I booked in to see Dr Yusra to discuss a few concerns and shed some light on what it was that was making me look, and feel, so lacklustre. I felt that my complexion was dull and my face seemed to be changing (‘was this just age?’ was a question I had) and I didn’t feel my usual, vibrant self. Mostly I wanted some grounded, professional advice on how to combat this look, this feeling, of tiredness.
A bit of background: I’m 33, with pale skin from Irish parents that has had a fair amount of sun and exposure to harsh weather due to the work I do in sports and travel. I like to keep my skincare routine simple – it never really goes beyond two steps (cleanse and moisturise), despite sporadically attempting to do more. So far exercise and suncream (but, if I’m honest, only recently) have kept me on track. I dye my hair, I have a few tattoos, but I’ve always been dubious about the whole Botox thing. Perhaps it’s that stubborn, suspicious feeling that accompanies the unknown, or it’s more tied up in the politics of it all (a topic for another time…) but more recently, as I reach my mid thirties, I sit on the fence with it. More and more friends have (and admit to having) Botox. And suddenly I felt like a latecomer – (preventative Botox, another topic for another time…).
I finally got in to see Dr Yusra for an initial appointment at her Harley Street Clinic in winter last year; a busy doctor with several practices (Liverpool and London). During the intro meeting, we discussed my own conceived ‘problem’ areas and she patiently answered questions from me on random and wide ranging skincare and beauty topics. She put to bed a few concerns I have been baselessly, or preemptively, worrying about. We spoke a lot about lifestyle, and stress, and what I could do, holistically, to combat it. Regarding my complexion, she offered a few simple tips that would help a few minor concerns of mine (did you know you shouldn’t wash your face in the shower, as it’s often too hot?) and offered to send a personalised skincare plan with products to augment my daily routine (still two steps, with an option for an easy third). I ran past her that I’d noticed my jaw and face shape had changed in the last few years, and how it was becoming much more noticeable in the past six months. I have invested in a face roller that I keep in the fridge and roll along my eyebrows, temples and jawline for a really lightweight yet intensely felt massage. I hadn’t really put two and two together, that I might be feeling, generating or holding a lot of stress in my face.
I have a square-shaped face and my jaw has always been a defining feature. Except recently, it was dominating rather than definitive. What I had noticed was that it seemed to jut out as much as my cheek bones. Dr Yusra described it as hypertrophy of the masseter muscles, caused by grinding. I didn’t think I was a teeth grinder (but this was something that became very noticeable post treatment, but we’ll get to that). Jaw clenching, a side effect of stress or anxiety, can lead to headaches, migraines and fractures in the back teeth (and in turn, the need for very expensive dental treatment). Dr Yusra, previously a dentist, tactfully informed me of all this, emphasising the likely soon-to-follow issue of tooth cracks. She confirmed Bruxism as a parafunctional habit. From an aesthetic, frontal view assessment, the distance between the jaw at its edges – the bygonal width – was becoming slightly wider than the zygomatic width – the distance from cheekbone to cheekbone. The excessive muscle activity from grinding or clenching, was causing, as with any muscle, bulking. She suggested Botox in the masseter muscle.
The beauty of this procedure is, I learn, that the overworking muscles are trained to relax. The more you continue to train the muscle, the more it atrophies. It helps reduce bad habits, and the muscle shrinks. As the Botox wears off, the muscle is smaller and weaker, and cannot cause as much damage. Aesthetically, it produces a slimming of the face and a sharper, less square jaw. Dr Yusra also advised a quality dentist guard. Not only would this protect my teeth from cracking but it would train my jaw out of grinding, or clenching in my case.
Appointment Two, the treatment: Botox in the masseter, 30 units per side
A few months later and I’m back with Dr Yusra, ready for treatment. I had done some research and brought some more questions about Botox, some founded and some plain silly, which she handled sensitively. I felt very assured. Quick, painless and over in minutes. Dr Yusra asked me to clench and relax as she marked up the muscle area along my jaw. It seemed straightforward enough, with the muscle mass jumping out proud as I clenched. Three injections points to each side, one centimetre behind the anterior points of muscle, and I was done. I was warned not to lie flat for four hours or do any strenuous exercise that day, and that was it. For the next week, the only signs were tiny marks where the needle pierced. Over the following weeks, when the Botox was kicking in, I had curious, dull aches in my jaw; Once, when eating a particularly crusty baguette, and often at random times, which, I soon discovered, was clenching. Or trying to. My muscles were trying to work against the elixir forcing them to relax. This subtle side effect actually allowed me to take stock and realise when I was stressed. It takes a real, conscious effort to disengage my jaw, to learn how to relax my face (I wonder what other effects this is having on my face (surely wrinkles!) and body and health?).
