Treatments: Anti-Wrinkle Injections

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Anti-Wrinkle Injections

Anti-wrinkle injections (botulinum toxin injections) are used medically in tiny doses to alleviate unwanted muscle spasms. When injected into these muscles the treatment produces a temporary relaxation in the muscles.

They are commonly used by oculoplastic surgeons for the treatment of a condition called "blepharospasm" which results in an involuntary eyelid closure, but the same injections can also be used for the treatment of facial wrinkles and lines. They can also be used to enhance the results of cosmetic eyelid surgery. Frown lines are caused by involuntary contraction of the muscles between the eyebrows (this area is referred to as the glabella). These lines can be removed by the use of anti-wrinkle injections in most patients under the age of 45. Over this age the lines can be improved or softened. Residual lines can be treated by the use of filler injections e.g. Restylane. Likewise anti-wrinkle injections can be used to improve the "laughter lines" around the eyes, and in some patients, horizontal creases in the forehead. When used to treat frown lines in the glabella and the laughter lines the injections can cause a secondary eyebrow lift (see below). This is due to the weakening of the brow depressors allowing the elevator of the brows, the frontalis muscle, to work unopposed. Great care is taken when treating horizontal forehead lines with anti-wrinkle injections as these work by weakening the frontalis muscle which can cause an undesirable brow droop if used in too high a dose.

The injections are very quick and simple to perform using a tiny needle. The results in suitably trained and experienced hands are very good and reproducible. In general, the initial effect of the injections is seen within three days. The maximum effect is seen one to two weeks after treatment. Each treatment lasts approximately three to four months and can be repeated indefinitely. Some patients notice a longer lasting effect after a few treatment sessions and mayonlyneed repeat treatments twice a year. Some patients prefer regular injections at 3-4 monthly intervals to maintain the effect.

At repeat treatment sessions the dose can be increased where necessary as each person responds differently to a standard dose. The very first treatment session is undertaken very conservatively to avoid any risk of over-treatment and top-up injections are given if required 1-2 weeks later.

Botulinum toxin injections can also be used to improve the appearance of the mouth. A single small injection can be given to the outer aspects of the chin to weaken the muscle which draws down the outer aspect of the mouth. This can be combined with filler injections e.g. Restylane. Botulinum toxin injections can also help migraine sufferers and can be used for hyperhydrosis (excessive sweating).

Botulinum toxin should be avoided in the following situations:

Side Effects

Side effects may occur from misplaced injections of botulinum toxin, but these are temporary. Higher doses may cause paralysis in nearby muscles (e.g. in the upper eyelid resulting in a droop of the eyelid). It is for this reason that a low dose is used initially and increased later depending on the response.

As with all injections, bruising may occur but the risk of this is minimized by applying firm pressure immediately after the injection. Because of this it is important to inform your surgeon if you have a bleeding disorder, or if you are using anti-coagulants e.g. warfarin, aspirin or arthritis medications such as ibuprofen.

Allergic reactions to the toxin itself have not been recorded but extremely rarely a skin rash or localised swelling can occur. This usually settles a few days after.

Follow-up

No follow-up appointments are usually required. The patient telephones the clinic to arrange further injections when required.

Experience with Botulinum Toxin Injections

Mr. Leatherbarrow is a fellowship trained ophthalmic plastic and cosmetic surgeon who has a vast experience with the use of botulinum toxin injections. He was trained in the use of these injections during his fellowship at the University of Iowa Hospitals & Clinics, Iowa, USA in 1991-92. He has over 17 years of experience and uses this treatment regularly both in his NHS and private practices. Mr. Leatherbarrow also uses botulinum toxin to supplement the effects of operations on the eyelids and eyebrows particularly in patients with thyroid eye disease (see below).

	Before treatment		“Chemical brow lift” following botulinum toxin injections
	Frown lines before treatment		Frown lines following botulinum toxin injections
	Patient with frown lines, "bunny" lines and eyelid "laughter" lines		Same patient following botulinum toxin injections to glabella, upper nose and outer aspects of the eyelids. No surgery has been performed. The brow lift has been achieved by the use of botulinum toxin alone. This photograph was taken 7 years after the photograph on the left.

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