ABOUT COSMETIC INJECTIONS FOR GLABELLER LINES AND CROWS FEET

 

I have put together some information for you to help you decide if neurotoxin injection treatment is right for you. I have covered information on the things I need to know about your medical health before treatment, the treatment itself, preparation and aftercare, and risks and side effects.

As a surgeon, I know that the vast majority of complications and side effects are rare, but they can, and do, occur, and it is important that you are aware of these before you decide to proceed.

 

There are a range of options available to give a fresher, more relaxed look to facial appearance, and I will be focussing on injections of neurotoxins to the upper face. These areas include frown lines (between the eyebrows), forehead lines, and smile lines, or crow’s feet, at the corners of the eyes. When I do an assessment, it may be that an injection treatment to relax the muscles that cause upper facial lines may not be a suitable option for you. At the moment, I am not offering other treatment options, so the information here will only relate to wrinkle relaxing injection treatment.

 

The Science

Neurotoxins are highly refined protein produced by the bacterium Clostridium Botulinum, and have a role in the temporary treatment of facial wrinkles or frown lines, forehead furrows and crow’s feet. The kinds of wrinkles that respond to injections are the ones caused by repeated muscle contractions during facial expression such as frowning or squinting and are known as dynamic wrinkles.

 

Muscles contract when neurons (nerve endings) release a chemical called acetylcholine, a neurotransmitter, to stimulate the muscles. Neurotoxins, used in a highly diluted dose, blocks the transmission of the neurotransmitter to the muscles, and stops muscle fibres from contracting, causing a temporary muscle weakening. When excessive contractions are reduced, facial lines are smoothed out over time, and future lines may be prevented. Over time, the nerve endings regenerate and the neurotransmitter is released again – this is why the effect wears off after 3-6 months.

 

The Consultation

As this is a medical procedure, with a prescription only medicine, I will take a full medical history, including medications, and allergic reactions. I will ask about previous cosmetic procedures, and response or reaction to these.

I will take photographs of your face at rest, smiling and frowning from the front and sides. These photographs form part of your medical records and are kept securely on industry standard practice management software. Before and after photographs are required as a condition of my Aesthetics indemnity insurance and I will not be able to proceed if you do not consent to the photographs being taken and stored as part of your medical record.

Injectable neurotoxins cannot be given you are on drugs or have conditions which increase your risk of bleeding. Safety is not known in pregnancy or breast feeding therefore you will not recieve treatment with botulinum toxin A if these apply

 

Contraindications

You cannot undergo this treatment if you fall into any of the following categories

• Taking anticoagulants (blood thinners) such as Aspirin, warfarin, clopidogrel
• Have a blood coagulation disorder
• Taking aminoglycoside antibiotics such as gentamycin, tobramycin, neomycin, spectinomycin, amikacin, kanamycin.
• Taking penicillamine
• Taking calcium channel blocker group of drugs
• Pregnant or breast-feeding
• Neurological disease such as myasthenia gravis, multiple sclerosis, Eaton Lambert Syndrome, motor neurone disease, motor neuropathy
• Infection in the proposed injection site
• Hypersensitivity or allergic reaction to any botulinum toxin products or any of its constituents (albumin)

 

Potential side effects

There have been no known long-term adverse events reported with injections for facial cosmetic use when used as approved

Local effects

• Bruising at site of injection (temporary)
• Swelling or small bumps at site of injection (temporary, should settle within an hour))
• Brief pain or headache (temporary) – you can take a mild painkiller such as paracetamol the night of your injection if the headache persists
• Numbness or tingling sensation at site of injection (temporary, may last a few days)
• Redness at site of injection (temporary)
• The eyebrow arches more than you would like – paralysis of the muscles at the outer edge of the eyebrow causes elevation of the brow (Jack Nicholson, Spock or Mephisto brows); although some people want this kind of lift, it can be corrected with a small amount injected above the raised area at a two-week review
• Weakness or paralysis of upper eyelid (ptosis, 2-5% risk) – lasts for several weeks, improves as effect of neurotoxin wears off; if it is mild it can be improved by using special drops which I can prescribe
• Weakness or paralysis of the eye muscles causing double vision and squint – lasts for several weeks, improves as the effect wears off
• Difficulty blinking causing corneal exposure with a risk of corneal ulceration and sight loss

Distant spread of toxin

Risk of symptoms from botulinum toxin has been reported in relation to the higher doses used for treating medical conditions such as muscle spasticity and cervical dystonia, where much higher doses are used. Adverse events have also been reported with unapproved use of neurotoxin

• Dysphagia (difficulty swallowing)
• Dysphonia (difficulty with speech, change in voice)
• Dysarthria (difficulty with speech, articulating words)
• Breathing difficulties

Hypersensitivity Reactions

• Serious or immediate allergic reactions have been reported, including anaphylaxis, urticaria, soft tissue oedema (swelling, puffiness) and wheezing or shortness of breath

Other effects

• some people may experience headaches or flu-like symptoms after injection of botulinum toxin A.

Human Albumin and transmission of viral disease – there is a theoretical risk of transmission of CJD (Creutzfeld-Jakob Disease)

There are several precautions we take to reduce the risk of complications and side effects, although these can not be eliminated entirely

Instructions before your treatment

1. Avoid alcohol and caffeinated beverages for 12 hours before your treatment
2. Avoid aspirin, green tea, gingko biloba, vitamin E, fish oils 24 hours before your treatment
   1. The use of these drugs may thin your blood and increase the risk of bruising at the injection site
3. Schedule your injection treatment at least 3-4 weeks before any special occasions
   1. This is to allow any potential bruising to settle, and for the effect of the toxin to start showing

 

The Procedure

I will take photographs of your face at rest, smiling and frowning from the front and sides. These photographs form part of your medical records. I will cleanse the areas to be injected with antiseptic wipes and mark the injection sites with small white marks which will be wiped away at the end of the procedure. I will photograph the marked-up face and then I will inject small amounts into multiple locations on your face depending on the areas we are going to treat.

 

Aftercare

1. Remain upright for four hours after your treatment
   1. The treatment effect is intended to remain local to the injection site. If you lie down before the drug has bound to the target tissue it may spread and have effects where they weren’t intended
2. Do not rub or massage the treated area for 3-4 hours after injections
   1. This includes facials, chemical peels, dermabrasions (See 1a)
3. No strenuous exercise, heavy lifting or straining for 2-4 hours following treatment
   1. Botox takes 2-3 hours to bind to the nerve and take effect, and by increasing circulation with exercise etc., the drug may be washed away from where it was injected
4. Avoid excessive heat for 4 hours after your treatment (see 3a)
5. Mineral makeup can be applied soon after your treatment, but other makeup should be applied after 12 hours. This is to reduce the risk of infection at the injection sites.
6. It can take 10-14 days for your treatment to take full effect. I will see you at 2 weeks for post treatment assessment and photos.