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Frequently Asked Questions 

Anti wrinkle injections

 

Anti-wrinkle injections use botulinum toxin A, a naturally occurring toxin, to eliminate wrinkles. Botulinum toxin A binds to receptors on muscle cells, preventing their nascent neurotransmitter from binding to them and therefore blocking muscular contraction. This creates a smooth appearance of the overlying skin. 

Which areas can be treated by anti-wrinkle injections?

  • Horizontal forehead lines 

  • Frown lines 

  • Crow's feet 

  • Brow lift 

  • Bunny (nose) lines 

  • Lip flip 

  • Perioral (smoker's) lines 

  • Downturned corners of mouth 

  • Cobbled chin 

  • Masseter (for jawline slimming or tooth grinding/ TMJ dysfunction) 

  • Neck (Nefertiti neck lift) 

  • Underarms to stop sweating 

The most commonly treated areas are the forehead (frown lines and horizontal lines) and crow's feet. Other areas include 'bunny lines' next to the nose perioral (smoker's) lines and cobbled chin, As well as creating a smooth appearance of the skin, anti-wrinkle injections can also be used to create lifting e.g. of the eyebrows and the corners of the mouth. They can also be used to drop the lip in individuals with gummy smiles. In addition to affecting skin, botulinum toxin A can be used to stop sweating e.g. underarm sweating, and injections into the masseter muscle help to slim the jawline and treat temporomandibular joint dysfunction and tooth grinding. 

 

How quickly do anti wrinkle injections take to start working and how long does their effect last?

 

Anti-wrinkle injections do not work immediately, most people will start to see an effect after 5-7 days and the maximal effect is seen 2 weeks after treatment. If unwanted residual movement remains at this point a top-up can be used to minimise this. After 2 weeks the effects gradually start to wear off. Thicker muscles regain their movement faster than thinner muscles, so frown lines tend to return before horizontal lines. The duration of treatment depends on many environmental and genetic factors. Factors that speed up breakdown of toxin are fast metabolism, regular exercise and use of sunbeds. Anti-wrinkle injections typically last 3-4 months. The duration of effect will increase over time as the muscle thins from disuse. 

Are anti wrinkle injections safe?

 

Yes! Anti-wrinkle injections are one of the safest aesthetic treatments available. There are only a few contraindications to them and these include patients with neuromuscular disorders such as Lambert-Eaton syndrome and myasthenia gravis, women who are pregnant or breastfeeding and those who have previously had a reaction to botulinum toxin A. The amount of toxin injected is tiny when compared to a toxic dose and is injected locally into the muscles rather than into the bloodstream so systemic effects are not seen. Possible side effects, as with any invasive treatment, include bleeding, bruising and infection. There is a very small risk of temporary drooping eyelids but this should not occur if the product is injected into the correct area. 

What is a top-up and do i need one?

 

A top-up is when we reassess the results at 2 weeks and add more product to specific areas if required. It does not mean a repeat in the full treatment and it must be done between 2-4 weeks post the initial treatment. Personal factors affect the effectiveness of the treatment and this, along with the client’s individual desired effect, determine whether a top-up is required. The top-up is included in the initial treatment cost but it is the patient’s responsibility to request a top-up in the required time frame.

 

 

Aftercare instructions

 

Following your anti-wrinkle injection treatment you must abstain from the following: 

  • Avoid intense exercise for 24hrs

  • Avoid rubbing the area for 24hrs- no exfoliation, no microdermabrasion

  • Avoid applying makeup to treated areas for 4hrs to allow the holes to heal over and prevent infection

  • Do not go to sleep or lying for an extended period for at least 3hrs after treatment- gravity is required to spread the product through the muscles 

  • Avoid excessive alcohol for 24hrs after treatment to reduce risk of bruising 

  • Do- practice facial expressions e.g. raising eyebrows and frowning inwards, for 30 mins after treatment to help distribute the product throughout the muscle 

 

What to expect following your treatment 

  • You will start to see an effect at 3-7 days with maximal effect at 14 days

  • Top-up from 14-21 days if required

  • Natural course of treatment: maximum effect is seen at 2 weeks. Some people will achieve a fully frozen appearance whereas others will have some residual movement. We cannot guarantee a full freezing effect, even after a top-up, as this depends on internal factors of the client. In those who do achieve full freezing effect, this will last for up to 2 weeks, after which point movement will start to return. This generally occurs first where the muscle is at its strongest. Gradually all movement will return.

  • Note: duration of treatment depends on many factors including non-modifiable intrinsic factors such as metabolism and modifiable lifestyle factors such as frequency of exercise, use of sun beds etc.

  • Average duration of treatment 3-4 months, although for some patients this will be longer and others shorter. Generally repeat treatments, if administered before the muscle regains its full strength, lengthen the duration of the treatment effect up to a maximum. This cumulative effect is particularly evident after the first few treatments.

