Treatment
What is Botulinum Toxin and How Does it Work?
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium botulinum. This bacterium makes several different types of protein which are called type A to type F. These varying proteins cause muscles to relax at different levels.
There are currently two different types of botulinum toxin commercially available in the United Kingdom – type A toxin (Botox® / Vistabel®, Dysport® / Azzalure® and Xeomin®) and type B toxin (Neurobloc®).
How does it work?
Our facial expressions change because the muscles in the face contract or relax. This is caused by the brain sending a signal via our nerve endings that we want to, for example, frown or laugh. When botulinum toxin is injected into a specific muscle it blocks the signal from the nerve to the muscles in the face. This means that the nerve ending cannot tell the muscle to move. This is not a permanent condition, however, but it will last for around 3 – 4 months.
After botulinum toxin injections, your skin around the area which has been treated will look smooth and less wrinkled; but do not worry, the rest of your face will not be affected. Botulinum toxin allows the untreated areas of your face to move as normal and you will still be able to laugh, smile and frown, but with less wrinkling of the skin in the areas treated.
After a while, most patients will notice that the lines and wrinkles around their treated areas will continue to become less deep and pronounced. This is a result of the botulinum toxin as the new skin has a chance to grow without being repeatedly creased. Hence, it appears to be smoother on the surface because it has not been creased by constant muscle activity.
Botulinum toxin can be used to treat all wrinkles which are the result of normal facial movement. It is not suitable for permanent wrinkles caused by excessive exposure to the sun.
Botulinum toxin does not remove wrinkles indefinitely; it is usually necessary to have a treatment every 3 – 4 months to maintain and improve upon the original results. It has been proven to be quite safe to have botulinum toxin injections at the above frequency over a period of years.
What areas can it be used to treat?
The upper third of the face is where the best treatment results are obtained, commonly for reduction in the appearance of crow’s feet around the eyes, and frown lines and wrinkles on the forehead and between the eyebrows.
Experienced practitioners can use botulinum toxin to reduce the appearance of fine lines underneath the eyes as long as the skin is not too loose in this area before the treatment. This procedure often leaves the patient with a slightly wider open – eyed look.
Botulinum toxin can also be used to reposition or lift the eyebrows by a few millimetres. This is sometimes called a “chemical brow lift”. It can lessen so-called “bunny lines” (lines along the top of the nose caused when some people smile.) More seriously, it can help people who have suffered facial trauma or Bell’s palsy. In these cases, the face can take on a “lop-sided” look, and botulinum toxin can help to correct this distressing condition.
Experienced injectors may also treat fine vertical lines in the lip area and around the corners of the mouth. Usually in these cases, an injection of botulinum toxin would be accompanied by a dermal filler. This literally fills up some of the deeper wrinkles like a cosmetic polyfilla!
A dimply chin caused by the underlying muscle that occurs in some people can also be softened as can “necklace lines” or horizontal lines around the neck.
“Platysmal bands” – bands of muscle that stand out from the neck and make the neck look stringy in appearance can also be softened with botulinum toxin
What happens during the treatment and how long will it take to recover?
Preparing for treatment
This treatment is simple, quick and safe. You can resume your normal activities immediately after the procedure. Many people have their treatments in their lunch-time, for example, and return to work straight afterwards.
The first time you visit a clinic, a detailed discussion with a practitioner should realistically and clearly highlight your expectations of the cosmetic effect from this treatment. The practitioner should then be able to tell you if this is how they see the treatment working for you. If your expectations and theirs do not match each other, do not proceed until you are entirely happy with what they are telling you.
The practitioner may then take a medical history to make sure that there are no reasons why you are not suited to be treated with botulinum toxin. Then you would normally be asked to sign a consent form indicating that you have understood what the treatment may do, the potential side effects and also that the drug is not currently licensed for this specific use in the U.K..
Photographs may also be taken by the practitioner with you smiling and frowning and with your face at rest. This will be used as “before and after” images to show you how successful your treatment has been.
All this may happen in your first visit. If you are happy to proceed further, the practitioner may also give you a first injection at this time. Equally, you may decide to keep your treatment separate from the necessary “paperwork” and not begin the procedure until your next consultation.
The injections
First, the area to be injected will be cleaned with an antiseptic wipe. You do not require any anaesthetic or sedation. Then, using micro needles and disposable syringes, tiny amounts of botulinum toxin, will be injected into several points in the agreed area.
For your first treatment, we recommend that it might be wise to have just one area treated (i.e. your frown lines, for example) so that you can become comfortable with the process and the practitioner can see how you respond to your first injections.
Repeat procedures
Depending on the area treated, dose used, and how you respond to botulinum toxin, repeat treatments will be required around every 3 – 6 months. These will maintain and potentially improve upon the initial effect observed.
Recovery time
The whole treatment should usually take no longer than 10 – 15 minutes and you can normally drive immediately and go about your usual activities.
