Wrinkling is a prominent feature of skin aging. Over time, skin loses volume as dermal collagen, hyaluronic acid and elastin reduce.
This process is accelerated by sun exposure and other extrinsic factors such as smoking. Repeated movement of facial muscles also contributes to the formation of visible lines and wrinkles.
At first, lines and wrinkles are only seen during facial expression but over time, they become more permanent, resulting in static lines at rest.
Botulinum toxin is a drug derived from a neurotoxin (which disrupts signals between nerves and muscles) produced by the bacterium Clostridium botulinum (found naturally in the environment in its inactive form).
Medically, it is used to treat many muscular conditions and in Aesthetics, it is used to relax lines and wrinkles by temporarily paralysing the underlying muscles. Very small amounts of the toxin are injected and are perfectly safe. It is used in over 70 countries for over 50 conditions. Its safety and efficacy have been studied for over 20 years.
Wrinkle relaxing injections are commonly administered to diminish lines in the upper third of the face;
• Frown lines between the eyebrows
• Horizontal forehead lines
• Laughter lines (Crow's feet)
• Gummy smile
What is Botulinum Toxin?
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum. In a purified form; as is the case with many drugs/medications such as Penicillin, Botulinum toxin is a very safe, effective treatment not only used in cosmetic clinics, but also for a number of medical conditions, including migraine and excessive sweating.
All botulinum toxins are prescription only medicines (POM) and can only be prescribed by doctors, dentists and nurses with the prescribing qualification, following a face to face assessment and consultation with the qualified prescriber. Botox® is a licensed brand of Botulinum toxin A. Other licensed brands include Azzalure®, Dysport®, Xeomin® Bocouture® .
Many people refer to Anti-wrinkle treatment as "Botox" ...
This is not quite correct and we educate our patients, explaining the Botulinum Toxin generic concept.
A similar analogy would be the generic reference to all vacuum cleaners as Hoovers. We use the attached poster during a consultation to explain this "Botox" generalisation. The resemblance works very well.
BOTOX® is one of Botulinum Toxin type A medications.
There are currently a few brands of Botulinum Toxin type A available in the United Kingdom: Botox (Vistabel), Dysport (Azzalure) and Xeomin (Bocouture).
Botulinum toxin can be used to treat wrinkles, which are the result of normal facial expressions. Its mechanism of action results in blocking the signal from the nerve to the muscle.
It is a POM, prescription only medication, and must be prescribed after a Face to Face consultation.
How Does it Work?
The toxin blocks the transition of chemical messages from the nerve to the muscle so that the muscle stays in a resting state for a period of 8 to 12 weeks on average. This may be only a partial reduction in movement allowing some remaining movement or a full block in which case there is very little remaining muscular movement in the area – this very much depends on the amount administered and location of product placement –treatment may be tailored to suit your individual requirements. Your expected treatment outcomes and whether they can be achieved will be discussed at the time of consultation.
Does it Hurt?
A very fine needle is used and generally this treatment is not described by most as painful and can be well tolerated with no anaesthetic. Please request an anaesthetic cream or ice, if you are nervous about needles.
Used to Treat
The aim of the licensed treatment is to significantly reduce the movement of the muscles causing expression lines (dynamic lines) specifically the frown and crow’s feet and worry lines on the brow may also be treated as an ‘off label indication. Successful treatment may not cause the expression lines themselves to disappear completely. It may not ‘completely freeze’ the expression, particularly if extreme effort is exerted to make an expression. Botulinum toxin is not suitable for lines present without expression (static lines), your practitioner will advise you.
How Long will it Last?
Results tend to last 3-4 months. Movement will begin recovering from 8 weeks. Frequent treatment at intervals of less than 3 months is not recommended. Repeating treatment when movement recovers will deliver optimum results over time. Frequency of treatments may be reduced according to the quality of your skin and your response to treatment.
Patients are usually able to return to work immediately after treatment. It is advisable to avoid strenuous activity for 24 hours after treatment. Excess heat (e.g. saunas) should also be avoided. Also advisable to avoid extremes of heat or cold, lying down or leaning over for 4-6 hours.
Duration of Effects
The results are usually notable after 2 - 3 days, with optimal results demonstrated at two weeks. Effects are usually evident for around 12 weeks but this depends on the individual's metabolism, muscle activity and other variables.
Some people experience a tension-type headache in the first 24 hours following treatment but this is nothing to be concerned about. There may be some mild bruising or swelling at the injection site, which will usually subside within 48 hours.
It is important that you return for a review with your practitioner two weeks after the procedure. This ensures your appropriate dose can be established and any necessary adjustments can then be performed. An adjustment cannot be performed after 3 weeks - after this a new prescription will be required.