Many facial lines are caused by the repeated use of the underlying facial muscles, which over time results in a permanent crease or wrinkle. Botulinum Toxin (Botox) offers an alternative to surgery for many people with relatively mild wrinkles. Botulinum toxin reduces these lines by temporarily reducing the action of the underlying muscle. This gives a smoother, more rested appearance to the face. Botox also has a preventative effect when used repeatedly to reduce the onset of wrinkles forming in the long-term. To achieve the best results, Botox is injected to a level, which does not cause complete freezing of the muscles, but weakens them so that some movement is still possible.
Botox is most commonly used in the upper face. The most common areas requested are the horizontal forehead lines, vertical frown lines between the eyebrows, and crow’s feet (or laughter lines) radiating away from the eyes. It can also be used for some types of lines around the mouth. Several tiny injections are usually required. The smallest needles are used and the medicine itself does not tend to sting as much as injections of local anaesthetic. It is advised not to use aspirin as this can increase the risk of bruising.
Frequently Asked Questions
Following the treatment, do not massage the area of the injection and do not lie down for about 3-4 hours. Frowning and closing the eyes tightly intentionally after treatment may help to localise the Botox to the selected muscles. Do not take any aspirin for two or three days either side of the injections as this may help to reduce the chance of bruising. It is also advised not to perform any vigorous exercise for 24 hours after the treatment.
Successful therapy is signaled by muscle weakness that begins 3 and 5 days after injection with the main effect visible at about 7 days. The effect after the initial injection lasts between 3 and 5 months for most patients.
Repeat treatment is suggested every 4-5 months to keep the muscles sufficiently frozen to allow the furrows to smooth out. In practice, this means coming three times in the first year. After using botox for one year, the intervals between injections may be a little longer so that you need it only twice a year.
As with any sort of injection, there can be some bruising and minor swelling although this is not severe and usually settles within a few days. Very rarely if the botox reaches the upper eyelid muscle, there may be transient drooping. This is the most significant risk and occurs in about 1 in 1000 injections. It occurs from a local spread of the botox from the injection site and can be minimised by accurate dosage, proper placement, as well as keeping in an upright position for three to four hours after the injection. If drooping eyelids occur, it usually resolves over a few weeks. Special eye drops may temporarily reduce eyelid droop if it occurs.
The following people should not have Botox:
- Pregnant women
- Breastfeeding mothers. There is no evidence that Botox is expressed in breast milk but it is best avoided if breastfeeding
- Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid Botox
- Patients taking the following medicines should not receive Botox: aminoglycoside antibiotics, penicillamine, and calcium channel blockers (Calan, Cardizem, Dilactor, Norvasc, Procardia, Verelan)
- Known allergy to human albumin (egg white) or Botox; currently there are no documented cases of allergy to Botox