Botulinum A toxins such as Botox® and Azzalure, Xeomin Vistabel and Dysport are all the same drug pharmaceutically. (Names given for information only). These drugs can produce a dramatic reduction in upper facial lines, often with no downtime at all. This preparation was first used in medicine over a hundred years ago. It was readopted in ophthalmology in the 1960's and has become more widespread in its applications. Its cosmetic uses were discovered by chance, in the late 1980s. It is licensed in the UK for cosmetic use on the brow and for medical use. It has been used in aesthetic medicine in the USA for many years.

Are Botulinum toxins safe?

As Botulinum toxin is one of the most powerful neurotoxins known to man, it is naturally surprising to learn that it can have any beneficial effects.

Botulinum toxin is a naturally occurring protein which is produced by bacteria. Botox® is purified and used in very small quantities. It cannot produce any permanent damage. It only attaches to the muscles it is placed in. True, the toxin is the same one that causes food poisoning, but used in very, very much smaller quantities. These medicines are prescription-only drugs that has to be written up by a medical professional. Prescription only drugs cannot be advertised and this is why you will not find any information sheets in the waiting room.

Interestingly, it is not the first time that people have used minute amounts of toxic substances for cosmetic reasons. Italian ladies used belladonna hundreds of years ago to make eye pupils larger.

How does it work?

When Botulinum toxin is injected into target muscles it temporarily puts them to sleep for 3 to 4 months. Botox® has great effect in areas in which "dynamic" wrinkles are produced by continual creasing. The facial skin overlying the target muscle will appear smoother and more relaxed. It can soften wrinkles that are there at rest, as skin has a chance to repair, but cannot erase these static lines. Probably, most desirable, is its ability to stop any worsening of wrinkles.

What areas can it be used to treat?

The upper third of the face is where the best results are obtained: the crows' feet, the upper forehead and the brow. Botulinum toxin can also be used to lift the eyebrow position by a few millimetres and to soften dimply chins and horizontal neck lines. Careful use, will produce reduction in the stringy vertical bands and horizontal lines in the neck.

The Treatment

After cleaning the area, anaesthetic cream will often be applied. Careful measurements will be made and I will ask you to repeatedly frown or squint. Small amounts will be injected with micro fine needles. I like to see and document your results after two- three weeks so that the regime can be improved if necessary.

The down side?

• Bruising may occur. This is not very common but is more likely around the eyes.
• Slight redness, lasting minutes to hours.
• Headache, particularly with forehead procedure and especially with a first treatment: again not common but may require mild painkillers.
• Very rarely; nausea, distant muscle tremors or a 'flu like illness.
• Botox® contains a small amount of human albumin that is collected from pooled blood donations in the United States. Particular care is taken with the control of donors, the manufacturing process and the removal or inactivation of any viral contamination. There is a theoretical risk of virus transmission, but none has ever been reported.

What could go wrong?

The following are complications and are never expected as a part of treatment. They are extremely rare.

• Drop in eyebrow position. This is specific to horizontal forehead lines treatment: Some patients and most men, due to their heavier brows, are not candidates for treatment of the upper forehead. If heaviness occurs, it is only temporary but can take 10 weeks to go. I have produced this complication 3 times in the last 16 years, which again, is much lower than the published incidence.
• Droop of the eyelid. (Medical name - Ptosis) This is specific to brow frown treatment: The drooping is caused by weakness in the muscle holding up the eyelid. This happens in less than 1% of patients and will disappear over a period of 2 - 10 weeks. It is often treatable with eye drops. It may be due to travel of the injected solution and can be reduced by keeping strictly to the aftercare instructions. I have never experienced this complication.
• Double vision. (Medical name-Diplopia) This is generally specific to around and especially, under the eye treatment. This can be due to tracking of injected solution. The problem will probably only last a couple of weeks but is not treatable and will mean driving is not possible. This has occurred in only one of my cases in the last 16 years, which is much smaller than the published incidence.
• "Spock or Diablo" brow, generally specific to horizontal forehead lines treatment. An asymmetric elevation of one or both eyebrow tails is more common that other complications but also very easy to treat.It is thought that high doses and frequent top ups can lead to developing a resistance to the drug such that, it no longer works as effectively. For this reason, it is advisable to have all areas you require treated at one sitting.

What to do after treatment

• Try to remain upright for 4 hours afterwards; no yoga classes or shoe shopping!
• Do not touch the area for 12 hours, work away from eyes and up from the brows when cleansing.
• No air travel for 24 hours.
• No facial massage for a week.
• For the first few hours, feel free to work your face by frowning and smiling! This may help the treatment to work by speeding the absorption of Botox®.
• Wait for up to two weeks for the treatment to work.
• It is a good idea to attend the clinic for a follow up visit any small top-ups required and face mapping after your first treatment. This is in order to tailor the treatment and adjust the dosage to your optimum level.

Who should not have treatment

• Pregnant, breastfeeding or clients trying for a baby.
• Patients who have any diseases that affect muscle activity, for example, Bell’s Palsy, Myasthenia Gravis or Multiple Sclerosis.
• Bleeding disorders or those taking drugs that affect bleeding time e.g. warfarin, heparin, aspirin and glucosamine.
• Drugs that may interact with Botox® examples include; aminoglycoside antibiotics, spectromycin and quinine sulphate. It is also probably safest to avoid usage whilst taking antimalarial quinine based drugs too, although an interaction is only a theoretical problem.
• Surgery or active infection in the area.
• Intolerance to egg albumin (still being debated)

Price of treatment

Botulinum A toxin is charged per unit. An average price is £220 for one area in a female. One area can be defined as the crows' feet or the vertical frown line between the eyebrows or the horizontal forehead lines. Two areas are charged at £260 and 3 areas at £300.

It is worth knowing that men, with heavier musculature, especially across the brow, will probably require higher (and therefore, maybe more expensive) amounts of the drug.

My opinion

Botulinum Toxin treatments comprise the mainstay of my work, amounting to about 60 % of my working week. It is a treatment with almost no downtime which gives really great, predictable results. Care must be taken to keep the look natural: much better to attend a couple weeks later for a small top-up, after all; its easy to add more, but impossible to take it out.

Treatment Clinic in Hassocks, Mid Sussex. 07809 415211