It’s about five months since I had the treatment with Dr Yusra. I can tell the Botox is wearing off, with the clenching returning, subtly, slowly. It’s almost satisfying to notice this return, proving that the clenching that I was initially unaware of is definitely there. The muscle is building back up – I can feel the small knotty muscle, especially on one side – and I am getting a faint ache return as the weakened muscle builds.
Aesthetically, I noticed a big difference. Although subtle, which is exactly what I wanted and why Dr Yusra started with 30 units per side for my first use, it made an impact. My jawline is slimmed down and sharper, like my younger self (without the stress). My face feels more angular, and I’m running with the look with slicked back hair and contouring makeup, which is fun.
The months before treatment, I was having one of those phases where you can’t get along with any makeup, hair, clothes, that made me feel chic. I’m sure most people didn’t notice any physical difference, but I certainly did, as did an eagle-eyed sister and another friend who said that 33 was suiting me. For someone who has always been very expressive with their face and confident, I was certainly starting to feel less like myself. I felt like I had the chubby cheeks back from my teenage years and I was clearly carrying around a bit of stress. Luckily, I didn’t get any cheek drooping – one possibility after masseter Botox. Or, as far as I can tell. I’ll check in with Dr Yusra when I go in (stat!) for more. But I’m 100% happy.
Whether it’s to do with the injectables, or the prescribed products, there’s one other notable thing to feed back: I used to get incredibly painful spots along and under my jaw. These under-the-skin spots would stick around for weeks. They’d appear every month, perhaps every other month, after a big night or a sleepless week. Perhaps I was using products that were too strong or badly suited. Very likely linked to hormones, I wonder also if these were brought on by clenching, and the localised stress in my jaw. Because I haven’t had one since. The relief from these spots is huge. Generally my skin has been noticeably better over the past four or five months – these products really are working for me, so I am incredibly grateful to Dr Yusra for prescribing those that really suit my complexion and fit my simple skincare routine.
Nearly six months on, I have re-bought the face moisturiser – why mess with a system that’s working so well? The Obagi face wash is still going strong so I’m convinced it’s worth spending a little more on something that goes much further. I should probably at this point have used up the face factor 50 spf – which is in no way thick, sticky or claggy like lots of high SPF – so I note I need to use it more. Every day. Top up every two hours, come rain or shine. I think I’ll also try a powdered form of suncream this winter that was recommended by Dr Yusra to put over makeup as a top up.
Personalised Skincare Plan
My favourites are from the Obagi Medical range. Obagi offers prescription-strength products, but not all in the range are prescription, though the initial programme should be supervised by a physician. The Obagi gentle cleanser, designed for dry and sensitive skin types: A soap-free, scent-free, wet-use cleanser for every day that doesn’t alter the pH of the skin and cause irritation. (£50, 200ml). The Obagi Hydrate moisturiser is a gamechanger, butter-like in texture but not too oily. Containing Hydromanil, a technologically advanced ingredient which retains water, it gradually delivers moisture to the skin. It looks simple and medical-like in its packaging, but is superlux to use. (£55, 48g). The Intensive Daily Repair from the SUZANOBAGIMD skincare collection was a new kind of product for me, and Dr Yusra’s recommended extra third step to my usual efforts. Applied after moisturiser and before sun cream, it’s a hydrating and rejuvenating daily lotion containing polyhydroxy acids (PHAs) that gently exfoliate dull, old skin cells to improve skin clarity, texture and the visible signs of skin ageing, as well as pores. The non-irritating, non-sensitizing formula contains antioxidant vitamins C and E. (£85, 60g). Colorescience sunscreen, Sunforgettable Total Protection Face Shield (SPF 50) tint is a non-chemical, broad-spectrum sunscreen to shield skin from harmful rays. The neutral, universal shade blends with all skin tones, leaving no white traces. (£35, 55ml). Heliocare’s 360º Invisible Spray SPF50 is a light sunscreen spray that positions itself as non-oily, but that I found quite oily. I used it on my face one – an accident – to top up but it got in my eyes and I suffered for the rest of the day. I used it on my neck and chest through summer, but it’s quite oily, even for here. I found it best for shoulders and arms. Bonus is, it can be applied on wet skin. And despite the oily texture, I didn’t break out at all from it, so it’s good for sensitive skin. (£29, 200ml).
Treatment Time 5-10 mins
Results in 14 days
Results duration Approx 3-6 months
Pain None to minimal discomfort
Price Dr Yusra at the Harley Street London clinic, prices for migraine treatment (Botox in masseter) range from £200 – £500.