Q. Who should not be given Botox treatment?
Almost anyone can have Botox treatment however there are some important exceptions. Patients who are pregnant or are breast feeding, those with certain neurological diseases or medical conditions or who are on certain medications should not have Botox. You will be asked to complete a health questionnaire and also be asked further questions by a doctor to ensure that there are no medical reasons why you should not have the treatment.
Q. Who is a candidate for Botox?
Men or women of any age who have prominent wrinkles, frown lines or furrows particularly in the upper part of their face will usually respond well to this treatment. An easy way to see if the treatment is likely to work is to contract the muscles of the face near the wrinkle and see if it becomes deeper. If it does then Botox is almost certainly likely to help. Anyone with excessively sweaty armpits or hands can also benefit from treatment.
Q. How does injecting Botox into a muscle reduce wrinkles?
By using facial muscles repeatedly throughout your lifetime, the skin becomes creased in the areas of greatest use for example around the eyes (crow’s feet or laughter lines) and on the forehead (worry lines and frown lines). This, coupled with natural thinning of the skin as part of the aging process, causes the creases to become permanently visible even when the muscles are not contracting. This can make your face look older or give the face a worried or stern appearance. By reducing the movement of the muscles in these areas, the skin stops being creased and causes the lines to soften or even fade away with repeated treatments. If you have deep wrinkles then Botox treatment may not be entirely effective and other techniques such as wrinkle fillers may be a more appropriate treatment. If the wrinkles are caused by permanent skin damage from exposure to the sun, Botox is again not usually effective and you may wish to consider skin resurfacing treatments.
Q. Are the results permanent?
No. On average the effects of a treatment will last about 3 or 4 months. You may need several treatments before the skin recovers enough to for the more permanent wrinkles present at rest to disappear completely. As a general rule three or more treatments are needed each year to prevent recurrence of the wrinkles maintain the effect of Botox however there may be a gradual lengthening of the time interval between treatments over the years. It is possible to develop resistance to the treatment but this is very rare.
Q. How does Botox work?
If Botox is injected into or near a muscle it attaches itself to the junction between the nerve and the muscle stopping the transmission of nerve impulses to a muscle causing them to become weakened or inactivated. If injected into the skin of the armpits, hands and soles of feet it can also block the nerve impulses to sweat glands and so reduce the amount of perspiration produced. Only tiny amounts are used and so only the area within 1 cm of the injection site will be affected so it does not have an effect on the rest of the body. Although it causes permanent blockage of the nerve endings new nerve endings grow out to the muscle over a period of months allowing the muscle to respond to the nerve impulses again. This means that any effects of Botox will only usually last 3 or 4 months (slightly longer if done for excessive sweating).
Q. Is Botox treatment safe?
Botulinum toxin injections have been used by millions of patients around the world over the last 30 years. In 2003 quite extraordinary 2.2 million Americans had Botox treatment and the numbers are increasing every year as cosmetic treatment it is becoming more popular and acceptable. It is also used in an increasing number of medical conditions such as squints, muscle spasms due to cerebral palsy or strokes, some voice disorders, tension headaches and even anal fissures – to name but a few. In some of these medical conditions very much higher doses are given than are used to treat the small muscles of the face with relatively few side effects. Although it is a toxin when given in a controlled and responsible manner it is safe and has an excellent safety record with no serious generalised side effects reported. Only in extremely rare cases have individuals developed an allergy to the treatment or resistance, i.e. it has little or no effect on the injected muscles.
Q. Are there any side effects?
There are very few. You may get a few pinprick marks and possibly a little redness and swelling at the injection sites. Occasionally you may get some localised bruising which may last for a few days although this is uncommon. If this is noticed ice cubes can be applied to the area 3 or 4 times a day for 10 minutes until it settles. It is possible to develop a drooping eyelid or brow (ptosis) or even double vision (due to a squint) but these side effects are very rare (< 1%), usually only last a few weeks and always resolve spontaneously. If drooping of the eyelid does develop special eye drops (apraclonidine) can be prescribed which counteracts the effects and helps lift the eyelid back into its normal position. Sometimes the eyebrow position may alter and the edges become raised. If this is a problem a further dose of Botox can be injected above the outer eyebrow to let it drop back into position. If you experience any worrying side effects you should ring the clinic for advice.
Q. What happens during the procedure?
A fully qualified and trained nurse will see you to check that there are no medical reasons why you can’t have the treatment. The actual injection procedure will be performed either by the doctor or an appropriately trained clinic nurse under his/her supervision. Firstly the skin of the face is wiped clean and then multiple small injections are given just under the skin. As the needle is extremely fine and only very small amounts of liquid are injected at each site there is very little discomfort but you may notice a stinging sensation for a few seconds. We often advise you have just one area treated on the first occasion so that you can get used to the procedure. Most people do not require local anaesthetic cream (unless you are having your armpits done) but do discuss this with the nurse if you are concerned about this.
Q. How long does the procedure take?
The initial consultation takes approximately 30 minutes and each injection session takes around 10-20 minutes, depending on the number of areas to be treated.
Q. What should I do after the treatment and can I return to work and drive afterwards?
It is a good idea to exercise the muscles for 2 hours after injection by frowning and smiling as there is some evidence it speeds up the onset of action of the Botox. There is no restriction on working or driving afterwards and you can go straight back to work if you wish. It is best to avoid jogging, gym workouts and saunas on the day of the procedure and also avoid massaging the areas for 4 hours to avoid spreading the Botox so that it does not have unwanted effects on other nearby muscles. We also advise keeping your head slightly elevated on the first night to help reduce any swelling and bruising.
Q. When will I see results following my Botox treatment?
Results are usually seen within 4-7 days but full effects may take up to 2 weeks to be seen. You will be offered a review appointment at 2 weeks to assess the response and perform further ‘top-up’ injections into the treated areas (at no extra cost) if necessary.