Wrinkle Treatment – Botulinum Toxin Type A

• What is Botulinum Toxin Type A?
• How does it work?
• What areas of the face can it be used to treat?
• Does it cause a 'frozen face' look?
• What are the potential complications and side effects?
• What happens during the treatment?
• What happens after the treatment ?
• Frequently asked questions

Facial rejuvenation is gaining in popularity whilst the array of available clinical options is increasing. One of the signs of ageing is dynamic wrinkles which are created by many years of muscular activity in the face, especially in the brow, next to the eyes (crow's feet), above the mouth and around the neck. One of the most clinically proven options to treat dynamic wrinkles is Botulinum Toxin Type A.

Please note that Wrinkle-relaxing treatments, are available by prescription only in Ireland and so must be administered by a medically qualified person.

What is Botulinum Toxin Type A?
Since its discovery in the 1960's as a non-surgical treatment for children suffering from squints, it has gradually received approval to extend its application for many other uses including facial rejuvenation, and especially for the elimination of dynamic wrinkles.

It belongs to a class of drugs called botulinum toxins, which derive from the bacterium Clostridium botulinum. Although there are seven different types of botulinum toxin (A, B, C1, D, E, F, and G), most of the research conducted to date has focused on type A.

How does it work?
It works by impeding the messages sent from nerves to muscles. The bacterium produces a protein that blocks the release of acetylcholine, which normally transmits messages from the nerves to the muscles to make them contract and move. Once transmission has been blocked, muscles relax, providing relief to patients with overactive muscles, reducing spasms and pain. The effect is completely reversible and generally lasts for three to six months in most clinical uses.

What areas of the face can it be used to treat?
They can be used primarily to treat the following facial areas:

1. The glabella lines between the eyebrows and forehead
2. More pronounced horizontal lines on the forehead
3. The lines on the outside or lateral of the eye (otherwise referred to as Crow's Feet)
4. Downturned lips
5. Mild level of eyebrow droop

It is important to realise that it cannot be used to support sagging face and neck skin, increase the volume of thin lips, or help skin imperfections, such as thread veins.

In order to optimise your facial rejuvenation treatment it can be combined with dermal fillers or other cosmetic procedures including light and laser rejuvenation. For example, wrinkle-relaxing treatments may be used on forehead wrinkles, while adermal filler may be better used to treat lines at the mouth area.

Your Consultant Plastic Surgeon or Dermatologist is the most suitable person to advise you on what option(s) is most appropriate for you.

It is important to note that in Ireland botulinum toxins can only be administered on prescription and hence only medically trained doctors and surgeons can prescribe and perform this treatment.

Does it cause a 'frozen face' look?
Many people are concerned that wrinkle-relaxing treatments may ruin their facial expressions or lead to a frozen-looking forehead that doesn't move when they laugh, smile, or frown. However, an experienced Dermatologist or Consultant Plastic Surgeon will try to make sure that wrinkle-relaxing treatments affect only the tiny muscles being directly treated and not the surrounding muscles. This way, when you laugh or frown, the untreated muscles work normally so your expressions still look like you.

What are the potential complications and side effects?
It is a prescription treatment in Ireland and as such may have some side effects. The risk of side effects is generally reduced by being treated by a Consultant Plastic Surgeon or Dermatologist.

Prior to your treatment you should discuss your medical history and detail any medicines you are currently taking, with your Surgeon. Similarly you should ensure that your Surgeon is aware of your expectations for the treatment. If you have a history of previous allergies to botulinum toxins, or currently have an active infection such as acne around the injection site or a history of disease affecting your nerves and muscles you may not be a suitable candidate for this treatment. Patients who are pregnant or who plan to try to become pregnant soon, or are breastfeeding, should also seek advice on the suitability of this treatment.

It is one of the most studied medicines in the world and has been the subject of many clinical studies whose results have been published in respected medical journals worldwide. According to some of these studies the most common side effects of injections around the eyes and in the face include temporary bruising, eyelid drooping (ptosis), dry eyes, and double vision. Facial droop can occur with injections into the cheek area. It is generally agreed that in the hands of experienced Consultant Plastic Surgeons and Dermatologists, these side effects are considered rare.

In a study of 65 patients who received repeated injections for 10 years, side effects were all temporary and mild and decreased after repeated injections. Examination of the eye muscles has shown that repeated injections do not cause irreversible muscle atrophy (wasting) or any other degenerative changes, and muscle function after injection reverts to normal.

It should never be injected into muscles used for motoric functions such as the eyelids and the lips. It is particularly effective for dynamic wrinkles but not for static wrinkles such as the nasolabial folds on either side of the nose.

