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Upper Facial Lines : The Dynamic Versus Static Lines
The external signs of aging vary widely among individuals . Major determinants of facial aging are genetics , smoking , sun exposure and muscle activity . As the skin ages and the support of the underlying structures is lost , more wrinkles and folds will develop . The orientation and depth of these folds and lines are greatly influenced by underlying muscle activity . Both fixed structures and the slowly changing structures together contribute to the physical features of an individual . With aging , upper facial lines appear and develop progressively . These result in part from repeated contracture of underlying musculature and are among the most visible signs of aging .
Contraction of facial muscles causes facial movement and also creates transient wrinkles and furrows perpendicular to the direction of muscle contraction . When facial lines form only with muscle contraction , they are called dynamic facial lines . Frequent formation of dynamic facial lines can lead to the creation of facial lines even without muscle contraction , or static facial lines .
The interpretation of facial expressions is an integral component of interpersonal communication . It is primarily universal and constant across time and cultures . An individual with the brows depressed , furrows between the brows , lines on the forehead and a downward turning mouth is universally interpreted to be angry or displeased . However , when these lines become permanent , their presence in the face at repose incorrectly signals an emotion that is not felt . These facial miscues create a mismatch between an individual ’ s emotion and the societal interpretation of the implied facial expression , which can lead to miscommunication . For individuals with facial lines that transmit facial miscues , the inability to convey accurately their emotions with their facial expression may be equally frustrating . �or example , an ingrained glabellar crease alone on the face may incorrectly be interpreted as signalling anger , anxiety or irritation . For some individuals , the negative impact of their facial
lines will drive them to seek treatment , frequently with minimally invasive procedures . In my practice , I often find this to be a common motivation for patients dropping in for a visit .
Treatment of the upper face lines are very individualised and there is no one single rule or code that fits everyone . Personalised assessment of the experienced eyes on the muscle bulk and hyperactivity , positioning of the transverse forehead lines height from the orbital rim and its depth , eyebrow height and positioning , upper eyelid droop , double eyelid positioning , downward turn of the lateral canthus and the association of the muscle activity with the formation of the lines are of paramount importance when it comes to treating upper face lines .
�se of neuromodulator injections continue to be the most popular procedure mainly for the dynamic lines however when it comes to the management of the static lines with dermal fillers in the forehead region which is always perceived as dangerous zone in view of vascular occlusion incidences , choosing the right product and staying in the safe depth of the skin determines the outcome of the results . In Figure 1 , this very expressive beautiful lady was treated with Xeomin� ( incobotulinum toxin A ) and Belotero� Soft ( hyaluronic acid dermal filler ) by Mer� Aesthetics ( �anguard Aesthetics ) and the results achieved were two ( 2 ) weeks post procedure .
Dr Usha Hoh is the CEO , Senior Medical Director of MX Clinic and APAC Trainer & International Speaker for Merz Aesthetics in Malaysia .
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