Month: September 2018

Is your Depressor Anguli Oris (DAO) muscle the reason for your ‘frowny face’?

Dr Harry Singh explains how we can relax this muscle with botulinum toxin to turn your smile from ‘upside down’ to ‘happy clown’!

Do people often ask you if ‘everything is alright?’, or tell you to ‘cheer up’? If so, then this could be a sign that you have a reverse or ‘upside down’ smile, such that the corners of your mouth, even when you are not moving your mouth or lips, have a tendency to point downwards, creating an uphappy look.

The cause of this downwards ‘tugging’ is an overactivity in one of the many muscles that we use to move our mouth so we can speak, eat and make facial expressions.

The muscle in question is called the Depressor Anguli Oris or DAO for short. The clue in its name is the word ‘depressor’, as this is the muscle that is responsible for lowering the corners of the lips and mouth, often used when we wish to express displeasure or repulsion. We have a DAO muscle on each side of the mouth. It is triangular-shaped with an anchor at the corner of the mouth and a flat side along the chin. If this muscle is too active, then it can start to tug down on the corner of the mouth even when we aren’t calling on its services to make faces. This repeated action can lead to the formation of marionette lines, as the overlying skin is constantly being pulled down by the overactive muscle. As we age, these lines will become more and more pronounced.

In another recent blog, I looked at treating deep marionette lines with dermal fillers. Marionette lines are the lines, folds or wrinkles which start from the corners of the mouth and head in a downwards direction, eventually reaching the chin. They get their name from the mouth shape of marionettes or ventrilloquist’s dummies.

If you try to do a sad face, you will be able to see and feel the constriction of the DAO muscle at the jawline and can see how strong it is at tugging down the corners of your mouth.

As well as treating deeper lines and wrinkles in this area with dermal fillers, such as the Restylane range which I use in my clinic in Stevenage, Hertfordshire, the DAO can also be relaxed with the use of botulinum toxin injections. This is a prescription only medicine and isn’t right for everyone, but after a face-to-face consultation with me, I will be able to diagnose if you have an overactive DAO and if injections with botulinum toxin, on its own, or with dermal fillers would be the most appropriate treatment for you. In my clinic, I like to use the Azzalure™ brand of botulinum toxin, other products include Botox®.

Treating the DAO and marionette lines in this way, in fact any injections of botulinum toxin in the lower face, i.e. below the usual areas of crow’s feet and frown lines, is very much an advanced technique and must be performed by someone with significant training and experience. I have been prescribing and performing wrinkle-relaxing treatments of this kind for over fifteen years. In the wrong hands, complications could arise through incorrect placement of the treatment in the muscles which could have an effect on the positioning of the mouth, lips and teeth, and even effect your ability to bite, chew, suck or talk. That’s why it’s important to see someone like me, with years of experience; plus as a dentist, I am very familiar with the anatomy of the mouth.

If you are fed up of everyone asking you to ‘smile’ or thinking that you’re miserable, then please call 01438 300111 to book an appointment to see me, Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

Everything you need to know about the signs of skin ageing

Dr Harry Singh is here to enlighten you on the changes in your skin as you age

Ageing, yes, I know it’s a dirty word and none of us want to think about, but like death and taxes, it is sadly unavoidable. The first signs of ageing will start to appear around your late 20s or early 30s, maybe not until your 40s, depending on luck and lifestyle. Luck in terms of your genetics – have a look at how well your mother and father are ageing – and lifestyle in terms of how good you are to your body – smoking, drinking, bad diet and sun exposure all lead to premature skin ageing.

Most us expect to see fine lines and wrinkles as we age, but there are other signs that show that your skin is not as youthful as it once was. When we are young, we have plump, smooth skin, but as we age skin becomes more dehydrated, dull, poor in texture and tone and everything starts to sag and lose volume. Other signs of skin ageing, and photo-damage caused by ultra-violet radiation from the sun, include pigmentation changes, often referred to as ‘age spots’, ‘sun spots’, or ‘liver spots’, which are like oversized freckles plus areas of dark patches or hyperpigmentation.

Fine lines and wrinkles will usually start to appear around the dynamically moved areas of the face and are most commonly noticed as crow’s feet around the eyes, noticeable when smiling. Other common early wrinkles are ‘eleven’ lines in between the eyebrows, caused by frowning. Reduction of lines and wrinkles, caused by dynamic movement, can be achieved with botulinum toxin injections such as Azzalure™ or Botox®. Deeper wrinkles can also be smoothed out or filled with the use of dermal filler injections, with hyaluronic acid-based gel products like Restylane®. Skin tone and texture can also be improved by stimulating new collagen production using treatments like medical-skin needling with Dermaroller.

Hyaluronic acid (HA) is an important component of the skin and an essential, natural moisturiser that we produce daily. HA helps our body to draw in moisture to our skin and it is this which gives it the plump, youthful appearance. In our youth, we produce HA in abundance, but as we age, production slows down and we simply don’t make as much HA as our body would like to keep skin at its optimum levels of hydration. A lack of adequate HA leads to lacklustre skin which is dry, rough, lacking in firmness and elasticity, as well as prone to sagging in places such as the jawline. Dark circles around the eyes may also become more apparent. Thankfully, hyaluronic acid can be put back into the face with products such as the Restylane® SkinBoosters which can be used to deliver small droplets of HA gel across the whole face using superficial or mesotherapy style injections to restore hydration. Regular maintenance treatments can make a real difference to the quality of your skin as moisturisation is returned.

As well as reduced levels of hyaluronic acid, skin can suffer from volume loss, both due to a loss of collagen and elastin structures as well as shrinkage of the fat compartments in the face, most noticeably in the cheeks. With gravity being the enemy, this loss of elasticity and skin firmness leads to a drooping of the tissues. Eyes may start to ‘bag’, the forehead and brows will lower leading to droopy upper eye lids, jowls will form in the lower face and naso-labial folds, or nose-to-mouth lines, will appear as the cheeks lose their volume.

But it’s not as terrible as it sounds, careful placement of dermal fillers and botulinum toxin can address many of these signs of ageing, and Silhouette Threads can also be used to lift tissue in a non-surgical thread lift. Alongside a good skincare regime, we can hold back the flood gates of ageing, as well as rejuvenate the skin to a more youthful appearance.

If you’re worried about the signs of facial ageing then why not arrange a consultation appointment with me, Dr. Harry Singh at Aesthetics in Stevenage, Hertfordshire and we can discuss which facial aesthetic treatments can help. Please call us on 01438 300111.