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Medical Aesthetics article for The Consultation: “The Botox Pout – the ultimate ‘prejuvenation’ treatment?


Turns out that Generation X were Botoxing all wrong – after the horse had bolted. Botox was meant to soften fine lines, never deep ones. But Xeners missed their window of opportunity and panic-injected all the way to facial asymmetry: rock solid foreheads strangely at odds with wobbling jawlines. Millennials learnt from their mistake: prevention is way better than cure.

Whispers that Botox could be used preventatively had been circulating for decades. If you can’t frown, you can’t get a frown line, right?

Dermatologists would never admit this publicly – it was a new treatment and they were learning on the job. In reality, a good doctor could stop an expressive face ageing prematurely, especially if caught in the nick of time – late twenties or early thirties. Fine lines didn’t stand a chance.

No such discretion from millennials. They proudly rebranded Botox as a ‘prejuvenation’ treatment, (prevention and rejuvenation rather than correction), an almost wholesome part of their ‘self-care’ grooming routine.

Well guess what – Botox can be used around the lips as well! I have been secretly ‘prejuvenating’ for years, ever since my late twenties when a dermatologist explained that I had an overly expressive face. Horrified, I tried these treatments so you don’t have to:

Botox for lip lines (perioral) lines:
Pouters beware: Deep lip lines will make you look like a sixty-a-day smoker and it is really hard to get rid of them. Botox can relax the muscle around the mouth that causes lip lines, but Dr John Burns, President of the Dallas Plastic Surgery Institute, recommends using only small amounts, otherwise “you can’t pucker and it makes you talk awkwardly.” So, it is more suitable for fine lines; for deeper ones, he recommends combining Botox with laser resurfacing.

Lip lines weren’t even on my radar until I noticed them on one of my peers. Botox does feel a bit restrictive at first, but you can still pout – just.

Botox Lip Flip
Where has my cupid’s bow gone? By our late thirties, the bone above our teeth gradually shrinks backwards and our poor lips are left hanging. They start to curl inwards and the cupids bow flattens.

A small amount of Botox injected into the middle part of the upper lip relaxes the muscle around the lips until it gently unfurls upwards. There aren’t many optical illusions in the world of aesthetics, but lips really do look fuller without the use of filler.

The results are possibly too subtle for trout pouting millennials who have overdosed on filler, but may well appeal to more mature patients. I started having this treatment many years ago, before it even had a name, and I love it.

Botox for Chin dimpling
Again, bad news for pouters. Again, pouters beware. I hadn’t even heard of Botox for chin dimpling until my dermatologist stuck his Botox needle in my chin, but Dr Burns has noticed its growing popularity:

“And then sometimes when they close their mouth, the skin around the chin gets dimply, almost like cellulite on their chin…Botox relaxes the muscle and helps that look better. We do a lot of that.”

Botox Mouth Corner lift.
Do you have ‘resting bitch face?’ Overtime, the corners of the mouth drop downwards, making you look sad and grumpy. Botox subtly lifts the corners of the mouth, so no wonder it’s so popular in Dr Burn’s clinic: “if you use a little bit of Botox, you don’t look quite as angry or old.”

I remember my dermatologist asking me to grimace: it is only needed if your lips naturally turn down. Guess what – mine did. Just bear in mind that eventually gravity will take its toll – the fold will become entrenched and filler will be needed.

So, should we all be shooting up Botox?
Some doctors are sceptical. Dr Uliana Gout, President of the British College of Aesthetic Medicine welcomes a shift towards prevention rather than cure, but prefers to maintain tissue health before reaching for toxins such as Botox. She pointed out that many perioral lines are actually caused by sun damage rather than hyperactive muscles:
“So, because the first thirty years of our life we accrue all the sun damage, the UVA, the UVB, and then the skin thickens up, and you get fine line formation. The epidermis thickens, it gets more leath-ery- like.”
Her rounded ‘strategic’ approach considers all layers of the skin:
“So, for me it’s all about diagnosing what’s happening from an external ageing perspective and in-ternal ageing; so external factors like pollution, sun damage and diet and then internal factors like your genetic predisposition. And then when you know what’s happening there, you look at what’s happening with the skin: the dermis, epidermis. What’s happened to the muscle structure. The fat pads. Then once you narrow it down, then you know how to approach it.”
So, she starts by prepping the skin with sunscreen and regular exfoliation. Unlike Dr Burns, she rec-ommends resurfacing treatments before trying injectables:
“Half the challenge we have is really bringing the skin back to normal. You wouldn’t automatically jump to toxin. You would start with resurfacing. You may not have static lines now, but you are de-veloping early onset sign.”
Let’s hope that millennials are using sunblock.

So is ‘prejuvenation’ the future of aesthetics?
But can ‘prejuvenation’ go too far and have the opposite effect? Dr Christopher Ardant, a biochemist with over twenty years in aesthetics, believes that lack of movement after Botox can ironically be age-ing and prefers to keep the face flexible. He warns against the ‘charm of the quick fix’ and prefers a long-term topical approach:

“when a subject follows a high-tech topical program containing cleansing, toning (to lower skin pH) growth factors and retinoids (especially Retinaldehyde), plus a good daily sunscreen with 18% of zinc oxide (and up), paired with chemical peels (as Modified Jessners) — well those subjects tend to abandon the use of Botox, as the renewed bounciness and elasticity of the skin allows them to look attractive and younger looking.”

If we address ageing at a cellular level, he states, then patients won’t need to rely on tweakments which can end up looking ‘done’. Perhaps he is the ultimate preventionist.


Charlotte Wilkes

Charlotte Wilkes Beauty Writer