Anti-wrinkle injections (botulinum toxin A injections)
Botulinum toxin A injections or BTXA (e.g. BotoxTM, AzzalureTM, DysportTM, VistabelTM) have been used for more than 30 years for numerous medical reasons. In more recent years they have been used for cosmetic treatments and are now the most popular cosmetic treatment worldwide.
These injections work by temporarily weakening specific muscles and thereby reducing undesirable lines and wrinkles in the facial skin overlying these muscles.
The most popular treatments are aimed at treatment of frown lines (between the eyebrows), crow’s feet (outer corner of the eyelids) and forehead furrows.
By treating the muscles that pull the eyebrows down (the brow depressors) these injections can actually raise the eyebrows (“chemical brow lift”). People who have regular treatments with BotoxTM and other similar treatments can often keep their lines and wrinkles to a minimum and maintain a subtle but very pleasing brow lifting effect.
Anti-wrinkle injections can also be used in conjunction with cosmetic eyelid surgery (blepharoplasty) or brow lift surgery by relaxing the brow depressors prior to and for several months following surgery.
The beneficial effect of these injections usually lasts 3-4 months. After this period the treatment is repeated to help maintain the effect.
The number of medical applications for BTXA injections continues to grow. Facial medical BTXA treatments include:
- Blepharospasm (involuntary spasms of the eyelid muscles resulting in disabling forceful blinking and closure of both eyelids)
- Hemifacial spasm (involuntary spasm of muscles on one side of the almost invariably resulting in disabling blinking and closure of the eyelids on the affected side)
- Corneal exposure (BTXA can be used to induce a droop of the upper eyelid to help protect an eye that is at risk of serious damage from exposure related to an incomplete closure of the eyelids (lagophthalmos)
- Crocodile Tears (some people with a facial palsy develop embarrassing watering from the eye when chewing food and BTXA applied to the lacrimal gland can reduce this tendency markedly)
Anti-wrinkle injection procedure overview
Anti-wrinkle injections are given as an outpatient treatment. No anaesthesia is required but a chilled pack applied for a few seconds before treatment can help minimise any discomfort. The treatment only takes a few minutes and is usually very well tolerated.
Tiny quantities of injections are given using a very fine needle through the skin. The effect is usually noted at around 3-5 days after the treatment. The maximum effect of treatment may take 2-3 weeks. Occasionally a top-up treatment is required but this should be deferred for this period to allow the previous injections to have their full effect.
Risks and complications of anti-wrinkle injections
In the hands of an experienced practitioner BTXA injections are associated with very few problems.
The treatment is extremely popular and has stood the test of time because of the very successful outcomes and low risks associated with it.
That said, all treatments have some potential unwanted effects. Those associated with BTXA anti-wrinkle injections include:
Very Common effects (affects more than 1 user in 10)
- Redness, swelling, irritation, rash, itching, tingling, pain, discomfort, stinging
- Bruising at the site of the injection - substances that increase the risk of bruising include aspirin, and other non-steroidal anti inflammatory drugs e.g. ibuprofen, diclofenac, Nurofen. Vitamin E supplements can also predispose to bruising.
Common (affects 1 to 10 users in 100)
- Tired eyes or dim vision, drooping of the upper eyelid or brow, swelling of the eyelid, watering eyes, dry eye, twitching of muscles around the eye
- Weakness of some facial muscles
Uncommon (affects 1 to 10 users in 1,000)
- Disturbed, blurred or double vision
- Itching, rash
- Allergic reactions
Rare (affects 1 to 10 users in 10,000)
- Itchy and lumpy rash
- Eye movement disorder
Extremely rare (affects 1 to 10 users in 100,000)
You must seek urgent medical help if:
- Anaphylactic reaction (severe allergic reaction)
- You have difficulties breathing, swallowing or speaking
- Your face swells or skin goes very red or you get an itchy, lumpy rash. This may mean you are having an allergic reaction
Temporary under/over correction, asymmetry (unevenness) can occur.
In a very small number of individuals, the injection does not work satisfactorily or last for as long as usual.
Pregnancy and neurological disease
There are certain medical conditions where botulinum toxin injections are not recommended. These include:
- neuromuscular disease i.e. myasthenia gravis and multiple sclerosis
- Pregnancy and breastfeeding