I’m in My Mid-40s and Got Dysport. Can It Age You?

Photo-Illustration: by The Cut; Photo: Getty Images

And the Oscar goes to … Annette Bening’s face!

Well, no, it actually didn’t. But I think Annette Bening’s face deserves an award, or at least some kind of wide recognition that a face aging without intervention, with the obvious manifestations of age, can be very beautiful. As Nancy Etcoff pointed out in her book, Survival of the Prettiest, the more we see alternatives to beauty culture’s limited ideals, the more we will become accustomed to them, and maybe even find them not only acceptable but — is it possible? — even valued.

And as people of younger and younger ages are considering or submitting to various in-office aesthetic treatments — for example, the TikTok tab #BabyBotox has drawn 189 million views — it’s not surprising that we might be concerned about the long-term effects of such interventions. What might their faces look like in, say, 40 years? Which brings me to a recent reader question about the potential perils of neuromodulators.

Q: I got injections of the neuromodulator Dysport in my forehead and masseter muscles not long ago during my mid-40s. I loved how it kept me from clenching my jaw (and consequently causing headaches). I also loved how the “stress line” on my forehead disappeared. But I started worrying that the shots were making my skin tone more droopy and saggy. That issue, more than wrinkles, is my biggest fear/unhealthy preoccupation with my appearance. I’m curious whether neuromodulators can contribute to that sagging effect. Logically, it would make sense because wouldn’t the frozen muscles lose their tone? I’d love an expert to weigh in.

A: Your thinking does make sense, dear reader. And I’ve wondered myself if years of Botox in your face will eventually lead to a face lacking muscle tone, a frightening conclusion. So I emailed dermatologist Doris J. Day, M.D., for her advice.

“This is an excellent question and it’s something that I don’t think most people fully understand,” she wrote. “Regarding facial muscles, there are two main kinds of movement. One is when you voluntarily make a facial expression, like furrowing your brows. If you eliminate that movement (with a neuromodulator), there’s no adverse effect, because you still can see and function perfectly well,” she wrote. “The other kind of movement is only partially voluntary; it comes from a signal your brain sends to your facial muscles to make certain expressions like opening and closing your eyes and lifting your brows. And using a neuromodulator to interfere with a movement like lifting your brows can be problematic.”

Why? As we age, our brow often drops and our eyelids look heavy. The natural response is that our brain sends a message to the forehead muscle to contract to lift the brow, making our eyes feel more open, said Day. This movement happens unconsciously. And as a result of both this repetitive movement plus sun damage, we see deepening forehead lines. But it is this muscle movement that’s critical to keeping our brow from dropping.

This is one reason why it’s so important to choose a physician highly skilled in injecting neuromodulators. “And it’s why I’m very hesitant to completely inactivate the forehead muscle to eliminate forehead lines,” Day said. “It’s more effective to relax the muscles between the eyes (a.k.a. the “11s”) and the muscles outside the eyebrows. When you relax these, what you get is less of a brow drop and more of a lift,” said Day.

It’s also important to understand that the forehead muscle is very big. When you try to freeze all of it, any part of the muscle you miss will continue to try to move because the brain is still sending its signals, which may result in odd, unnatural lines and wrinkles in the forehead and a heavy brow.

Are you now inclined to eschew the neuromodulators? Day has a suggestion. “An alternative — and free — technique, is to exercise the muscles that lift the ears instead of lifting the brow,” she wrote. “I’ve made videos about this and have been doing it myself for over 20 years. You get that same sensation of a brow lift, because your eyes do feel more open and you end up not only not making forehead lines but also looking more awake.”

You might also try a series of treatments with an ultrasound device such as Sofwave, which can restore and enhance collagen, and that consequently may have a more long-lasting effect. By eliminating that feeling of heaviness, the treatment diminishes the desire to contract the forehead muscle to lift the brows.

One final, potentially helpful technique: Learn how to see yourself without objectification. Constantly scanning your face for flaws will surely lower your self-esteem, if not your brow.

As for treating migraines, Day says that low doses work as well as high doses and that injecting higher on the forehead can help reduce brow drop and atrophy of the forehead muscle.

As always, an experienced doctor will help you decide if a neuromodulator is right for you, and when to start.

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I’m in My Mid-40s and Got Dysport. Can It Age You?