Common questions concerning wrinkle relaxing injections

Provided below are some of the common questions asked by patients, and answers regarding this treatment. These questions and answers about botulinum toxin are to provide information and in no way intended to replace a consultation.

Botox® is the brand name for the original and most popular botulinum toxin treatment. Botox is an FDA-approved treatment for the temporary relaxation of overactive muscles. A spin-off of its original use in spasticity was that it smoothed out frown lines.

Botulinum toxin treatment causes temporary blocking of nerve signals to muscles. So those expression lines that occur when we use our facial muscles will look softer once the treatment has reached full effect.

In the upper face, vertical frown “eleven” lines between eyebrows, “crow’s feet” lines at the corners of the eyes which are distressing to patients, are approved indications for treatment with botulinum.
Botulinum is also used to improve lower face expression lines, such as a downturned “mouth frown” and prominent neck lines.

Botox® injections are given using very fine tiny needles, usually no numbing is required. However when a large number of injections are required, such as for treatment of excessive sweating with botulinum toxin, numbing cream is applied prior to treatment.

Side effects of treatment with botulinum toxin such as Botox ®, Azzalure (Dysport) include:

  • needle site redness
  • bruising or hematoma
  • if injected above the outer half of eyebrows, can cause the eyebrows to be heavy.
  • if injected too close to the upper eyelid or rubbed inadvertently causing migrate into the eyelid muscle, it can cause a droopy eyelid.

There are reports of side effects caused by distant migration of botulinum toxin, including weakness of swallowing. However, the current understanding is that when the total amount of toxin used is kept to the minimum required for effect, used after prudent medical consultation and understanding of the depth of injection and muscles being treated, Botox is a safe treatment in the right hands.

In the unfortunate event that you develop a droopy eyelid after treatment with Botox, you must contact your treatment provider immediately. At Reverse Time, this will be the physician who treated you. They will look into possible causes of this that could have occurred during treatment. However, it is often due to migration of the Botox into the eyelid elevation muscle because of rubbing, pressure from helmets and goggles or other lapses in aftercare. You will then be reviewed and your eyelid response to Iopidine (apraclonidine) eyedrops will be assessed. This is a test for whether a small eyelid lifting muscle has been affected by Botox.

If Iopidine relieves the droopy eyelid for a span of 2-3 hours, then you could use this following your physician’s advise until the effect of Botox wears off or weakens.

It is important to remember that all side effects of the Botox itself are temporary, and will be reversed over the duration of effect of the toxin, that is 10-12 weeks.

Unfortunately, there is a risk of getting a heavy eyebrow when the horizontal forehead wrinkles are treated overzealously with Botox. To understand why this happens, we must understand how the vertical and horizontal forehead lines are formed, when they occur with expression.

Vertical “11” lines are caused by the depressor muscles (which pull the eyebrows down and inwards) and the horizontal lines when you raise your eyebrows are caused by the frontalis muscle which acts to pull the eyebrows up and outwards.

It follows that for a good balanced result with Botox treatment, one has to accept a trade-off between the depressors and elevator action. Trying to “freeze” all the horizontal lines in the forehead with Botox will inevitably cause inability to raise the brows. Often this will be noted by patients as being unable to apply their eye makeup or mascara without manually lifting their eyebrows using a finger.

During consultation for Botox treatment, experienced injectors will ask you details of how your previous treatments with Botox or other botulinum toxin such as Azzalure went, did you have any side effects, heavy brows, droopy lids. This is important to understand how you respond and tailor a good Botox treatment for you.

The first 2 weeks are crucial to botulinum toxin treatment producing a satisfactory outcome.
Immediately after treatment, the needle marks may be visible. These will fade over the next day. There is no downtime.
Visible results become noticed in 10-14 days after Botox treatment.