Fashion & Beauty

Trying Times

August 21, 2022



Can’t get enough Valerie Monroe? There’s more at

By Valerie Monroe

For nearly 16 years Valerie Monroe was the beauty director at O, The Oprah Magazine, where she wrote the popular “Ask Val” column.

If you’re interested in feeling happier about your appearance—especially as you age—you might like reading what she has to say about it. For more of her philosophical and practical advice, subscribe for free to How Not to F*ck Up Your Face at

I GOT WAYLAID this week; I started out writing in one direction and wound up, for various reasons, trying another . . . and then another. And so I started thinking about persistence. You know, “Try, try again.”

And maybe when to stop trying . . .

“Ask Val” answers your urgent questions.

Yes, you, way in the back with the deeply knit brows. Confused about something?

Q: I would shell out 401(k) funds for neurotoxin injections if they worked, but the last couple of times I got them for the “elevens” (those vertical lines between the eyes), the effects lasted for two weeks—then less than two weeks, then not at all. When I talked to a dermatologist about this, she promised her injections would work . . . but they didn’t, so she gave me a free booster—and still I had deep vertical scores. I’m currently sleeping with a mouthguard and foot contraptions for plantar fasciitis, so adding strips of tape to my face would be too much. Should I keep trying neurotoxin?

A: We seem to be on a detour here at How Not to F*ck Up Your Face, diverted to a side road where the scenery is all about sticking needles between your eyes. So let’s be clear: A lifetime of neurotoxin injections to mitigate wrinkles isn’t and never was our final destination (if we have one). But sometimes the Zeitgeist, like a collective unconscious Waze, suggests an unexpected rerouting. And here we are on Botox Boulevard.

First, those strips of tape our confused reader mentions don’t work to eliminate wrinkles. I guess if you started using them when you were around 5, and wore them day and night your whole life, they might prevent your forehead muscles from contracting. On a similar note, I once tried tape that you hide under your hair to pull back the skin; you can read my thoughts on that letdown here.

Now, a humbling admission. Though I count a number of dermatologists and plastic surgeons as friends—from whom I’ve gathered a mountain of information—it would be unwise to rely solely on my advice when asking about a medical issue. Why? Because, not actually having gone to medical school, I can be wrong. Which was recently emphasized to me when I suggested to the reader above in a personal email that I thought her “elevens” were probably too deep for neurotoxin and might require filler.

When I wrote to facial plastic surgeon Michelle Yagoda to confirm my diagnosis, she quickly corrected me. “To decrease facial lines created by movement—like the ‘elevens’—they must be treated with a neurotoxin to stop the movement,” Yagoda says. “Patients who complain about persistent ‘elevens’ often haven’t been treated adequately, meaning their corrugator muscles (the two triangular facial muscles between the eyebrows) are still able to move. Additional neurotoxin is needed until the corrugators are immobilized.

“It’s common for these muscles to remain mobile after the first treatment,” says Yagoda. “When they’re fully relaxed—after a second treatment—the ‘elevens’ should disappear.” She adds, though, “As the aging process progresses, sometimes more neurotoxin—or a different type—is needed to achieve results. And in rare cases, people can become ‘immune’ to a neurotoxin.”

Keep in mind that a treatment typically takes up to to five days before it’s effective, and the time between the two treatments should be around three to five months, or when the results begin to subside (which could be as long as four to six months).

“If after two treatments resulting in full muscle relaxation the lines remain,” says Yagoda, “then a small amount of superficially placed filler can be added. BUT filler is not a good idea when there’s any mobility whatsoever in a corrugator muscle, because with muscle movement the filler can clump and cause a bulge that’s visible long after the filler disappears.”


So: Rerouted, we wind up in a cul-de-sac. One last shot (or several last shots) at reducing your “elevens” and then continuing maintenance indefinitely as the neurotoxin wears off? On a scale of one to . . . eleven, how much do the lines bother you? If you lose them, will you feel happier? Would you consider a combination of other treatments (microneedling, laser, surgery) to address the issue?

The good news is there are options. The more complicated good news: You have to choose which one, if any, is worth a try. For me, the likelihood of pursuing a particular aesthetic goal declines the more steps required to reach it. Evidently, there’s a cap on the amount of energy (and $$$) I’m willing to expend in this arena. Try again? Maybe. Try, try, and try again? I doubt it. Because sometimes letting go is the most expeditious route to happiness.

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