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Professional Cosmetic Surgery and Healthy Ageing Clinic

Mr Jeya Prakash M.S. F.R.C.S.(Ed) 94 Harley Street London W1G 7HX
020 7224 1622

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Dynamic Sculpting of the Face...

1.   What Is Botox?
2.   Brief history
3.   How safe is it?
4.   Brand names
5.   How does it work?
6.   Prevention is better than cure -
7.   What are the common uses of botox?
8.   What botox cannot help with?
9.   Are there any contraindications to having botox injections?
10. What are the possible side effects?
11. Explain about the actual treatment procedure.
12. What are the pre and post treatment instructions to follow?
13. How long does it last?
14. Response to treatment
15. What are the advantages of having botox?
16. What are the disadvantages of having botox?
17. What are the procedures/treatments that compliment Botox injections?
18. Is it a life time maintenance treatment?  - NO
19. What should I do if I notice anything unusual following the treatment?
20. What will the surgeon do to ensure I don’t have a ‘frozen look’?
21. Is there anything else I should know about before I decide to have the treatment?


What Is Botox?

Botulinum Toxin Type – A is a toxin derived from the bacteria (Clostridium botulinum) usually found in the soil and contaminated tin food. Botox is one of the brand names of this toxin.

Brief history

It has been in use as a muscle relaxant since 1978, for squint eyes, facial spasms, spasmodic neck and spastic legs and was later on also used for lid spasms. The first cosmetic effect was noted and published in 1990 and it has been used for cosmetic indications since then.  It was formally approved by the FDA for aesthetic usage in 2002.

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How safe is it?

Botox is one of the safest treatments. It is a simple procedure that gives maximal results. Even though theoretically there is a possibility of an allergic reaction, the chances of it are remote. The dose of toxin that is injected is physiologically safe and is usually 1/10th of the safe dose used for spasms. It has been safely and effectively used for the treatment of cross-eyes and lid spasms since early 80’s. The effect of the treatment is  fully reversible. The substance cannot cause any permanent damage by travel within the body because it attaches itself to the muscle and cannot migrate from there. Millions of people around the world have had the treatment so far. 

Brand names

There are several manufacturers of botulinum toxin type – A. Some of the leading brands are Botox, Dysport and xeomin.

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How does it work?

It works by blocking the transmission of impulse from the nerve to muscle and temporarily reducing the muscle function. On wrinkle treatment, it acts only on dynamic wrinkles, which are produced by muscle activity attached to the skin. The aim is to weaken the target muscles (not paralyse them), thereby ensuring softening of the wrinkles and not total wiping out of the same

Prevention is better than cure -

Botox injections otherwise known as the Hibernation Treatment is a PREVENTATIVE treatment in aesthetic medicine. In aesthetic usage, the aim is to break the habit of frowning before it gets too strong and educate the patient in his or her facial movement so that one eventually forgets how to frown.

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What are the common uses of botox?

Dynamic wrinkle reduction: Facial lines are caused by the repeated use of the facial muscles in a particular manner.  Just as a freshly ironed shirt will become severely creased at, for example, the elbow as a result of bending the arm, likewise facial lines form whenever we frown, squint or smile.  Some people have a distinctive facial habit – grimacing, raising eyebrows, using one side of their face more than the other – and they will in time see a set of facial lines appear which reflect this individual habit and character. Dynamic wrinkles are expression lines usually seen in frown, forehead, crow’s feet, nose (bunny lines), around the mouth (smoker’s line, smile fold, marionette fold), chin (chin pits) and neck (spasmodic turkey fold). These can be effectively treated with Botox.   

Facial Reshaping: Botox can be used to dynamically sculpt the face with an overall skin rejuvenating effect. There are 2 sets of muscles that shape the face namely those that pull facial soft tissue downwards and those that lift the facial soft tissue upwards. By modifying this muscle activity, by means of treating it with Botox, we can achieve the following – raising the brow gently (medical brow lift), widen the distance between brows, soften the forehead, widen slit eyes, reduce the scrunching of the nose , reduce gum exposure while smiling,  lift the angle of the mouth, soften the upper smile fold, smoothen the chin pits, reduce the jowl, reduce the prominence of the cheek muscles due to excess chewing thereby reshaping the face to achieve a more pleasing look. For further information on facial reshaping please click here.

Botox Injections
have been noted to increase the quality of skin and reduce the tethering and visibility of  scars that are attached to muscle, by repeated long term treatment.

Facial asymmetry (by birth or due to paralysis): Some people have a markedly lopsided face due to an overactive muscle on one side.  Botox treatments can be used to weaken an overactive muscle thereby balancing the resting tone on both sides of the face.

Hyperhidrosis (increased sweating)
: Botox has been used for controlling excess sweating for over 10 years. It acts by reducing the release of the chemical substance from the nerve endings, which induces the secretion of the sweat glands. It is mostly used for the arm pit area and occasionally used for the palms.

Injecting Botox into the trigger spots in the temple, forehead and the back of the neck relieves migraine headaches temporarily, even though the mode of action is unknown.

Muscle sprain: It can be used to treat the pain in the back, shoulder and leg areas by reducing the muscle spasm due to injury.

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What botox cannot help with?

Botox cannot help static wrinkles or folds in the skin. This can be treated with fillers. Botox cannot give the maximal results equivalent to having a brow lift surgery.

Are there any contraindications to having botox injections?

