but successfully improve the overall appearance of the face like a magic wand.

Clinic 42 have a team of leaders in the cosmetic medicine sector, priding themselves on up-to-date offerings in the ever-evolving industry. In this issue of M2woman, we talk to Dr. Joanna Romanowska to discuss how Botox has changed over the years to become a holistic medicine and what we can expect from clinicians.

I’ve heard that Clinic 42’s philosophy comes from the desire to treat appearance from a holistic perspective. Due to what we have been exposed to, having cosmetic medicine to work in this manner sounds paradoxical. How do these seemingly opposite approaches work together?

At Clinic42, we approach cosmetic medicine from a holistic point of view in two ways.

The saying “look good feel good” goes far beyond vanity. The real effect someone’s appearance has on their self-esteem is well documented and there is even evidence to show that Tox used to treat frown lines can have positive effects on mood.

I’m reminded of a young patient (mid-thirties) who had never smoked, but her lip lines made her look and feel a lot older. A tiny correction of the skin on her upper lip, which no one else noticed, had a dramatic effect on her wellbeing. Beaming from ear to ear, she told me later that she felt so much better about herself that she had become motivated to exercise, eat healthier and was making more of an effort to balance work and family. Both her health and her family benefited from the miniscule change in her appearance!

Another debilitating and often embarrassing condition is excessive sweating (hyperhidrosis) and it’s not just reserved for areas like armpits. Places like the palms of hands, feet, or upper lip can be affected by excess sweat. Tox can temporarily disable these glands from producing sweat. For those who have had to deal with this condition, it’s a life changing effect.

Chronic migraines are another condition rendering sufferers helpless and unable to live a normal life. Thankfully, Tox can help this condition by blocking the neurotransmitters that carry pain signals to the brain, stopping them in their tracks before they reach the head and neck. For those who grind their teeth from stress, we can treat jaw-muscles to relax that area.

Conversely, some people use cosmetic treatments a bit like “retail therapy”, with an expectation that more is better. At Clinic42, we take time to get to know our patients, assess their requests and consider the best solution for each concern.

The patient may come in with the expectation of a certain treatment (e.g. filler to the lips to create fullness of the lips), but the problem may not be volume deficit, but muscular inversion of the lips. Therefore, the solution would be relaxing the muscle to prevent the inversion, at a fraction of the cost and without the risk of looking over-done.

We take our time to assess the issues and educate patients on why it may not be desirable to keep doing more and more, sometimes referring to other practitioners or even turning patients away.

We also consider the patient’s emotional state when they present for treatment. Tiredness, stress and anxiety not only increase pain perception, but can also skew our view of ourselves, so we may offer relaxation exercises (especially for needle-phobic patients) or encourage them to reschedule if they are under excessive stress.

Cosmetic medicine isn’t just skin deep, a holistic assessment of the whole patient is required to ensure optimal results and wellbeing.

Let’s talk about Botox – it is the most requested cosmetic procedure in the world. How has its science changed over the years? What can we expect from clinicians these days?

Over the last 30 years of therapeutic and cosmetic use of these products, things have changed a lot. New neuromodulators like Xeomin and Neuronox have joined Dysport and Botox in the marketplace, with other products on the way. They all have slightly different properties physiologically and a skilled practitioner will utilise these specific properties to optimise results. The differences are mainly related to the complex proteins in the products as well as various unit strengths offering differing clinical effects.

In the hands of an experienced practitioner, the days of the “Botoxed look” are history. At Clinic42, we prefer to reduce doses (with a financial benefit to the patient) and aim to achieve a natural, relaxed, refreshed look, more in keeping with the European understated aesthetic, rather than the Californian ‘overdone’ look.

Another popular effect which has evolved, is the so-called Mesotox or Microtox, where the product is injected diffusely all over the target area (eg whole face or neck & décolleté), very superficially into the skin, for a smoothing of the skin and refining of pores, rather than modifying expression. This technique also combines well with other procedures eg. hydrating hyaluronic injection or IPL to optimise skin brightness.