Botox causes more wrinkles?

Photos: Above, “bunny lines” on the noses of actresses Renee Zellweger, left, and Nicole Kidman, right. (Getty Images photos) Below right, actress Kim Cattrall and her “bunny lines.” (Photo courtesy of Daily Mail.)

NEW WRINKLES FOR OLD

Botox injections in one part of the face can cause new facial wrinkles to appear elsewhere.

Local cosmetic doctors have seen it happen in their patients. It’s also visible on faces of celebrity Botox enthusiasts such as Renee Zellweger, Nicole Kidman (pictured above) and Kim Cattrall (pictured at right).

Here’s how it happens: After a Botox session, a patient tries to make a facial expression, but Botox-injected muscles can’t move. Nearby muscles contract instead, causing new wrinkles. The process is called “recruitment” of the nearby muscles.

“We have all seen muscles adjacent to site that we have treated being ‘recruited’ and causing an adjacent wrinkle,” said dermatologic surgeon Dr. David Sire of Fullerton. “Usually a small injection of Botox [into the newly contracting muscle] corrects this problem.”

Plastic surgeon Dr. Joseph Cruise of Newport Beach explained:

The human body is made to adapt. … When one muscle is injured, other muscles will quickly take over and assume the functions of that lost muscle. The same holds true for muscles that are paralyzed by Botox. Surrounding muscles will act more intensely to “pick up the slack”. This may cause new wrinkles to form in areas adjacent to the original wrinkle.

Dermatologist Dr. David Becker, an assistant professor at Weill Cornell Medical College in New York, described the phenomenon for the latest edition of Journal of Cosmetic Dermatology.  It’s a topic he has been discussing since at least 2003.

In the dermatology journal, Becker noted that Botox shots to eliminate wrinkles around the eyes can lead to “bunny line” wrinkles at the bridge of the nose. That’s a common look for Botoxed celebrities, such as those pictured above.

When that news broke, bloggers and tabloids had fun with headlines such as “Wait a minute—Botox actually GIVES you wrinkles?” and the inaccurate “Botox can actually make you look older.”

The same process can cause elevated “Joker” eyebrows, said plastic surgeon Dr. Val Lambros of Newport Beach:

The classic place where you see recruitment is in the forehead. When you inject … in the center of the forehead, the outer brow will try to compensate and elevate and you wind up with the Cruella de Vil eyebrow. [Pictured above at right.] It’s a classic post-injection look and is easily treated.

Those arched eyebrows have been prominent feature of Nicole Kidman (pictured below right), at least in the past. Her cosmetic doctor seems to have adopted improved injection techniques that avoid the arched look in recent years.

Sometimes what look like new wrinkles are merely old wrinkles that a patient didn’t notice until Botox smoothed away more prominent ones, said dermatologist Dr. Vince Afsahi of Tustin and Newport Beach.

In general, patients like what Botox does for them, said Dr. Christopher Zachary, chairman of the UCI Department of Dermatology.  But he added, “The use of botulinum toxin is an art, and not an exact science. Some patients do vary in their response.”

Join the conversation: Follow “In Your Face” on Twitter and Facebook for the latest information, discussions and gossip about cosmetic medicine, celebrities and regular people.