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    On point with off-label Botox


    Reasons to Smile

    For fine lip lines, Dr. Lickstein says he might use Botox as an adjunct to such treatments as laser resurfacing and fillers. Botox, he says, can weaken some of the fibers of the orbicularis muscle, just at the vermillion border, to further reduce those fine lines.

    Patient shown before and after botulinum toxin type A to treat a gummy smile. Photos courtesy Dr. Larry Lickstein.“In small doses (8 to 10 units total), this result can be achieved without impacting lip movement,” Dr. Lickstein says.

    Botox can also weaken the depressor angularis oris, which pulls down the corners of the mouth, according to Dr. Lickstein.

    Dr. KaplanSan Francisco-based plastic surgeon Jonathan Kaplan M.D., MPH, says he uses Botox to treat that downturn of the lip corners.

    “I … place it on either side of the chin to allow the corners of the mouth to go up (turning that frown upside down),” Dr. Kaplan says.

    Dr. Kaplan also uses it for sweaty palms, as he demonstates in this YouTube video.

    And to address the gummy smile, physicians like Dr. Lickstein use Botox to weaken lip elevators and soften smiles that show the gums above the upper dentition.

    Antiaging specialist Lionel Dr. Bissoon, D.O., who practices in New York, N.Y., says he also uses Botox for gummy smiles.

    “… we'll inject one to two units of Botox into the upper lip muscles and below the nose to relax and weaken the muscles, which then lowers the upper lip down the teeth for a normal, gum-free smile,” Dr. Bissoon says.

    No Sweat

    Cosmetic surgeons are among the providers using botulinum toxin type A to treat hyperhidrosis.

    Again, it’s not something Dr. Torkian says he pursues, but he’ll do it when patients ask and are candidates for treatment.

    “Every year, around this time of year, before summer, I’ll do about a handful of armpit injections. I don’t do many hands or soles of the feet because they tend to me more painful. The armpit can be tolerated very easily,” Dr. Torkian says.

    NEXT: Wound Healing

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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