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The era of the frozen forehead may be thawing. After years of chasing a perfectly smooth, line-free complexion, more patients are heading into their injectors\u2019 offices with a different goal: keep the wrinkles that make them look like themselves and soften only the ones that don\u2019t. Dubbed \u201cstrategic wrinkles,\u201d the approach aims to use neurotoxin selectively instead of freezing out every line, thereby preserving expression. The goal? Ease the furrows that make you look tired, stressed or perpetually annoyed while leaving the lines that light up when you laugh.<\/p>\n
\u201cThere is a cultural reset in aesthetics in which the natural look is the coveted look,\u201d says Washington, D.C. dermatologist Nina Hartman, MD. And, as Southlake, TX dermatologist Janine Hopkins, MD puts it, \u201cA beautiful result can absolutely include wrinkles. A face can look healthy and refreshed and still move.\u201d<\/p>\n<\/div>\n
Strategic wrinkles refer to preserving certain expression lines while softening others with neurotoxin treatment, Dr. Hopkins explains. \u201cI think the interest reflects a desire to look natural and less visibly treated. Preserving expression has long been part of thoughtful cosmetic dermatology; the terminology is new.\u201d<\/p>\n
Some lines are worth keeping, says Dr. Hartman. \u201cThey convey warmth, personality and authenticity. Moreover, preservation of movement looks more natural, and complete paralysis can make someone look odd and older than their age.\u201d<\/p>\n
While most patients don\u2019t specifically ask to keep wrinkles, they often express that they \u201cwant negative expression lines softened while preserving pleasant animation. They tell me they don\u2019t want to look mad or sad when they aren\u2019t feeling that way,\u201d says Dr. Hopkins. \u201cI like to ask, \u2018Which lines bother you, and what do you love about your face?\u2019 That helps us soften an unintended frown while keeping the warmth of a smile.\u201d<\/p>\n
For many, it\u2019s the lines around their eyes. \u201cThe most common areas people want to preserve are the crow’s feet, or the lines around the eyes that result from smiling,\u201d says Dr. Hartman. \u201cThese lines are tied to warmth and happiness. A big smile reads as authentic, and patients are increasingly aware that eliminating the crow’s feet entirely can make the smile look less natural and flat.\u201d<\/p>\n
Yes, if an injector doesn\u2019t account for how the surrounding muscles move. \u201cFacial muscles work together, so we cannot simply chase individual wrinkles,\u201d Dr. Hopkins explains. \u201cTreating one part of the forehead without accounting for the remaining activity can create uneven movement or an exaggerated brow arch. Overly weakening the forehead can also cause brow heaviness because that muscle helps support the brows. Anatomy, placement and dose all matter.\u201d<\/p>\n
Dr. Hartman agrees: \u201cThere are always risks in injecting muscles without understanding how the surrounding muscles will change or compensate. This is where the skill of the injector becomes critical. For example, treating the forehead without the glabella or \u201811 lines\u2019 can lead to new, diagonal lines along the forehead. Similarly, partially treating the forehead without careful planning can result in a Spock-like elevation of the lateral brow. The key is a thorough understanding of facial anatomy and a very individualized injection strategy. It’s not simply about using less product\u2014it’s about placing it with precision.\u201d<\/p>\n
\u201cOur approach always starts with an in-depth conversation about what the patient values and wants, followed by a thorough evaluation of his or her anatomy. From there, we use a \u2018less-is-more\u2019 philosophy, often starting conservatively,\u201d says Dr. Hartman. \u201cIt is much more preferable to have a patient return for a touch-up than to be overtreated.\u201d<\/p>\n
Dr. Hopkins starts consultations by listening to patients and watching how their faces move at rest and as they talk, smile and frown. \u201cI assess muscle strength, brow support and any existing asymmetry alongside their goals,\u201d she explains. \u201cMy goal is to soften expressions that unintentionally communicate anger or sadness while preserving warmth and personality. A successful result should still look and feel like you,\u201d says Dr. Hopkins. <\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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