Dr. Tranter Aesthetics

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The Eyes

The Eyes

Such an expressive area and one that gives away negative emotion very easily as we age, and a big area of concern for lots of my patients.

I often have people say to me at their appointment “I feel as though I look so angry”, “I hate the deep frown between my eyes, it makes me look so concerned”, or “the wrinkly skin under my eyes makes me look so tired”.

These negative expressions that we are inadvertently giving out is a result of lots of repeated movements of the muscles in the upper face, combined with the effects of UV -induced photoaging, and other risk factors (such as smoking, stress, dietary factors, and your baseline genetic predisposition). Over time this leads to fine lines and wrinkles, sagging, and crepey skin. While some of these risk factors are modifiable – think stopping smoking and tidying up your diet, some aren’t, such as your genetics.

We also have another tool in our arsenal to fight against the progression of these signs of aging – in-office cosmetic treatments, and in this blog post I want to focus on the use of targeted, micro-dosed anti-wrinkle treatments for this area.

The use of anti-wrinkle injections with a neurotoxin has been in the cosmetic space since the 1980s and makes use of a toxin that acts at the neuromuscular junction to block muscle activity and cause muscle relaxation.

The results gradually become evident over 7-10 days, and the results last for 3-4 months.

When used in the upper face we can treat the forehead, frown, and around the eyes. The effect of using it here is that we can target the muscles that contribute to the formation of negative expressions.

There are other treatments that can be used in this area, but I’ll cover them in a later post!

Example: the frown area.

Muscles responsible: procerus and corrugator supercell

MOA: procerus draws medial eyebrows downward and corrugator supercell (along with orbicularis oculi) pull the eyebrows medially and inferiorly

We often frown when looking concerned or angry. To elicit muscle contraction when I’m assessing someone for anti-wrinkle treatment, I ask them to “look angry”!

By targeting these muscles with neurotoxin we are relaxing their ability to draw the eyebrows into a frowning expression, thus creating a more relaxed and less wrinkled expression.


I personally like to assess everyone as an individual. I don’t do generic anti-wrinkle treatments because everyone is different and what may work for one person, maybe too much or not right for another.

These are the factors I consider when assessing your upper face for an anti-wrinkle treatment:

· Your face in a rested expression (i.e. no movement at all – that way I can see where you have static lines)

· Your face in animation (I’ll get you to look angry, look sad, smile, raise your eyebrows – all to give me an idea of how your face is moving with expression)

· How strongly your muscles contract and what is the dominant muscle activity in a certain area

· The proportions of your upper face (i.e. how large your forehead is!)

· How do your upper eyelids sit, are they heavy or hooded?

· The shape and proportion of your eyebrows

· The condition of your skin – is it crepey? If so, intradermal botox can really help here by smoothing the skin

· What your concerns are – some people hate their forehead and frown lines but enjoy seeing their ‘laugh lines’ (around the eyes) as they associate this with positive expression and feeling happy!

I also take into account your age, lifestyle factors, and medical history…so you can see there are lots of factors to consider when having anti-wrinkle treatment, but the results can be fantastic – see below for some examples:

These examples demonstrate how the use of targeted anti-wrinkle treatments can open the eyes, smooth the skin around this area and subtly raise the tail of the eyebrow – I think the result is quite amazing, with positive emotion preserved and in no-way looking frozen or expressionless.

A word on treating the forehead to enhance the brow…

Treating the frontalis can be extremely tricky as it has 2 main functions.

1) to depress the hairline

2) to raise the eyebrows

When treating the forehead, we must remember that the upper half performs the depressing action, while the lower half does the lifting. If you have a naturally small forehead or are a more mature patient, then caution must be used in this area as we can inadvertently cause the eyebrows to drop and look heavier.

We can also significantly affect the shape of the eyebrows if we do not plan our treatment to this area meticulously. This is where treatment planning for forehead injections comes in when attempting to lift the brows. Treating the frontalis will not just smooth forehead lines!

The diagram below outlines some of the considerations when treating this area. I would first start by assessing the shape of the eyebrow and where the natural arch should be. Then I use this to determine the area of the forehead that will be in action to cause elevation of this part of the brow – this area should be avoided with toxin treatment as it makes sense that if you relax this area, the elevating function of that muscle in that area will be counteracted by the toxin…i.e. it will cause depression of the brow here…which is the opposite of what we are trying to achieve!

We also want to avoid the area of the frontalis that raises the eyebrows – the blue hatched area below. The principle is the same, relaxation here causes depression of the brow, and again, is the opposite of the desired effect of treatment.

Another example: Crow’s feet and around the eyes

Muscles responsible: orbicularis oculi

MOA: when smiling the orbicularis oculi contracts pulling the lower eyelid upward and the upper eyelid downward and inward, this causes crow’s feet wrinkles to appear, starting from the outer corner of the eye. The eyebrow also moves downward slightly due to orbicularis oculi contraction.

This movement also often results in fine lines appearing in the tear trough area (as the skin here is much more delicate and thinner in comparison to the rest of the face).

The use of intradermal neurotoxin just under the eye, in the tear trough, results in a smoothing effect and helps diminish those fine lines we see here. Additionally, a micro-dosed toxin to the lateral orbicularis oculi (i.e. the portion of the muscle found at the outer part of the eye and the lateral eyebrow) prevents crow’s feet and gives the eyebrow tail a subtle lift. You’ll still maintain the ability to smile warmly, but the skin around the eyes will be softer and smoother.

My top tips:

Find yourself an injector who knows their anatomy and who will take their time assessing you and your face.

Discuss your concerns with your injector – they should be able to answer your questions and explain their reasoning behind their proposed treatment.

Don’t feel pressured into having a treatment there and then – you’re able to take some time and think about it and have the treatment on another day!

Any questions?

Find me on Instagram @drtranteraesthetics or send me a message via the contact form on my website! I love helping/giving advice and am happy to share any other tips!

Masters in Clinical Dermatology Dissertation. This PDF download is provided for personal use and is the intellectual property of Dr. Sarah Tranter  and Dr. Tranter Aesthetics. It cannot be copied or reproduced without permission.

The Efficacy and Safety of Topical Retinoids for preventing and reversing the effects of photoageing (pdf)

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