CLM Fall 2018

MIND, BODY & SOUL
Relax,Don’t Freeze It
TEXT BY DR. SUMMIT KUNDARIA
More is usually better. There are several examples to
prove this. Ice cream, peanut butter, and the number
of days in a weekend, to name a few. When it comes
to the face, however, moderation is almost always
the winner. One of the first places I see a downfall in
the “more is better” mentality is with the use of
Botox (or one of its cousins, Dysport and Xeomin).
Too many faces, whether at the mall, on television,
or runway, are moving too little, if at all. This needs
to change.
First, a little background. Botox, Dysport, and
Xeomin, are the most common plastic surgical procedure
done worldwide, and involve injected
medication that temporarily relaxes the muscles
they are injected into. The effects last for 3-6 months
in most people, and at the end of this time you
return to your pre-treated look.
The most common places to treat are the frown
lines (the vertical lines between the brows, or “the
11s”), forehead furrows (the horizontal lines across
the forehead), and the crow’s feet (the radial lines
emanating from the outer corners of the eyes).
Additional treatments can be of the “bunny lines” of
the nose, the vertical neck bands, and the jawline
slimming treatment of the massater muscles,
though the vast majority of use is in the upper third
of the face.
The natural history of the skin of the face is that it
starts out thick, rich in collagen and elastin, proteins
that give the skin volume and resilience. Inserted
into the skin are muscles to move the face, enabling
you to make expressions, such as raising your brow,
smiling, and squinting (though not necessarily all at
the same time). The muscles keep moving your face
as time passes, but the skin continues to thin over
time, losing collagen and elastin, and the thickness
of youth. The muscles eventually pull a line in the
skin, which is initially only present with motion, but
with time become etched lines, or wrinkles, that we
see in the mirror at rest.
Lines that are present only with motion (such as
the frown lines in a young face) can be treated before
they become etched into the skin. This treatment is
aimed at prevention. Lines that are already present
at rest can be treated so they are less deep at rest,
and to slow their progression.
The problem arises when faces are over treated,
and they “freeze”. They are not moving at rest, and
58 | CHARLOTTE LIVING
they also cannot move with effort. Why is this a
problem? Because our faces are made to convey
emotion. A mismatch in expressive motion of the
face between the upper half and lower half is perceived
as “strange” by an observer, even though they
may not be able to pinpoint why it feels so.
Being able to show emotion is an integral part of
non-verbal communication. Someone looks at us
with a happy face, and our face instinctively mirrors
that emotion. This is called emotional resonance.
This emotional resonance is interrupted when one
face is unable to express, as the communication loop
cannot be completed.
A study done in France in 2012 compared children
who used pacifiers during the daytime (impairing
their emotional resonance) with their counterparts
that had no pacifier use. They found that children
that had extended daytime pacifier use at a young
age showed decreased emotional engagement compared
to their peers even 5 and 18 years after
stopping pacifier use. There have been follow-up
studies to this as well, but this result alone showed
that emotional resonance is important in day to day
life. It’s easy to take these results too far, though you
can see how it may apply to communication
between adults.
I am not suggesting that using Botox to relax the
facial muscles is going to give us long term emotional
impairment, but I am also trying to convey
that it may have consequences. These effects may be
felt in your daily life as you communicate with your
peers and family, even if they seem invisible. That is
why I promote relaxation, not full paralysis, of the
facial muscles during cosmetic treatments. Having
less motion at rest, with the retained ability to move
with volition, is the goal of treatment, and should
preserve our nonverbal communication. Furthermore,
using less looks more natural and is lower in
cost, making it a win-win for all.
If you have questions or would like to know more,
contact Dr. Summit Kundaria at Nuance Facial Plastics,
704.593.6802 or email doctor@nuancefacialplastics.com.
To learn about the latest surgical and non-surgical
options, visit nuancefacialplastics.com.