  • When to book in for repeat treatment- It is time to book in for a repeat treatment when pulling a facial expression, such as raising your eyebrows, triggers formation of fine lines. This creation of dynamic lines risks skin forming static lines.

Dermal fillers 

Dermal fillers are used for volume replenishment. The active ingredient in dermal fillers is hyaluronic acid, one of the natural constituents of our connective tissue. Hyaluronic acid is hydrophilic, meaning that it attracts water, giving a more plump appearance to the overlying tissue. As we age we lose volume as our natural hyaluronic acid and collagen stores deplete. We also lose skin elasticity, leading to sagging and wrinkling of the skin, along with hollowness of the cheeks and orbits. Dermal fillers can restore this volume loss. They can also be used to artificially create volume in those who lack it naturally. We can use different density (thickness) fillers to create different effects. For example, if we want to fill the tear trough (sunken under eye) region we use a thin filler to prevent a puffy or lumpy appearance. If, on the other hand, we want to strengthen the chin or increase the prominence of the cheekbones, we need to use a thick filler that will replicate bone. 

Which areas can be treated with dermal fillers? 

Many areas can be treated with dermal fillers. These include: 

  • Nose- the 'liquid rhinoplasty' can be used to smooth out bumps in the nose and elevate the tip, giving a more refined appearance 

  • Tear troughs- these are the hollow regions under the eyes. Note- filler cannot be used to help with eye bags or hyperpigmentation of the skin under the eyes 

  • Cheeks- thick filler can be used either to restore volume to the cheeks that has been lost with age or to create a more defined appearance of the cheekbones. 

  • Nasolabial lines- these are sometimes referred to as smile lines and extend from the corners of the nostrils to the corners of the mouth 

  • Lips- There are many techniques that can be used to augment the lips depending on the client's desired look. 

  • Marionette lines- sometimes called puppet lines, these are the lines that extend vertically down from the corners of the mouth. They deepen with age 

  • Chin- Chin filler can be great for balancing the profile, creating a more harmonised appearance. It is often used in conjunction with jawline and cheek filler. 

  • Jawline- jawline filler aims to create a more defined appearance of the jaw, often in combination with chin filler. Note- this may not be suitable for all clients, especially if there is excessive sagging skin or a high concentration of fat under the chin 

How quickly do dermal fillers take to start working and how long do the effects last? 

Dermal fillers give an immediate result, although there is often swelling and bruising in the initial period that will take time to settle. The hyularonic acid in the filler will also take time to attract water and create its plumping effect. Expect to see your final results at 2 weeks. The duration of action of dermal fillers depends on many factors, both genetic, environmental and related to the product. Thinner product tends to be broken down by the body faster than thicker filler. Lip fillers generally lasts between 9-12 months, whereas nose fillers lasts between 12-18 months. 

Are dermal fillers safe? 

Dermal fillers carry more theoretical risks than anti-wrinkle injections. Contraindications to dermal fillers include previous allergy to dermal filler or local anaesthetic, which is found combined with many fillers (note individuals with local anaesthetic allergy can still have filler but they need to inform their practitioner so that they can obtain filler without anaesthetic in it), pregnancy, breast feeding. We avoid administering lip filler in individuals with active cold sores and certain drugs, such as isotretinoin (roaccutane) can increase swelling. Patients taking blood thinners, such as warfarin, apixaban, rivaroxaban and dabigatran, are likely to experience more bruising but they may still have dermal filler treatments if they desire. 

Do i need a top-up of dermal filler? 

Most dermal filler treatments do not require a top-up, although areas that may require top-ups are the nose and tear troughs. Your results will be assessed 2-weeks after the initial treatment and a decision made as to whether a top-up is needed. If required, top-ups are included in the price of the initial treatment. 

What to expect 

At your appointment you will first have a thorough consultation where we will discuss your hopes for the treatment. I will assess your suitability for the desired treatment and will offer alternatives or additional treatments that would improve your results if applicable. Once we have decided on a treatment plan i will ask you to sign a consent form, if you haven't already. I will then take before photos and then apply numbing cream if applicable. Around 10 minutes later we will start the treatment. The fillers themselves contain local anaesthetic so you will have a dual numbing effect from the numbing cream and the filler. 

Aftercare instructions 

  • Avoid touching and rubbing the treated area, or applying make-up for 4 hours

  • Avoid extreme heat/cold for up to 1 week post treatment

  • Abstain from Alcohol and heavy exercise for 24 hours

  • Stay out of Sunlight/UV radiation until redness and swelling has resolved.

  • You may find it helpful to apply iced gauze to the treated area

  • You may experience bruising to the affected area. This can take up to 2 weeks to resolve. Arnica cream can be used to speed up the healing process.

  • If you have had dermal filler on your lips then you can expect your lips to continue swelling for 24 hours after your treatment. The swelling will then slowly subside and should mostly resolve by 2 weeks, when your final result will be visible.

  • Anti-histamines, such as piriton, can be taken for the first few days to help reduce swelling 

  • Dermal fillers can last anywhere between 6 -18 months

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