“My lines seem more obvious again. Is it time for a topup?”

Ask Dr Imaan : “My lines seem more obvious again. Is it time for a topup?”

Like any decent doctor and surgeon, my consent process for any procedure is fairly extensive- I explain many many things; what can go wrong; what to expect- immediately, soon, in two weeks’ time and in the next few months. When it’s time for a top up. If I have consent to take photos and use them for my website; if I have consent to email reminders etcetc.

Sometimes, because I have done this process so many times, I forget that patients can’t take it all in at the time, may be nervous and therefore inattentive or excited and eager to proceed or any combination of the above. Because of this, we miscommunicate. And the single biggest question I get after the treatment, is “Do I need a topup/more treatment already?” in relation to static lines.

What are static lines versus dynamic lines and why does it matter? 

If you ask a 5 year old child to look angry, they’ll develop wrinkles between their eyes; these go away as soon as they are laughing however. These, are dynamic lines. Lines that are visible when the muscle underneath is being used, but disappear when it is relaxed.

As we age, and our habits keep us frowning when we concentrate, or squint  or concentrate; or we use our forehead lines to see better, to open our eyes up for photos; or we laugh and over time, crows feet form around our eyes. Over time and repeated use over years and years, the lines don’t disappear completely when we aren’t using those muscles. These lines are static lines and they deepen over time as we continue to use our muscles, lose the plumpness of the skin with age and skin damage.

Anti-wrinkle treatment is great at treating dynamic wrinkles; it is less effective at treating static wrinkles, BUT it does soften these lines over time, usually within a year of ongoing, back-to-back treatment.

So. When someone contacts me to say their lines are more obvious again, but frowning is still harder than usual, it’s usually because their static lines are still visible, and as the effect of treatment begins to wear off, they are beginning to use those muscles more.

OR they didn’t have a big enough dose to begin with. So for eg, if someone really needed 25 units of Brand A but only had 20 units initially with a review planned at 2 weeks which wasn’t attended, an opportunity for topup was missed.

Sometimes, as the effect of the treatment that wasn’t enough begins to weaken, the habit of frowning in this example, comes back, causing static lines to look more obvious next to the smoother treated skin.

The solution, is a review. It’s not possible for any decent practitioner to give you a consult over texts or phone without seeing your face, your muscles in action and their strength.

I understand it may feel like a waste of time, but it truly isn’t, and you may end up shortchanging yourself in the process.

In this patient, I’d suspect that she’d been underdosed and would have benefited from a topup at the two week review with another 4-6 units for best effect. Or, quite possibly  due to the bunching effect next to her brows, that she was using other muscles instead of her frown muscles to cause the bunching and lines, none of which can be assessed except in person.

Finally, everyone reacts differently to the same dose of treatment. Here is an example of another person at 6 weeks, still unable to frown, as seen by her squinting: