WHAT ARE BOTULINUM TOXIN INJECTIONS?

Botulinum toxin is produced by the bacteria Clostridium botulinum. It has been used for decades for medical purposes in the treatment of various diseases associated with muscle spasms eg. cerebral palsy.Since 2002 botulinum toxin has been approved for use within the cosmetic industry. The brand Botox® is the original product produced by Allergan but there are other brand names such as Azzalure, Dysport, Vistabel and Xeomin which all contain the same active ingredient Botulinum toxin type A.

Botulinum toxin injections are a prescription medicine that can help to rejuvenate the ageing face by reducing the appearance of wrinkles and making skin appear younger and smoother.

HOW DOES BOTULINUM TOXIN WORK?

Botulinum toxin temporarily blocks signals from the nerves to the muscles. When injected into the facial muscles it temporarily relaxes the muscles resulting in the softening of wrinkles.

Botulinum toxin injections are most often used on forehead lines, crow's feet (lines around the eye), and frown lines. The injections will not diminish wrinkles resulting from sun exposure. In these circumstances other treatments to improve the quality of the skin may be of benefit eg. chemical peels.

WHAT AREAS CAN BE TREATED?

Wrinkles can be identified in two ways: expressive or static. Dynamic or expressive lines are caused by the repeated movement and contraction over the years every time you express emotion such as laughing, smiling or frowning. Wrinkles such as frown lines and crow’s feet (laughter lines) fit into this category.

Static lines are those which are visible all the time even when the face is relaxed eg. the deep lines that run from your nose to mouth or from the corners of your mouth downwards. In these cases you may be advised that dermal fillers would be more suitable for you. Please read the section on ‘Dermal Fillers’.

As anti-wrinkle injections work by temporarily relaxing the movement of specific facial muscles, it is most commonly used to treat wrinkles in the upper face.

Wrinkle relaxing section picture

The main areas that may benefit from an anti wrinkle injection are as follows:

Glabella – frown lines

The Glabella is the area between your brows. Over time, some may find that there is a deep line that becomes quite prominent. The use of botulinum toxin can not only relax the muscle to stop you overworking that area, it can also reduce the appearance of that static groove.

Forehead – horizontal line

The forehead is an area that we tend to get both expressive and static lines. The use of botulinum toxin relaxes the area to stop over-expression.

Crows Feet

Crow’s feet or laughter lines appear around the eye, classically starting at the outer corner of the eye. Many people associate them with age, as they tend to deepen and expand with age and some people consider them to be an undesirable trait.

Brow Lift

A brow lift works by relaxing specific muscles around the delicate eye area, and smoothing away worry lines and deep grooves caused by frowning along the lower forehead. When the right muscles around the eyebrows are relaxed, the skin appears smoother, more toned and the brows are lifted. This injection area may be particularly effective for people who have naturally-drooping eyelids and low-hanging eyebrows. The brow lift literally ‘lifts’ the skin tissues above and around the eyebrows so that the natural eyebrow arch is a few millimeters higher.

THE PROCEDURE

Typically botulinum toxin treatment involves giving 5-8 small injections per area to be treated. A very fine needle is used so most patients experience only a minor level of discomfort but it is brief and the overall treatment time is usually around 10-15 minutes making it great to fit in around your life.

HOW LONG WILL THE EFFECTS LAST FOR?

It usually takes between 3-7 days for the injections to take effect and the full effect should be visible after 2 weeks at which point it is advisable that you have a follow up appointment to assess the success of the treatment. Any improvements or corrections needed would usually be done at this visit.

The effects of the injections usually last between 3 and 6 months after which point you may wish to return for a further treatment. With repeated treatments it is possible that the effects of the injections can last longer resulting in less frequent injections.  

PRE-TREATMENT GUIDELINES

  • The following measures can reduce the risk of bruising:
    • Avoid alcohol at least 24 hours prior to treatment
    • Stop aspirin* and non-steroidal anti-inflammatory tablets for 10 days prior to treatment
    • Avoid vitamin E for 2 days before your treatment
    • Avoid Gingko Biloba and St. John’s Wort ideally for 1 week prior to your treatment

* if you are prescribed aspirin for a medical condition then do not stop unless permitted by your doctor

  • Schedule your appointment at least 2 weeks before an important occasion or special event to allow any localized bruising to subside.
  • Please remove make-up before you have your treatment
  • Ice packs can be placed on the area to be injected just prior to injection. This may help decrease the pain of injection (which is minimal) and decrease the incidence of bruising.

POST TREATMENT GUIDELINES

  • You can resume normal activities straight after the procedure
  • Exercise the injected muscles for 1 hour after the treatment
  • Avoid straining, heavy lifting or vigorous exercise for 3-4 hours following treatment.
  • Do not bend over or lie down for 3-4 hours following treatment.
  • Avoid alcohol for 2 days after treatment.
  • Avoid extremes of heat for the first 2 days after treatment – saunas, steam rooms or excess sun exposure.
  • Avoid squeezing or massaging the area for 12 hours afterwards as this could subtly change the results.
  • Avoid other facial treatments for 2 weeks after having botulinum toxin injections.

WHAT ARE THE SIDE EFFECTS OF BOTULINUM TOXIN INJECTIONS?

There have been no reports of permanent damage caused by botulinum toxin injections. Since the effects of the injection are temporary so too are any side-effects that may occur.

The most common side-effects include:

  • Mild discomfort and local swelling which usually subsides within 48 hours
  • Bruising - follow the pre-treatment instructions to minimise this risk
  • Headaches may occur for a few hours. Paracetamol will help but avoid anti-inflammatory drugs or aspirin as these may increase bruising
  • Ptosis (eyelid drooping) - is the most significant complication (less than 1%). This is caused by the botulinum toxin tracking into the upper eyelid muscle therefore to reduce this risk do not rub the area for 12 hours after the treatment. It generally starts after 5-7 days and lasts just a few weeks. Eye drops can be prescribed to lessen this effect if this side-effect is troublesome.

WHO SHOULD AVOID HAVING BOTOX?

  • Pregnant women or breast feeding mothers
  • Patients with certain conditions affecting the connections between nerves and muscles (such as Myasthenia Gravis and Eaton-Lambert Syndrome)
  • People with a previous allergic reaction to botulinum toxin, or with allergies to egg or human albumin
  • People taking the following medications: aminoglycoside antibiotics such as gentamicin, penicillamine, and calcium channel blockers
  • Anyone with a skin infection in the area to be treated
  • Caution should be exercised in any patients taking blood-thinning medication such as Warfarin (anti-coagulant) and Clopidogrel (anti-platelet) due to the possibility of severe bruising