Anti-Wrinkle Injections:

Frequently Asked Questions

Let's have a little chat about wrinkles. My five year old

nephew frowns a lot. He's normally a happy little boy but he's

got a bit of temper on him and he does a lot of frowning. I

love watching him. But when he stops frowning, his frown

lines go away. So why then when we frown do ours become

engrained and embedded? Part of this is because of the

aging process. So at the moment my little nephew's wrinkles

are going away but that process is going to stop unfortunately

for him. Except maybe not as he's got a good connection in

the industry.

What causes wrinkles? There are a number of factors that

cause wrinkles. We know repetitive muscle action creates

wrinkles. We know that as we age our collagen and elastin

breaks down so our skin doesn't repair itself as well which is

why those lines stay in place. We know that our bones even

remodel and that the shapes of our face change as we age.

One of the most important things that occur is that the fat that

sits underneath our skin actually shrinks as we get older and

doesn't hold the skin up as well. So, because of less support

there are more creases in place. Then of course, in terms of

the aging of the top layer of skin, sun, smoking, stress,

weight loss, bad skin care, bad makeup and obviously

genetics all contribute to how fast you're going to age.

I think some people frown so much that they don't even know

they're frowning. They frown in their sleep, they frown when

they're thinking. I haven't had any product for quite a while so

you will see I'll be doing a whole array of facial expressions

tonight during my talk because I’m a very expressive person.

I remember thinking when I couldn't stop frowning, what can I

do to get these wrinkles to go away before I first started in the

industry. I tried facial exercises, I tried massage, I tried skin

care, I probably would have tried everything out there. I never

thought I'd be dabbling in cosmetic medicine but I think I got

to the point when one day I looked in the mirror after a

particularly stressful period. I said, I didn't recognise the face

looking back at me. My father kept telling me how tired I

looked and that’s what really prompted me to explore this

industry.

I was having eight hours of sleep, I was eating organic, I was

doing hot yoga. I was doing everything that I could and so I

just remember thinking if I could just stop doing that face all

the time. It's very hard, very hard to take over full control of

your facial expressions and it's because we've been doing

these faces for such a long time.

So fortunately there is something we can do to stop pulling

those facial expressions. This is our little friend here. I'm

going to talk a little bit about the science of how anti-wrinkle

injections work. You may notice I said I wasn't going to

mention brand names and that's because we're not actually

meant to mention brand names of medications and that is

part of the Therapeutic Goods Administration guideline. But I

can still talk about the science behind the products we are

using.

Anti-wrinkle injections are a purified protein and this protein

actually gets made by this little guy here who is a little

bacteria called clostridium and he's everywhere. He's in our

gut, he's in food, he's in the soil but he's not really doing

much. If the environment is right for him to have a party and

get together with all of his mates then they can produce toxin

in a very large quantity. If ingested by humans orally in the

right amount it can make you incredibly unwell.

But they realised that one of the main side effects from this

toxic effect was you actually get muscle paralysis. So some

smart scientists thought what if we inject just a little, little, tiny

quantities that it is safe, we don't actually see any of these

toxic effects. In fact this was used initially as a medical

treatment in a number of different situations. It is used on

children with cerebral palsy who have muscle contractions to

relax their muscles. It's used in excessive sweating so people

who have excessive sweating under the armpits, people with

muscle spasms of the eyes. So it was used medically before

it was used cosmetically. Then when they realised that

people who were having it done for their eye spasms had all

of their wrinkles going away, they thought well that's a great

money spinner. So then we were able to use it elsewhere in

the face.

Any questions so far? No? All good. I'll just keep rattling on.

So how it works is when we inject it into your skin it gets

taken up by the nerve cell. The signal that gets sent from the

nerve to the muscle that tells the muscle to move, can't get

through. So as long as the product is present there the

muscles are forced to relax. We stop these wrinkles from

forming by relaxing the muscles.

Most people can have this product, there are a few people

that can't have it. So pregnant women, this is a category

C medication so you can't have it if you're pregnant and the

company do recommend that you do at least a three months

wash out before you do have treatment. Having said that,

anecdotally, in a recent dermatology journal I was reading

there have been a few case studies of pregnant women who

didn't know they were pregnant when they had their

treatment and it all turned out to be fine. But I wouldn't hang

my hat on a few case studies which is why I did my big detox.

You are not supposed to have it if you're breastfeeding. You

are not supposed to have it if you have a few different

muscular conditions such as Guillain-Barre syndrome and a

few others where you are not allowed to have it. You can't

have it if you have a known allergy to the product. Also there

are certain religions that don't want to accept human products

at all because there is a little bit of human element that goes

into the product in the manufacturing process.

I'll just run through some commonly asked questions that our

girls in the call center always get asked about these products.

The number one question is how do you inject it and does it

hurt? We inject it using really, really tiny needles, insulin

syringe needles. The number of injection sites you need

varies depending on which muscle groups we're treating.

Because the needles are so small it doesn't hurt but it also

doesn't tickle. I will not lie, it's still a little needle. But we can

keep you comfortable in a few ways and that's by using ice.

Here at VCI we also use nitrous or laughing gas to relax you

if you're a bit anxious. If you're very worried, you can even

pop some numbing cream on for a half hour before the

procedure. I describe it's almost like a little mozzie bite and

certain parts of the face do sting a little bit more than others.

Some certain areas of the face, my patients will say have you

done it already? So it really depends where you're having it.

