Anti-wrinkle injections (Botulinum Toxin or “Botox”)

What is Botulinum Toxin?

Botulinum Toxin, known popularly as “Botox” is a protein produced by a bacteria that has the effect of temporarily paralysing muscles. It is purified for medical purposes and injected in small doses to paralyse specific muscles for therapeutic or cosmetic benefit.

How does Botulinum Toxin improve wrinkles?

Wrinkles are caused initially by the activity of underlying muscles. The wrinkles on the forehead are a good example of this. By paralysing carefully chosen facial muscles with Botulinum Toxin these wrinkles will improve or even disappear.

Does Botulinum Toxin work on all wrinkles?

No. Wrinkles are also caused by the loss of natural elasticity in skin that occurs as we age and so some wrinkles particularly in the lower half of the face will not improve with Botulinum Toxin. However, it is usually possible to identify which wrinkles are likely to improve with Botulinum Toxin and which are unlikely to improve before treatment.

Can Botulinum Toxin be combined with fillers?

Yes. Some wrinkles are very deep and although they improve with Botulinum Toxin they may need fillers too for them to completely disappear.

How will I look after treatment?

At the sites of injection there may be small red bumps which normally fade over the next 24 hours. There may be some associated pain and tenderness or a feeling of heaviness.

How long does it take to have an effect?

The treatment will start to have an effect after about 5 days and reaches maximal effect after about 2 weeks. At this point some patients require a “top-up” or additional injections if excessive muscle activity remains.

How long will it last?

The effects of treatment last between 2 and 4 months and after this time muscle activity and the associated wrinkles will return unless a repeat treatment is given.

Are there any possible side effects?

As with any treatment, unwanted side effects can occur. Bruising may occur but gradually fades over days. Temporary numbness at the sites of injection can happen. Rarely there can be a drooping of the eyelid or effects on the muscles moving the eye but if either of these did occur they would gradually improve over weeks. In a small minority of patients the treatment is not very effective. As with any treatment that involves piercing the skin, infection is possible and would need treatment with antibiotics. In addition some antibiotics should not be taken at the same time as Botulinum Toxin. Very rarely, a patient may develop generalised weakness and fatigue. Lastly, Botulinum Toxin is not recommended for women who are pregnant or breastfeeding.

What should I do and not do after treatment?

Avoid touching the treated areas for 2 hours after treatment and avoid exercise for 4 hours. This to prevent provocation of bleeding. Do not lie down for 4 hours as they may cause mild swelling. Do not apply make-up for 12 hours as this may allow pigment to fall into the small holes made by the needles and thus cause tattooing.

If bruising does occur, vitamin K or Arnica cream should be applied 3 times daily starting 4 hours after treatment. Just dab the cream on rather than massage and continue until the bruising fades.

Where is Botulinum Toxin injected?

The commonest sites are the frown lines between the eyebrows (glabellar), the forehead and the fine lines around the eye (crows feet). It can also be used to treat fine lines on the upper lip, bands in the neck and in the hands, feet and armpits to reduce sweating. The common sites of injection in the face are shown below: