Injections of Botulinum Toxin A (Botox®)

By blocking the release of a substance called acetyl choline from certain types of nerve ending. One example of the type of nerve transmission blocked is that between a nerve and a muscle, and another is that between a nerve and certain sweat glands. In this way, for as long as the toxin has an effect, muscle or sweat gland function is inhibited. The duration of action for Botulinum toxin A varies from person to person, and according to how many times an individual area has been treated, but it will usually last between four and six months.

There are several cosmetic uses: most commonly in the treatment of certain types of skin wrinkles, but also to equalise facial and brow asymmetry and to deal with embarrassing under arm perspiration.

• Wrinkles that appear when the muscles responsible for facial expression contract and pull on the skin can be treated very effectively using Botox® or Dysport®. Wrinkles which are commonly treated to good effect with Botox® or Dysport® injections include transversely orientated forehead wrinkles; vertical mid forehead “frown lines” and “crows’ feet” around the eyes.
• Every face is slightly asymmetrical when left and right sides are compared. In some people this is readily noticeable but can be treated using injections of Botox® or Dysport® rather than resorting to surgery.
• The nerves which stimulate the release of the underarm sweat associated with body odour can be blocked using injections of Botox® or Dysport®

Patients who are pregnant, trying to become pregnant or breast-feeding should not be treated.

Anyone suffering from a neuromuscular disorder, such as Myasthenia Gravis or Eaton-Lambert Syndrome, should not be treated.

Certain medications (for instance quinidine and amino glycoside antibiotics) interact with Botulinum toxin A so you must tell me if you are taking any medication. We must discuss it if you are taking aspirin, non-steroidal anti-inflammatory pain killers and drugs like warfarin, which affect blood clotting, because they will make you prone to bruising after injections.

Otherwise, there are few restrictions on treatment with Botulinum toxin A. In general, healthy individuals, without underlying health problems, aged 18-65, with cosmetic problems amenable to this treatment are very happy with their results.

I numb the skin and then inject a very small volume, very precisely, into several areas in the region being treated. I use a tiny needle like that which diabetic patients use to inject themselves with insulin on a daily basis.

Because the skin is numbed, the needle is so fine and only a small amount is injected each time, there is minimal pain associated with these injections. You will feel a stinging sensation for a few seconds. No sedation or local anaesthetic is required, and you can resume normal activities immediately.

You should avoid alcohol for at least two hours after your treatment since drinking increases the circulation in the skin your face and so might theoretically wash the Botox® or Dysport® into unwanted areas causing side-effects.

It takes two days for Botox® or Dysport® to have an effect. The effect lasts between four and six months ‘possibly longer after several treatments. Effects last different periods in different areas, with patients noticing longer durations of action on vertical forehead wrinkles and less on wrinkles around the mouth.

Results will vary according to your skin type, biology and environmental factors (cumulative sun damage and years of smoking). Elderly patients with wrinkles which have been etched into their skin during a life spent smoking and sun-bathing will still have permanent lines in their skin at the site of the wrinkles, even after the action of Botox® or Dysport® has removed the dynamic wrinkle however, these may be amenable to improvement with fillers or after skin re-surfacing.

In general the younger you are when you start having treatment with Botox® or Dysport®, the better your chances of preventing wrinkles from forming.

This is a very safe treatment with any unwanted side effect limited only to the duration of action of the Botox® or Dysport®.

When used in the forehead, there is a potential risk of an upper eyelid becoming droopy after injections. This has been recorded in less than 0.5% of treatments and generally to those who are predisposed to this happening because they suffer from neuromuscular disease, which is something I will seek to exclude during your assessment.

Occasionally, a patient develops a bruise after injections, but to a degree that can be concealed easily with make-up.
Some patients have described mild headaches after injections.