Last weekend (10 days ago) I went to my medical school 25th year class reunion at the University of Wisconsin Medical School in Madison, Wisconsin. I had been so driven in my surgical residency, then marriage, then being on the faculty at Yale, that wonderful memories had been buried deep. This was the first time I set foot in Madison in over 25 years! Walking around campus was like a magical mystery tour where every spot my eyes landed on brought memories to life. With the benefit of time, even bad memories felt great. Madison is a beautiful town and the people are great.
At the alumni dinner the main topics of conversation were our kids, where they were going to college, etc. I found myself seated next to a colleague with whom I had had very little interaction during the Med School years. She gets Botox and Restylane done regularly by a dermatologist friend, for free. She asked me how she looked. Now this is a loaded question as every married man knows. There is only one answer to be uttered out loud and it is “You look great.” The Plastic Surgery answer is not so simple.
A face that has wrinkles “smoothed out” by Botox injections tends to look flat and featureless because botox weakens the muscles of facial expression. There is a big difference between a “smooth” forehead with diminished brow motion (Botox) and a more “open” forehead with brows moving normally (endoscopic Brow lift). Patients will often choose Botox because of money concerns, fear of surgery, or downtime, but the overall result is so much better with an endoscopic brow lift. The reason is that Botox will give you a smooth forehead, but the Brow lift will give you a younger upper face with a very long lasting result.
If you find yourself getting Botox injections for forehead wrinkles regularly, ask your dermatologist or surgeon about the risks and benefits of an endoscopic forehead lift. So coming back to my classmate, when she asked me what surgery I would recommend, I told her to consider a Brow lift, since she would probably no longer need Botox afterwards. And no, she didn’t ask me if I could do it for free.