In general, any side effects occur within the first few days following injection and are temporary. As expected for any injection procedure, pain/burning/stinging/swelling and/or bruising may be associated with the injection. The most common side effects are headaches, drooping eyelid (this should be temporary and should go away when the effects of the injection wear off), face pain, skin redness, and local muscle weakness.

Please note: that with all treatments there is a possibility of patient dissatisfaction with the outcome.

What happens during the Treatment?
The injection is relatively quick and will usually take only 10 to 15 minutes. The injection site is usually numbed by application of a topical anaesthetic approximately 15 minutes prior to the treatment, alternatively a bacteriostatic saline may be used.

Small volumes (0.05ml to 0.1ml) of it are injected by a needle with a small gauge into the muscle or muscle area over a short period of approximately 20 seconds. The contractions of the area treated can greatly reduced thus eliminating wrinkles. The insertion of the needle should only provide a tiny pin prick sensation as very small gauge needles are used.

For the brow area usually only five injections are made, for the eye area only two or three injections are performed.

The effect is usually noticed after two to five days and should last from three to six months. The effects of subsequent injections may be apparent for slightly longer.

What happens after the Treatment ?
To increase the effectiveness of the treatment you should try to use the respective muscles as much as possible for approximately 30 minutes after the injection. You will be advised to abstain from touching or massaging the injection area for 24 hours. The anaesthetic is purely localised and you can return to work immediately.

You will need to repeat this treatment for optimum outcomes every 4-6 months.

Please note that Wrinkle-relaxing treatments, are available by prescription only in Ireland and so must be administered by a medically qualified person.

Frequently Asked Questions

Below are some of the most frequently asked questions about wrinkle-relaxing treatments.

What is botulinum toxin type A?
Botulinum toxin type A is a prescription-only medicine that's administered to temporarily relax the muscles that produce moderate to severe frown lines between the eyebrows (glabellar lines). Administered correctly by a trained medical professional, it can give you a noticeable temporary improvement of moderate to severe frown lines, creating a subtle, more relaxed look.

How do wrinkle-relaxing treatments with botulinum toxin type A work?
During wrinkle-relaxing treatments, very low doses of botulinum toxin type A are injected into the small muscles that cause wrinkles. Each injection relaxes these muscles, smoothing the lines. Once these tiny muscles are relaxed, they no longer contract to form wrinkles.

When will I see results from my wrinkle-relaxing treatment?
Within days you should see an improvement in the wrinkles between your eyebrows. However, it may take between two to three weeks after the treatment for the full effects to be seen.

Is it a dangerous poison?
Botulinum toxin is potentially a dangerous poison but, as tiny doses are used for cosmetic purposes, it has been clinically proven to be safe when properly administered. There is a huge volume of clinical research studies that have been published in respective clinical journals worldwide proving the safety and efficacy of this treatment. It has been in use since 1973 and more and more applications are being approved.

Can Wrinkle-relaxing treatments lead to 'frozen-looking' facial expressions?
A lot of women worry that wrinkle-relaxing treatments may ruin their facial expressions or lead to a frozen-looking forehead that doesn't move when they laugh, smile, or frown. However, an experienced surgeon will try to make sure that wrinkle-relaxing treatments affect only the tiny muscles being directly treated, not the surrounding muscles. This way, when you laugh or frown, the untreated muscles work normally so your expressions still look like you.

Are Creams that contain Botulinum Toxin Type A like substances very effective?
No, it is best delivered by injection which ensures that it reaches the target muscles.

How long will the results last?
Your results should last about three to six months, and the effects of subsequent injections could last longer.

Are there any side effects?
Side effects may include soreness, swelling or mild bruising around the injection site. In rare instances patients may experience a droopy eyebrow or eyelid: this side effect tends to be temporary and disappears when the effects of the injection wear off. Headaches can also occur.

Before starting treatment you will want to discuss your medical history and what you can expect from your treatment with your consultant. Wrinkle-relaxing treatments should not be used if you have a history of previous allergy to botulinum toxins. They may not be suitable for those with an active infection such as acne at the injection site or a history of disease affecting your nerves and muscles.

In summary, any side effects occur within the first few days following the injections and are temporary. The risk of side effects may be reduced by going to an experienced Consultant Plastic Surgeon or Dermatologist.

What other conditions can it be used to treat?
Studies have shown it can relieve migraine headaches, excessive sweating, uncontrollable blinking and muscle spasms in the neck and eye. It is also used to help treat overactive bladders, control pain during operations, help children with cerebral palsy, prevent ringing in the ears, assist diabetics with weight gain and control drooling in some cerebral palsy patients.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.