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Wrinkle Reducing Injections

The use of prescription only medication Botulinum toxin (known as Botox®) produces relaxation of the muscles that account for the wrinkles and lines seen in the frown, forehead and crow’s feet. It can safely restore a relaxed look.

Doctors have been doing these injections successfully and safely for more than 20 years in many different specialities of medicine, eg Neurology, Urology, Surgery and Ophthalmology with no long term side effects reported.

How does it work?

Acetylcholine is a chemical messenger produced in our nerves to stimulate the muscles to contract. The botulinum toxin reduces the release of the acetylcholine and hence reducing muscle contraction, leaving the overlying skin smooth and unwrinkled. The action on the muscle is not permanent, and it works on specific muscles, leaving the surrounding muscles unaffected, producing normal facial expressions without the wrinkles. However, if you try very hard, you will still be able to move the muscles a little, but this does not mean the treatment has not worked.

Where can wrinkle relaxing injections be given?

  • Eyes – to reduce the crows feet appearance
  • Forehead – to reduce the frown lines
  • Brow – to reduce the frown lines and vertical line seen
  • Mouth – to reduce the fine vertical lines on the upper lip or to treat down turned mouths

How is the treatment performed?

Disposable syringes are used to inject the solution with a fine needle such as those used in diabetics, hence it is hardly felt. A small amount of botulinium powder is diluted with bacteriostatic saline and injected very precisely into several locations.

It will take 2-3 days for the effects to start to be seen, and is usually at its maximum effect by 2 weeks. The treatment may last from 2-6 months, on average 4 months. With ongoing repetitive treatment, the effects begin to last for longer after 18 months or so.

Occasionally you may require a top up injection at 2 weeks if the muscle is not fully relaxed.

Is Botox® Safe?

Botox® is a purified protein and is used in very small quantities. It cannot produce any permanent damage or travel within the body to make you ill. It attaches to the muscles it is placed in and can not migrate from there. Botox® is a prescription only drug that has to be handwritten up by a doctor. Prescription only drugs cannot be advertised and this is why you will not find any information sheets in a waiting room.

Are there any downsides?

  • Bruising – at the injection site, this is not very common, but more likely around the eyes.
  • Slight redness – again at the injection site, but this is transient and fades within an hour or so
  • Headache – particularly with the forehead procedure
  • Rarely – a flu like illness
  • Botox® contains a small amount of human albumin that is collected from pooled blood donations in the United States. Care is taken with control of the donors, the manufacturing process and the removal of inactivation of any viral contamination. There is a theoretical risk of virus transmission, but none has ever been reported.

What could go wrong?

  • Drooping eyelid – Usually due to travel of the injected solution. This happens in less than 1% of patients and will disappear over a 2-10 week period. It can be helped by eye drops, but reduced by keeping strictly to the after care advice.
  • Drop in the eyebrow position – this is usually due to having heavier eyebrows than usual (eg in men) and so this wouldn’t be suggested at first consultation. If it occurs it is only temporary but again can take 2-10 weeks to go.
  • Double vision – again can be due to travel of the solution when treating the crows feet lines. Using correct technique this is very uncommon, but may last a couple of weeks. Is not treatable and will mean that you cannot drive.

After treatment instructions

  • It is best to remain upright for 4 hours afterwards
  • During the first few hours, work your muscle groups treated by frowning and smiling a lot. This will help the treatment to work by speeding up the absorption of the Botox®
  • Do not touch the areas treated for 12 hours
  • No facial massages for a week
  • Wait for up to 2 weeks for the treatment to work
  • No air travel for at least 24 hours

Who should not have treatment?

  • Pregnant, breastfeeding women or those trying for a baby
  • Patients who have diseases that affect muscle activity (history of Bells Palsy, Myasthenia Gravis, Multiple Sclerosis)
  • Bleeding disorders, or those taking drugs that affects bleeding time (warfarin heparin, aspirin, glucosamine)
  • Drugs that may interact with the Botox® (aminoglycosides antibiotics, spectromycin, quinine sulphate)
  • Surgery or active infection in the area.

How much does it cost?

The procedure is charged per area injected. One area can be defined as the crows’ feet, or the vertical frown line between the eyebrows or the horizontal forehead lines.

One area injected costs £200 in a female, two areas are charged at £250 and 3 areas at £300.

Men have heavier musculature, especially across the brow and so will probably require higher amounts of the drug, and therefore will be more expensive (£220 / £280 / £330 respectfully)

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