Dr. Shervin Naderi breaks down upper face anatomy for Botox, explaining how corrugator and procerus muscles create different wrinkle patterns. Skin elasticity drops after 25, making wrinkles stick around longer. After 35, treating forehead lines risks heavy eyebrows, a trade-off he addresses with surgical options like brow reset.
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So if you zoom in here, you'll see that this, this 11 mark, 111 mark, 1 mark, it depends on everybody's a little bit different, but there's humans get vertical lines between their eyebrows, right? That's a normal part of human life. In some people, it's deeper down the middle. Some people form 11, some people form 111, some people have 1111, but it's always vertical marks. And 2 things cause that: the corrugator muscle that pushes the eyebrows together. And sleeping on your face. So you may get Botox, perfectly smooth, but if you're a face sleeper and a side sleeper, you're going to create that mark. Now, if you're 16, 17, 18, 19, you can do all the frowning and side sleeping you want, but the skin is so nice and elastic that those marks don't stay. Beyond age 25, we start to lose skin elasticity. That's why skincare is so important. Microneedling, peels, lasers, etc., Retin-A, All those things are important. You can't just rely on one or two things. You have to have a complete skincare approach. But when the skin is more elastic, it is more forgiving and it doesn't crack in as much. Now, the muscles that create this line are the corrugator. They go like this. They basically go upwards from the eyebrows. And by injecting these, I'll show you in a second, we're gonna relax that. There's a muscle here called the procerus that makes lines that go in this direction. We're gonna inject that as well. Here's the trickiest part, and a lot of people have had this issue. If you look, there are lines above the eyebrow. I have this discussion with patients all the time. We don't like these lines, especially after age 35. We don't like those lines. But if I go ahead and Botox these lines to relax the muscle, what ends up happening? The eyebrows feel heavier. So when somebody comes in after age 35, the conversation always is, do you want more open eyes, more lifted eyebrows, or do you want a smoother forehead? You almost never can have both, no matter what Instagram influencers tell you. It's just not going to happen past age 35 because the eyebrow gets heavier. So typically, we try to go with more lifted because open eyes feel better. Now, we have a surgical solution for it. A brow reset, an endo-style brow reset, sets the brow where it needs to be, gets the weight off of the eyebrow. An upper eyelid rejuvenation, trimming a little bit of that extra skin that happens in every single human being, That takes the weight off the eyes, and then you can actually Botox across the forehead, treat those lines more freely, and not have to worry about things dropping. So those are the things we're gonna do, and a little bit of Botox around the eyes. There's a sphincter muscle called the orbicularis oculi. It squeezes in this direction, creates the dreaded crow's feet. We're not gonna be able to get rid of it completely because even if you Botox that completely, when you smile, the cheek moves up and creates some of those lines, especially in people with thinner skin. So we're gonna soften a little bit, and again, I don't want to tether the smile. Some people get too much injection of Botox around the eyes and it's too deep. That's one of the tricks— never go deep there, because if you go deep, you actually get the muscle that controls the smile and you will block their smile and they look like they have Bell's palsy. It looks terrible. So we're gonna show the technique.
