Wrinkles Injections treatments (Botulinum A Toxin)

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Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium botulinum. There are currently three different types of botulinum toxin commercially available in the United Kingdom: Type A toxin: Botox (Vistabel), Dysport (Azzalure) and Xeomin (Bocouture) and Type B toxin: Neurobloc.

Botulinum toxin can be used to treat all wrinkles which are the result of normal facial movement. When it is injected into a specific muscle in the face it blocks the signal from the nerve to the muscle. This means that the nerve ending cannot tell the muscle to move, hence there will be less wrinkling of the skin in the areas treated. The upper third of the face is where the best treatment results are obtained, commonly for the reduction in crow’s feet around the eyes and wrinkles on the forehead and between the eyebrows. Depending on the area treated, dose used, and how you respond, repeat treatments will be required around every 3 – 6 months.

Our facial expressions change because the muscles in the face contract or relax. This is caused by the brain sending a signal via our nerve endings that we want to, for example, frown or laugh. When botulinum toxin is injected into a specific muscle it blocks the signal from the nerve to the muscles in the face. This means that the nerve ending cannot tell the muscle to move. This is not a permanent condition, however, but it will last for around 3 – 4 months.

After botulinum toxin injections, your skin around the area which has been treated will look smooth and less wrinkled; but do not worry, the rest of your face will not be affected. Botulinum toxin allows the untreated areas of your face to move as normal and you will still be able to laugh, smile and frown, but with less wrinkling of the skin in the areas treated.

After a while, most patients will notice that the lines and wrinkles around their treated areas will continue to become less deep and pronounced. This is a result of the botulinum toxin as the new skin has a chance to grow without being repeatedly creased. Hence, it appears to be smoother on the surface because it has not been creased by constant muscle activity.

Botulinum toxin can be used to treat all wrinkles which are the result of normal facial movement. It inot suitable for permanent wrinkles caused by excessive exposure to the sun.

Botulinum toxin does not remove wrinkles indefinitely; it is usually necessary to have a treatment every 3 – 4 months to maintain and improve upon the original results. It has been proven to be quite safe to have botulinum toxin injections at the above frequency over a period of years.

The upper third of the face is where the best treatment results are obtained, commonly for reduction in the appearance of crow’s feet around the eyes, and frown lines and wrinkles on the forehead and between the eyebrows.

Experienced practitioners as Dr Molina can use botulinum toxin to reduce the appearance of fine lines underneath the eyes as long as the skin is not too loose in this area before the treatment. This procedure often leaves the patient with a slightly wider open – eyed look.

Botulinum toxin can also be used to reposition or lift the eyebrows by a few millimetres. This is sometimes called a “chemical brow lift”. It can lessen so-called “bunny lines” (lines along the top of the nose caused when some people smile.) More seriously, it can help people who have suffered facial trauma or Bell’s palsy. In these cases, the face can take on a “lop-sided” look, and botulinum toxin can help to correct this distressing condition.

Experienced injectors as Dr Molina may also treat fine vertical lines in the lip area and around the corners of the mouth. Usually in these cases, an injection of botulinum toxin would be accompanied by a dermal filler. This literally fills up some of the deeper wrinkles.

A dimply chin caused by the underlying muscle that occurs in some people can also be softened as can “necklace lines” or horizontal lines around the neck.

“Platysmal bands” – bands of muscle that stand out from the neck and make the neck look stringy in appearance can also be softened with botulinum toxin.

Preparing for treatment

This treatment is simple, quick and safe. You can resume your normal activities immediately after the procedure. Many people have their treatments in their lunch-time, for example, and return to work straight afterwards.

We will then take a medical history to make sure that there are no reasons why you are not suited to be treated with botulinum toxin. Then we will asked to sign a consent form indicating that you have understood what the treatment may do, the potential side effects and also that the drug is not currently licensed for this specific use in the U.K..

Photographs will be taken by Dr Molina with you smiling and frowning and with your face at rest. This will be used as “before and after” images to show you how successful your treatment has been.

All this may happen in your first visit. If you are happy to proceed further, we may also give you a first injection at this time. Equally, you may decide to keep your treatment separate from the consultation and consent process and not begin the procedure until your next consultation.

