Botox has traditionally mainly been used in the upper face to treat frown lines, forehead lines and crows feet around the eyes. These three areas make up the vast majority of botox treatments and have a long history of safety and effectiveness.
However, there are some cosmetic uses of botox in the mid and lower face that are less well known.
Bunny Lines. These lines occur on the side of the nose from scrunching the nose. In some people they become more prominent after having botox treatment to the frown area. These can be softened with a small dose of botox.
Lower Eyelids. Lower eyelids are difficult to treat as too much botox can cause change to the shape of the lid and a watery eye. In younger clients (usually less than 40), bunching of the lower eyelid when smiling can be improved with a small amount of botox. Also, a small amount of botox can also soften crepey skin in the lower eyelid. Results are subtle as only small doses can be used and the client must be assessed for suitability.
Gummy Smile. A gummy smile refers to a smile where excess upper gum is showing. A small amount of botox near the nose can improve this be weakening the central lip elevator muscles.
Marionette Lines. These lines occur at the outer corners of the mouth and tend to cause the mouth to turn downwards. They are usually treated with dermal fillers. However, botox treatment in the outer mouth depressor muscles can give a pleasing result. This can also augment the results of fillers.
Dimply chin. Excessive muscle activity in the chin area can give an orange skin type appearance. This appearance can be softened by injecting a small amount of botox.
Masseter Muscles. The strong chewing muscles at the angle of the jaw below the ears can also be treated with botox. Treating these can create a more feminine, less square shaped jaw as well as reducing teeth grinding and, in some cases, tinnitus (ringing in ears).
Nefertiti Lift. This procedure refers to injecting botox along the angle of the jaw and in the neck bands. This can create a subtle lifting of the neck. Patient assessment and appropriate selection is important to optimise outcomes.
Results of lower face treatments often last longer than those in the upper face. It is not unusual to achieve a result for six months or more for the Nefertiti Lift and masseter muscle treatment. However, these treatments have a higher rate of complications. Facial asymmetry and difficulty talking and swallowing are risks of treatment. Therefore, it is important that you choose an experienced injector and discuss the expected benefits and risks prior to treatment.
Dr Stephen Wassall has a Masters Degree in Primary Care Skin Cancer Medicine and is a Member of the Australasian Society of Cosmetic Medicine. He practises on the Central Coast of NSW, Australia.
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