The aesthetic industry has witnessed a significant shift in patient preferences over recent years. More clients are arriving at consultations with photos of celebrities like Natalie Portman, requesting that natural, “refreshed” look rather than dramatic transformations. After her divorce from Benjamin Millepied, Natalie Portman has been fully embracing the change (and rocking so many chic looks)! Her recent public appearances have sparked conversations among cosmetic injectors about achieving subtle, elegant results.
Understanding the “Refreshed” Aesthetic
The modern approach to facial aesthetics has evolved considerably from the overfilled looks of the past. Today’s patients seek treatments that leave them looking well-rested and naturally youthful—not “done.” Key hallmarks of facial aging include loss of facial volume and descent of facial structures. Volume loss occurs within the subcutaneous fat compartments of the face, leading to a deflated appearance.
When patients bring in celebrity reference photos, they’re typically requesting treatments that address dynamic wrinkles while preserving natural facial movement and expression. Botulinum toxin injection is the most commonly performed cosmetic procedure in the world. While it has many areas of application, it is frequently used to manage and treat rhytids in the aging upper face.
The Upper Face: Primary Treatment Zone
The upper third of the face remains the most requested treatment area for patients seeking a refreshed appearance. Botulinum toxin was first approved by the U.S. Food and Drug Administration (FDA) for cosmetic use in 2002 as Botox to treat glabellar complex muscles that form frown lines and in 2013 to treat lateral orbicularis oculi muscles that form crow’s feet. It has become the treatment of choice for wrinkles occurring in the upper one-third of the face (i.e., frown lines, horizontal forehead lines, and crow’s feet).
Common upper-face concerns include:
- Forehead lines (horizontal rhytids)
- Glabellar lines (the “11s” between the brows)
- Crow’s feet (periorbital lines)
- Brow positioning and asymmetry
Botox only works on wrinkles that occur due to muscle movement. These are known as dynamic wrinkles and are often called “expression lines.” The most common dynamic wrinkles that Botox can treat are lines on the upper face, such as the “11” between the brows, horizontal lines on the forehead, and crow’s feet around the eyes.
FDA-Approved Products and Safety Considerations
Patient safety must always remain the primary concern for any cosmetic injector. There are several FDA-approved botulinum toxin products, such as Botox, which are only available with a prescription from a licensed health care professional. Patients should ensure they only receive these products from a provider who is licensed and trained to administer such injections.
The FDA’s official page on dermal fillers provides essential information for both practitioners and patients. FDA approval is based on the review of data collected from controlled clinical studies that evaluated the safe and effective use of the wrinkle fillers when injected into specified areas of facial tissue.
There are (4) Botulinum Toxin-A injectable products with Aesthetic FDA Approvals. The FDA Approvals vary based upon manufacturer but they are used in a similar fashion for a number of facial dynamic wrinkle applications.
For additional safety information, practitioners should review resources from the National Institutes of Health (NIH), which provides comprehensive clinical guidelines on botulinum toxin treatment of the upper face.
The Importance of Customized Treatment Protocols
Every patient presents with unique anatomy, and a one-size-fits-all approach rarely produces optimal results. Patients differ enormously in their facial anatomy regarding structure and function, both within and between genders, ethnicities, and age. Therefore, treating all patients with the same injection pattern and the same doses can result in undesired outcomes. There is a need for a tailored approach to achieve optimal results, as well as to increase patient satisfaction.
The shape and position of the eyebrows are key elements of upper facial beauty and are determining factors in the expression of emotion, masculinity, femininity, personality, and state of mind. Achieving celebrity-inspired results requires careful assessment and personalized treatment planning.
Injection Technique and Anatomical Knowledge
Success in cosmetic injections depends heavily on anatomical expertise. To inject facial fillers correctly, it is paramount to understand the appropriate injection depth. Knowledge of facial fat compartments is also important when performing facial filler injections.
In the upper face, there are five forehead and temporal fat compartments. Understanding these compartments helps injectors achieve natural-looking results while minimizing complications.
For forehead treatments specifically, the avascular subgaleal plane may be accessed with needle at 45 degrees to bone. Proper technique is essential for patient safety.
Patient Consultation: Setting Realistic Expectations
When patients arrive requesting a celebrity-inspired look, clear communication becomes essential. When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure. Non-surgical filler treatment is still a medical procedure that requires specific training, knowledge and skill to ensure safe treatment and natural-looking results.
During consultations, injectors should:
- Review the patient’s medical history thoroughly
- Discuss realistic expectations
- Explain treatment options and potential outcomes
- Review FDA-approved product options
- Obtain informed consent
Avoiding Common Pitfalls
Achieving subtle, refreshed results requires restraint and precision. Over-treatment can lead to an unnatural appearance that contradicts patient goals. It is important to note that not all points in the inferior limit line are typically injected, and where injection is necessary, the dose should typically range between 0.5 U and 1 U per injection site in females, to minimize the risk of brow ptosis.
“The most common risk is bruising, but there can occasionally be asymmetry and, in the worst case, eye ptosis [upper eyelid drooping]. But these are extremely rare in the hands of experienced injectors.”
The Role of Hyaluronic Acid Fillers
For patients requiring volume restoration in addition to neurotoxin treatment, hyaluronic acid fillers tend to be the most temporary option, and therefore are often recommended for first-time filler patients.
Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect.
Ongoing Training and Professional Development
The aesthetic field continues to evolve rapidly. For injectors looking to refine their techniques, resources from CosmeticInjectors.org provide valuable continuing education opportunities and industry updates.
Various products and injection techniques can be tailored to each individual patient to achieve ideal results. A detailed knowledge of facial anatomy is required to properly treat patients and to manage complications.
Conclusion
The desire for natural, refreshed appearances—inspired by celebrities like Natalie Portman—represents the current gold standard in aesthetic medicine. Successful outcomes require comprehensive anatomical knowledge, skilled technique, appropriate product selection, and clear patient communication.
Botox (and its counterparts, Dysport and Xeomin) has been used in the treatment of facial wrinkles since the 1980s and 1990s—although it was only approved in 2002 for cosmetic use. We have therefore been watching the effects and risks of this potent and effective treatment for over 30 years now. There are also few other medications that have been studied quite as much as Botox for both cosmetic and non-cosmetic uses.
By staying current with FDA guidelines, pursuing ongoing education, and prioritizing patient safety, cosmetic injectors can consistently deliver the subtle, elegant results that today’s patients desire.