The injections

First, the area to be injected will be cleaned with an antiseptic wipe. You do not require any anaesthetic or sedation. Then, using micro needles and disposable syringes, tiny amounts of botulinum toxin, will be injected into several points in the agreed area.

Repeat procedures 

Depending on the area treated, dose used, and how you respond to botulinum toxin, repeat treatments will be required around every 3 – 6 months. These will maintain and potentially improve upon the initial effect observed.

The whole treatment should usually take no longer than 10 – 15 minutes and you can normally drive immediately afterwards and go about your usual activities.

Most patients find that Botox® injections cause little discomfort. Many compare the feeling to a little insect bite! As the treatment is very quick, the needles used are tiny and only minute amounts of liquid are being injected into the skin; few patients experience any significant pain.

A few patients do, however, prefer to have an aesthetic cream applied half an hour or so prior to treatment to help numb the skin.

Other risks or side effects include a small amount of temporary bleeding or mild swelling which may occur at the injection site. In some cases more extensive bruising may occur, especially around the eyes, but this can usually be covered up with make-up, and is only temporary.

Occasionally, patients experience a headache after treatment, and, very rarely, double vision.

When botulinum toxin is injected into the forehead area, there is a very slight possibility that it may cause weakness of the muscle holding up the eyelid causing a “partial ptosis” or drooping of the upper eyelid.

In experienced hands this tends to happen in less than 1% of patients and will disappear over a period of 2 – 10 weeks. Some doctors also use an eye drop called apraclonidine to help to speed up the recovery if this effect occurs.

If the forehead muscles are relaxed too much, especially in patients with looser skin, the treatment may cause the eyebrows to drop slightly. Again, this is only a temporary condition and will vanish usually within 10 weeks.

Sometimes, the eyebrow position may alter so that the edges of the eyebrows become elevated. Some women like this effect, but it is generally unwanted in men. It is easily corrected with a small amount of botulinum toxin injected above the raised area of the eyebrow to help change its position.

All patients should remember that because the results of botulinum toxin are not permanent, any unwanted effects will disappear usually within a 3 month period.

During 2003 there were some press reports claiming that Botox® may cause more wrinkles to appear. We have looked at these claims and can find no evidence in the scientific literature, at this point, to support these reports.

As we have said, your life can proceed as normal following an injection of botulinum toxin, but as with all medical procedures, it is wise to observe the advice of your practitioner as closely as possible to ensure that you get the full benefit of the treatment, free from complications.

Post-treatment advice

– For a few hours after injections actively contract and use the muscles in the treated area. Work your face and practise frowning and smiling! There is some evidence that this helps the treatment to work better by speeding up the absorption of botulinum toxin;

– For a few hours after injections do not rub, or massage the treated area, or undertake vigorous exercise. Avoid any form of facial treatment or massage to reduce the risk of the botulinum toxin spreading to adjacent muscles where it might cause the eyelid to droop;

– Waiting for up to two weeks for the treatment to work fully, so be patient! Most people will find that, even after this period, if they try really hard, they can still move the muscles to a small extent in the area treated. This is quite normal. The aim of the treatment is not to prevent you from moving the muscles in your face, but merely to reduce the number of times that your muscles contract as this is when wrinkles occur.

  • Contact Dr Molina after 14 days, if you find that you can still use the muscles treated to the same extent as before the treatment and you cannot see any apparent improvement, we will repeat the injections free of charge.
  • Nomally we will ask you to return three weeks after your first treatment so that we can monitor the results. This is good medical practice and nothing to be afraid of;

– Contact us immediately if you experience any drooping of the eyelid or adverse eyebrow position or bruising problems, or infection following treatment.

Botulinum toxin should not be used in women who are pregnant or breastfeeding. The manufacturers have not performed clinical studies in this group, for obvious reasons, although it is not thought to be dangerous to developing babies.

If you are currently trying for a baby, it might be wise to delay any cosmetic treatment.

Patients who have any diseases that affect muscle activity, may not be suitable for botulinum toxin injections. You must discuss this with Dr Molina. We will ask ask you if you have a history of Bell’s palsy as this may affect the dosage that they use.

If you have any bleeding disorders or are taking drugs that affect bleeding time, or certain aminoglycoside antibiotics, please informed us before the treatment.

You should be prepared to tell Dr Molina about any medication which you are taking and any allergies you have.

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