Wrinkles are part of the ageing process. They can be attributed to sun damage, smoking, effects of gravity and muscle contraction resulting from facial expressions such as frowning and laughing. Wrinkles due to the effects of gravity represent natural sagging of tissue with age and are generally only improved by surgical tightening procedures. Wrinkles caused by muscle contraction such as frown lines, forehead lines and crows feet, can be improved by botox. The procedure is currently the most common aesthetic procedure in the US with 1.5 million procedures done in 2001. (up by 2356% since 1997!) It can also be used with success in the treatment of excessive sweating of the armpits and palms of the hands.

What can you expect at the time of your procedure?

The injection is injected directly into the muscles that cause the wrinkles, using a very small needle.

Several injections are usually needed at specific sites, depending on the area treated. When used to treat excessive sweating in the armpits, it is injected directed into the axillary skin. Localised discomfort and bruises can occur, but no sedation or local anaesthesia is generally required. Normal activities can be resumed immediately.

What are the results?

The effect commences 24-72 hours after injection, with maximum effect from about 2 weeks. Its duration generally lasts for approximately 6 months. When injected into the muscles that are responsible for expression wrinkles, it gives the face a more relaxed and smoother appearance. Sometimes longer lasting effects (9-12 months) are seen after treatment of excessive sweating. When a gradual fading of treatment effect is noticed you may return to have another treatment.

What are the limitations?

Whilst Botox treatment can be very effective in reducing wrinkles due to muscle contractions, it has no effect in reducing the fine lines on the face caused by sun damage, and lines due to sagging of facial skin. In those patients with very heavy lines, repeated treatments may be needed for maximum effect. Too frequent or excessive dosing of the agent may lead to patient’s resistance to treatment due to antibody formation and it may exaggerate any facial asymmetry.

What are the contraindications for treatment?

This treatment is contraindicated in people with neuromuscular disorders such as myasthenia gravis, those who are taking certain muscle relaxants and antibiotics such as aminoglycosides, pregnant or breast feeding women, those with infection or inflammation at the proposed site of injections and bleeding disorders.

What are the risks?

No severe complications after cosmetic use of the agent have been reported in the literature.

Very rarely excessive weakening of the target muscles and paresis of adjacent muscles can occur, resulting in facial weakness. This is self-limiting. When injecting above the eyebrows, upper eyelid ptosis or slight drooping may occur but only in 1:100. This can be corrected with eyedrops but will also improve as the effects wear off.