Fillers such as collagen, Restylane and Hylform work well for static wrinkles and sleep lines but have minimal impact on wrinkles produced by muscles of facial expression, so called kinetic wrinkles. Over time the effects of the muscles creasing the skin produces a permanent change in the architecture of the skin, leading to a crease line at rest, and deeper wrinkles when the muscle contracts.
Botulinum Toxin type A has been used to treat hemifacial spasm (over activity of muscles) for more than 10 years.
Botox has also been shown to reduce sweating in hands, feet and armpits for 2-8 months for axillary sweating, and 13 weeks to 12 months for palmar sweating.
Botox prevents transmission of nerve impulses to the muscle, thereby temporarily paralysing the muscle at the site of the injection.
After one week the skin wrinkling will be less due to weakness of the muscle. Then the dermis (deeper layers of the skin) starts to remodel, and plump the skin crease. When the muscle activity returns it is then harder for the muscle to crease the skin. Prolonged use of Botox should then prevent further deepening of the crease.
Botox will only work for dynamic wrinkles. It will not have any effect on wrinkles when the muscles are at rest. For example wrinkles due to sun damage, thinning of the skin or gravitational effects. Additional filler techniques such as collagen or Restylane can then be used to smooth out the wrinkles.
If you like to shape your eyebrows this is best done once they have been stabilised on Botox.
Following cleansing of the skin the Botox is administered via a fine needle directly into the muscle. Discomfort is minimised by relaxing the muscle. Stinging as the Botox is injected is common. The effects of the injection due not become apparent for 24 to 48 hours, and maximal muscle weakening is not seen for a week. Complete weakness of the muscle or complete cessation of sweating may not occur. You should not fly for 24 hours after treatment and should stay upright for 90 minutes.
The next treatment should be planned to be done just as the effect begins to recover.
The effects are temporary and resolve between two and eleven months after the injection. The duration of effect is different at different sites, and different with separate injections at the same site.
In one study a small number of patients developed resistance to the injection, such that subsequent injections were less effective.
Spread of the Botox injection may occur to surrounding muscles. This may produce unexpected muscle weakness. The incidence of this is very low, but upper eyelid weakness has been reported in a small number of patients.
Patients treated with therapeutic doses of Botox may experience exaggerated muscle weakness distant from the site of injection. If you have a history of swallowing difficulties or any neurological disorder you should not be treated with Botox.
In some areas, particularly between the eyebrows other muscles may try to work harder to produce a frown. This may result in wrinkles in other areas. Often this can be treated by further Botox injections.
A small bruise (haematoma) may occur at the injection site. This can be minimised by the application of digital pressure immediately following the injection.
Glabellar (between the eyebrows)
Platysma bands (anterior neck ridges)
Treatment of the axilla and feet can be very effective for up to nine months in reducing sweating. Treatment of the hands can result in weakness of the muscles, and should only be considered after a consultation to discuss the alternatives.
You cannot receive Botox therapy if:
Have a local skin infection
You take Warfarin
Pre-treatment may be required of you have suffered from oral cold sores.
A small red spot may be present at the site of injection. This may be removed when dry: usually 30 minutes after treatment, and make-up may be immediately applied.