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Botulinum toxin therapy for facial wrinkles and lines is an injection treatment to reduce facial expression lines. Botulinum toxin has been used for many years and is licensed for treatment of spasticity, and various facial tics and spasms. It is being increasingly used in medicine for treatment for tension headaches, migraine, and whiplash injuries to the neck, and is now licensed for the treatment of excessive axillary sweating, hyperhidrosis.

Botulinum toxin is not currently licensed in the UK for aesthetic treatments, but has been used widely since the early 1970’s for this purpose, and is generally a very safe treatment. Skin ageing is associated with the development of lines on the face and is caused by the action of muscles on the skin, and can be exacerbated by sun-damage and smoking. Botulinum toxin relaxes specific facial muscles that cause unwanted lines, for example, the deep creases between the eyes, crows feet and forehead lines.

How does Botulinum Toxin work?

By inhibiting the release acetylcholine, Botulinum Toxin prevents nerve impulses arriving at the muscle to cause contraction. The muscle is therefore temporarily paralysed, but this effect is completely reversible in time, and the muscle itself is not damaged.

How is the treatment administered?

A number of injections will be required, and these generally cause only temporary discomfort. The effect will develop gradually over a period of 3-5 days, and will generally be maximal at about 2 weeks, depending on various factors, including the initial magnitude of the lines, the size of the underlying muscles, and the amount of botulinum toxin used. The effect will last between 2-7 months, the average being 4-5 months.

Are there any risks?

Side effects of this treatment are rare and usually mild, and in one study, less than 3% of patients experienced a problem. However you need to be aware of the following:

Immediately after treatment, there will be some mild swelling and redness, and this usually settles within a few hours, as with any injection therapy, there is always a risk of infection, but this is very uncommon.

Bruising at the injection site may occur, and can be exacerbated by Warfarin and Aspirin treatment. Occasionally a temporary drooping of the eye lid or eye brow or double vision may occur, but this usually resolves in a few weeks.

An eyebrow lift may occur, but can be corrected by a small additional injection of botulinum toxin. The relaxation of the forehead muscles may rarely increase the risk of sleep line development, but this may be resolved by treatment with a dermal filler. Some experience a mild headache but tension headaches are usually improved. Rarely a transient numbness may occur in the treated area, and extremely rare side effect is generalised weakness and fatigue. If you are prone to cold sores, treatment may precipitate an eruption. For reasons that are not understood, some patients may be resistant to the effects of botulinum toxin, and these, treatment may not be as effective or as long lasting.

Special precautions

You should not undergo treatment if you are pregnant or breast feeding.

There are certain neurological conditions which can be made worse by treatment and the use of certain medications may not be appropriate with botulinum toxin. These will be covered in the medical questionnaire.

Alternative treatments

There are alternative treatments for lines and wrinkles other than botulinum toxin, and these include dermal fillers, chemical peels, laser treatments, surgical treatments or indeed no treatment at all

The Injectable Muscle Relaxant further information

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