Pregnancy, breast feeding, muscle disorders, nerve dysfunction, previous known allergy to the toxin, local infection at the site of injection, bleeding disorders, patient on antibiotics like amino-glycoside, prior to anaesthesia, high expectation patient and people who require hyper expression eg those in the acting profession

What are the possible side effects?

The possible side effects are bruising, swelling at the site, temporary drooping of the eyebrow and eyelid(ptosis), dryness of the eyes, and rarely skin rash, itching, allergic reaction, dry mouth, slight feeling of nausea and tiredness, brief visual disturbances, muscle thinning and cold like symptoms. Very rarely there is a possibility of headache, sensitivity to light and transient numbness or hypoesthesia. All the side effects are fully reversible.

Atleast 10 week’s interval should be maintained between the doses due to the cumulative effect of the treatment. Frequent injections may lead to lack of response due to antibody production.

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Explain about the actual treatment procedure.

Prior to consultation it is important for the patient to have read all the information provided on the procedure. Photo and video documentations are done for long-term assessment.

People with low pain threshold can request a local anaesthetic cream application for about 15 minutes or so prior to treatment. The area is cleaned using alcohol wipes and the medicine is injected into the muscle along the lines of expression in required areas. The technique of injection is unique with minimal discomfort and is less painful than a dentist injection. The required areas in the whole face can be injected in less than a minute.

Onset of Action: It takes minimum of 3-5 days and a maximum of 2 weeks for the full effect of the treatment.

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What are the pre and post treatment instructions to follow?

Following the injection, application of an icepack to the injected site is recommended for 5 – 10 minutes, to reduce the diffusion of the medicine and also bruising or swelling.

Refrain from touching the area for 4 hours, post treatment and refrain from massaging the area for a week to 10 days.

Remain upright for 4 hours, following the injection.

Basically any activity, which involves pressure, and posture, which aids the diffusion of the medicine to the unwanted places, should be avoided such as sleeping on the face, yoga, and other activities that put pressure on the face.

No facial massages or deep skin treatments for 2 weeks.

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How long does it last?

The results last from 8 weeks to 18 months with an average of approximately 3 months.

Response to treatment

Always wait for the full 2 weeks and not more than 3 weeks to gauge full response to the treatment.

A good responder will see a marked softening of the wrinkles, shaping of the area (in case of facial reshaping), reduction in habitual use of hyper expression, preserving all the movements in a gentle way, without freezing the face. The wrinkles will still be visible especially just above the eyebrow, under the lower eyelid and around the mouth. It is a habit breaking medicine not a wrinkle eraser.

A non-responder will notice marked wrinkles at the end of 2 weeks without any reduction. This is mostly due to developed immunity to the toxin. In such cases a different brand of the toxin can be injected (one with less protein composition) which might be effective. If you think the primary dose is not sufficient please do not wait longer than 3 weeks for a top-up.

An over-responder can experience a frozen look with droopiness of the brow and eyelid. This might be due to excess dose at the site, migration of the product to an unwanted area or individual sensitiveness. Some brands of the toxin diffuse rapidly yielding quicker action and giving a frozen look.

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What are the advantages of having botox?

  • Quick procedure.
  • Very little down time.
  • Maximal results from simple injection.
  • Cost effectiveness
  • Fully reversible if one does not like the effect.
  • Fully reversible side effects, if any.
  • Achievement of a natural relaxing look.

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What are the disadvantages of having botox?

  • Temporary results. (repeat injection necessary for cumulative effect)
  • Does not yield maximal results equivalent to that from a surgical brow lift.
  • Does not improve static folds and wrinkles.
  • Difficult to achieve an optimum result on the lower face areas.

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What are the procedures/treatments that compliment Botox injections?

Fillers, laser peel and facial surgery results can be complimented with Botox injections.

Is it a life time maintenance treatment?  - NO

Botox is primarily intended to reduce the habitual hyper expressions developed over the years. It is a habit breaking medicine not a wrinkle eraser. It is also advisable to consciously reduce the habit so that the results last longer and the habit can be broken quicker.  Stronger the habit, longer the time needed for breaking the habit. Younger individuals with treatment can break the habit over a shorter period while older individuals will need longer with higher frequency of treatment to break the habit.

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What should I do if I notice anything unusual following the treatment?

If you have any concerns regarding the treatment or its results please ring us to discuss them or make an appointment for a visit.

What will the surgeon do to ensure I don’t have a ‘frozen look’?

The surgeon will ensure, he starts with a low dose and increase the dosage only as required. He will make sure that he selects the areas to be treated as a full unit eg upper face, lower face or full face depending on the requirement and patient’s wishes (like painting a full wall rather than splashing at one area). Single site treatment always makes the neighbouring muscles more active, as a compensatory mechanism ,resulting in increased lines in the surrounding areas. The optimal dose is injected in required areas , at optimal time intervals.

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Is there anything else I should know about before I decide to have the treatment?

It is important to choose the right doctor for administration. Ideally a surgeon who performs facial surgery and has seen the muscles inside out is preferable. A surgeon can follow the muscle movement and inject along the same, to produce the most aesthetically pleasing and longer lasting effect with his full understanding of the mechanism of action of the muscles (static and dynamic).

Ensure that the person treating you does not look for a quick one site ‘measure and inject’  jab but has an artistic sense and aims to achieve an aesthetically pleasing look in dynamic facial expression.

Ideally look for a well-established, fully equipped treatment place that can provide better follow-up facilities.

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