Wrinkles Aren’t The Enemy
Today I saw a fifty year old woman in the office who wanted me to make all of her wrinkles disappear. For your edification, wrinkles are called rhytids in the plastic surgery world, but I digress. She was upset because when she animated her face suddenly “rhytids” appeared! But this is normal, as I explained. Even babies have wrinkles with animation, such as when they crying or laugh. But we would never consider doing Botox on a 1 year old. So what is the difference?
Why don’t babies look old when the cry or laugh? Well, wrinkles aren’t the only factor. The bigger one is volume. A babies face is filled with fat and fat faces (when fat is distributed in the right areas) looks youthful. Older faces are gaunt. But facial volume is a topic for an entire series of blogs. For now, let’s stick to wrinkles. For more on facial volume check out the page on fat grafting.
To refreshen a face, and make it look younger it is best to aim for the reduction of wrinkles at repose, or rest, NOT animation. That is, if you look in the mirror with a straight face and see wrinkles around your eyes or forehead, then Botox can work well for you. If you simply have wrinkles when animating, sure, Botox can reduce these wrinkles too, but at the price of significantly weakening your muscles of expression.
When we inject Botox we weaken or paralyze the muscles that cause wrinkles. If they are paralyzed completely, one becomes unable to generate proper expressions with their eyebrows. Because eyebrows function as emotional barcodes, any alteration in the ability to use these barcodes makes expression appear unnatural.
The point is that there is a balancing act. To ensure you are balanced correctly it is important to seek treatment from a qualified physician. Not all Botox therapy is created equal.

Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.