The Joe Biden Botox Debate

The New York Post ran an article today bringing to light what many people have curiously asked me about lately...Has Joe Biden had Botox? Now, the cosmetic surgeon who is quoted in the article gets scolded by one of Biden's reps (freedom of speech??), so let me put this in generalities.

If you inject Botox (and therefore paralyze) the frontalis muscle of the forehead, although it may make it smoother in appearance, the recipient will not be able to make much of an expression or furrow his or her forehead, and may not be able to elevate their brows much if any. Since the frontalis muscle is one of the only and strongest elevators of the brow, when it is knocked out by Botox, the brows descend and actually look low, which can lead to upper lid hooding in people who are in their 50's and 60's. This often causes a more aged appearance around the eyes than was intended. I generally avoid paralyzing the whole frontalis in older patients for just that reason. In patients in their 20's and 30's it doesn't make that big of a difference since they inherently have less or no brow ptosis, so this is the demographic that usually looks best with frontalis (forehead) paralysis.

In general, newscasters and other people who speak in front of the camera may look even more "done" when they've had their forehead Botoxed because of the hi-def, bright lights, heavy makeup, and the fact that we're used to seeing talking heads really express themselves into that 2-dimensional tube. When they can't raise their brows very high or their forehead is frozen something just doesn't look right.

Alternatively, if the smaller muscles between the brows are injected (the corrugators and depressor supercilii, which are the primary brow depressors), then their paralysis leads to medial brow elevation. I usually inject these muscles and the lateral orbicularis oculi (colloquially known as the crow's feet) in older individuals to get a brow elevation, or lift (which they usually need), and avoid knocking out the whole forehead muscle which can cause worsening of brow ptosis or droop. I'm just going to put these pictures (Before/2006 on the left, After/2008 on the right) up so that you can draw your own conclusions from the NY Post article.

Scientific Reference: Walden JL, et al. Plastic and Reconstructive Surgery Journal
An Anatomical Comparison of Transpalpebral, Endoscopic, and Coronal Approaches to Demonstrate Exposure and Extent of Brow Depressor Muscle Resection.