Botulinum Toxin-A…some facts

The lines on the face can be interpreted by some people as being manifestations of negative emotions, tiredness, stress or ageing. As part of their own personal habit, some people have a distinctive way of using their facial muscles. This continuous muscle contraction leads to the creation of facial lines.

There are many treatments available for the treatment of facial lines but few of them address the underlying cause which is the relationship between the lines and the underlying muscles. Injections of small quantities of botulinum toxin offers a reliable method of reducing these lines and wrinkles before resorting to surgery, as well as offering some prevention against the lines appearing when used consistently over many months and years. It gives a more rested appearance to the face enhancing the aura of calm and youth one would wish to portray!

Botulinum Toxin was identified in 1897 as being an agent which caused muscle paralysis. It has been used for many years to treat various medical conditions such as squint, and muscular disorders (such as tics, cerebral palsy and overactive muscles in babies as well as the muscular stiffness of Parkinson’s disease). Its use in the cosmetic field began in the early 1980’s when it was noticed as a side effect of treating eye disorders. Further research clarified its potential for reducing facial lines. The original patient who had these muscle relaxing injections for treating wrinkles continues to be satisfied with the result and I believe is still being feted in Canada!

Botulinum toxin has been shown to be both effective and safe. The doses used cosmetically are less than 1/20 of the doses used in conventional medicine. It is used all over the world in more than 70 countries and many millions of clients have been treated over the past 15 years.

Botulinum toxin-A is a protein derived from a purified form of a toxin released by a bacteria which causes food poisoning. When this is injected in a minute amount, by an experienced and appropriately trained practitioner, the toxin has a localised effect relaxing the nearby muscles. This has the effect of preventing the wrinkles caused by these muscles when they contract.

Before the treatment, a complete medical consultation is carried out in order to be sure that there are no reasons why the treatment should not be carried out. (pregnancy and breast feeding are contraindications for treatment as are some neuromuscular disorders, severe egg allergy and consumption of medicines such as some antibiotics, penicillamine and calcium channel blockers which are used to treat some heart disorders. This will be discussed at your appointment) This consultation also provides an opportunity for the pattern of forehead, frown and overall muscular facial movements to be evaluated. This allows the practitioner to see the exact pattern of contraction in order that the dose be tailored and the correct injection points identified. Before pictures are taken in order to provide an accurate record of the face prior to treatment

Botulinum toxin treatments are most commonly undertaken on the upper part of the face. The protein works on the muscles which are actively used in making an expression (such as smiling, frowning or looking surprised). Treatment of “static lines” (those which are visible when not making an expression) can often be better addressed by judicious use of dermal fillers such as Hydrafill ® and Restylane®

Botulinum toxin can also be very effective in minimising the “necklace effect” of wrinkles on the neck leading to a smoother and more youthful appearance.

Botulinum toxin has its own particular benefit in treating excessive sweating (hyperhydrosis) which can commonly affect the armpits leading to social isolation and severe wardrobe restrictions. Reductions in sweat production of up to 80% can result in resolution of social embarrassment and dressing limitations.

We recommend that you reduce your alcohol intake prior to your treatment and be aware that medications such as aspirin and vitamin C can cause more bruising afterwards. It is advisable to avoid waxing, electrolysis, lasers and the use of sunbeds for at least 48 hours prior to treatment.
Anecdotal research suggests that by using arnica homeopathic tablets for 3-4 days before treatment and about a week after treatment, the risk and extent of bruising is significantly reduced.

The injection process takes 10-15 minutes and can be slightly uncomfortable (comparable to an eyebrow waxing). This discomfort is significantly lessened by the prior application of a topical anaesthetic cream. (some of the injections will not even be felt) Afterwards there will be some tiny marks in the injection points which should fade over the next hour.

With any injectable treatment there are possible side effects such as bruising and swelling. These are rarely visible and usually short lived. Rarely there is some local spread from the original site of injection which results in a mild brow droop. This can be avoided by correct positioning of any injections, accurate dosaging and remaining upright without unduly touching the injection sites. Any droop will resolve over the next few weeks. If there is any eyelid droop, this can be temporarily treated with special eye drops.

The effect of the wrinkle softening treatment builds up gradually and reaches it peak after 1-2 weeks. The muscle will be more relaxed and so will be less able to contract and so fold the overlying skin. On average the effects last for 3-6 months. With subsequent treatments the time between injections increase due to weakening of the muscles. In some cases only one or two treatments per year are needed.
Some people can suffer mild headaches after treatment but these can be helped by taking simple analgesia such as paracetamol. Interestingly, Botulinum toxin has been recognised as being a useful treatment for chronic headaches and migraine (often thought to be partly related to muscular tension )

The main goal of the treatment is to break the habit of fixed muscular contraction (such as frowning) and so re-educate the muscles not to make the expressions which can result in wrinkling. Up to date research, which is followed by our practice, is to use sufficient Botulinum toxin to relax the muscle without totally freezing it so that some movement is possible when making an expression People who smoke or use certain drugs find that the treatment effects tend not to last as long. In very few cases some people become resistant to the drug and so it does not work effectively.

After treatment

• do not massage or unduly rub the area injected since this may cause the Botulinum toxin to have an effect on untargeted muscles nearby resulting in unwanted effects.
• Avoid lying down for 3-4 hours if possible in order that the facial muscles remain active.
• Avoid any vigorous exercise for at least 4 hours after treatment, (preferably 24 hours).
• Do not spend prolonged periods of time bending down for a few hours (i.e. not a good idea to go shoe shopping after treatment).
• Use the facial muscles as much as possible (pulling faces/ grimacing and frowning/smiling) to encourage a good uptake of the Botulinum toxin by the muscles targeted.
• It is not recommended to sunbathe, or have too much heat on the face (sauna/facials/peels/laser treatment) for the following 2 weeks.
• No problems with travelling in an aircraft after treatment.
• If you are prone to cold sores there is a risk that you may experience an outbreak after injection so it may be worth while considering prophylactic use of acyclovir for several days before your treatment.
• If you are taking aspirin, warfarin, anti-inflammatory or similar medication, you may experience more bleeding and bruising at the site of the injection. It is advisable to have not taken any accutane treatment( for severe acne) within 6 months of administering muscle relaxing treatments.
• An appointment will be made for you to be seen 2-4 weeks after the treatment in order that the results can be reviewed and areas that require topping up can be attended to. After pictures will also be taken to record the effects of treatment and can be used to compare with earlier photographs to accurately determine any treatment effects. These records are treated with a high degree of confidentiality and will never be used in any sort of marketing without prior written consent.
• Any additional treatment required at the follow up is included in the original price. Should you default on your review appointment, any top-ups required will be at no extra charge provided they are administered within a month of the original appointment. (unless otherwise agreed with the practitioner).
• If you decide not to continue with treatment and do not return within 4-6 months then facial lines will gradually reappear but should not be worse that the original wrinkles that were treated.