When does it start working? It starts working in about two

days. So the day you have your injections you don't notice

anything. A couple of days later you realise that you can't

really move that muscle anymore and then its maximum

effect is at the two to three-week mark. It lasts for around

three to four months. Some people do metabolise the product

faster than others. I've seen in some cases it last up to six

months in certain areas and then other people might run out

at about two and a half. Everyone is different. As a general

guide, we normally tell you three to four months.

Can I go back to work afterwards? Absolutely you can. This is

a lunchtime procedure. In terms of potential side effects we

always warn there's a risk of bruising, although it's usually

quite low if you've got a good injector. There is a risk of

swelling and that's normally just a temporary little swelling in

the skin like a mozzie bite from the fluid being injected under

the skin. That usually gets absorbed really quickly, usually

about thirty minutes or so.

When should I start having it? That depends on when your

wrinkles first show up. So I have a lot of people I’m in

conversation with and they'll say “I'm too young to start I'm

only thirty-five. I'll worry about it when I'm fifty.” But the reality

is if you've got lines when you're thirty-five, letting them get

really, really deep makes it harder for us to treat. So the

earlier you come in and recognise these changes the better

because we can completely eliminate them if you come in

earlier enough.

Can I have Botox in my lips? The answer is no because you

will be talking with difficulty because it's a muscle relaxant. So

when we come to lips that will be part of using derma fillers.

How much do I need? That's going to vary. We do find that

sometimes men do need higher dosages than women and

how much you need really depends on how strong your

muscles are in that location.

So you’ve all got a little face there now. Let's have a look. I

will break your face up into three and I will run through the

areas that we can treat with these products. So, upper face,

from your eyes up. We have our forehead and because this

muscle here lifts the eyebrows up we see the emergence of

horizontal forehead lines. Now we can actually inject through

that muscle there. So if you can see lines when you stop

raising your eyebrows, then that would be a good area for

you to start treating.

Not everyone likes to have that area done because people

use their eyebrows to animate. So it's certainly not an area

that everyone would need to have treated. Some people will

complain that they feel too frozen if they can't raise their

eyebrows. Or they just want a little bit in there to soften the

lines. That's also fine but they don't want no movement in that

area.

The other thing is that if you have very hooded eyes, if we

treat your forehead, we can make that hooding worse. So,

some people will come in and want me to treat their forehead

but I have a look at them and they're talking to me like this.

That's because they've got so much skin there that they're

using their forehead to hold their eyes open. In that case I'd

normally refer them to have a blepharoplasty or an eye

surgery done first before we would even think about putting

a product in the forehead muscle. So that's something to be

aware of.

The worst thing that can happen when you're having your

forehead done is one of two things. Either your eyes,

eyebrows drop, flatten and your eyes feel very heavy

from using a too high dosage or you can end up looking like

Mr. Spock. There are a number of celebrities running around

looking like Mr. Spock which is when the lateral portion of the

eyebrow shoots straight up. When they animate, this doesn't

move and this comes really, really high. Now a very mild Mr.

Spock can look good in some women. It can give them a nice

lateral eyebrow elevation. You certainly don't want to do it to

men. There are a few male celebrities that I've seen that

really need a correction of their forehead. The good news is if

we do give you a Mr. Spock look we can actually correct that

in a couple of weeks. But if we do get a flattening of the

eyebrows, we need to let the product wear off in order to

correct that usually.

The other main area in the upper face that we treat is the

frown line. Now I probably would say I treat frown lines the

most. Out of any area of the face people want their wrinkles

gone, most people want their frown line gone. That's because

of two things. One is it can make people look angrier than

they are. I have a lot of women who professionally prefer not

to able to frown because if they are in a position of authority

at work, they look cool, calm and collected. They look really

chilled out under pressure and that actually helps them

professionally.

But the other thing it does is it actually relieves tension head -

aches and migraine. So it's got a few medical applications as

well. It’s a nice little two in one. So when you do a frown line

some people think you can just put one there. It's actually

three muscles that we use to create our frown, so it normally

takes anywhere between three and seven injections to knock

the frown out properly.

In terms of risks with treating a frown, it's probably one of the

safest areas to treat but then again a bad injector could give

you a droopy eyelid on one side or not necessarily a bad

injector. It could happen to the best of us. But if someone

for whatever reason is not being particularly careful, that's

possible. Then a droopy eyelid would take a few weeks to

settle down.

So that's the upper face areas. In terms of dosages for a

typical forehead, people would have anywhere between five

and fifteen units, depending on which brand you're using go

in to the forehead. For the frown it’s anywhere from ten to

thirty units. The average dose would be about twenty units

that I use in most of my patients.

So coming to the mid face, we have crow's feet, we have

wrinkles in the corner of our eyes, and we also have our

bunny lines. They're the ones that you would get from

scrunching your nose. So again crow's feet are a really nice

thing to do. But in terms of the risks and the benefits, they

can alter your smile and not everybody wants that. But some

people want to look smooth and fresher like they did a few

years ago.

The main risk with treating crow's feet is that you can flatten

out the top part of someone's cheek if you inject too low. You

will see some celebrities who when they smile they end up

with a little flat shelf just on that corner. It looks a little bit

unnatural, they look a bit frozen and that's usually because

they've had too much injected here. They wanted to obliterate

all their wrinkles rather than just keeping a couple of little

ones on the outer edge that looks natural and smiley. But

everyone wants to go for different look. You can probably tell

I’m a little bit biased in that I like to achieve really natural

looking results. But it’s horses for causes, everyone has their

own opinion.

Treating these little bunny lines in the middle there is

something that your injector really needs to pay careful

attention to because a lot of women if they can't frown, will

actually start scrunch up their nose when they're angry. So

what we don't want to do is treat you in one area and create

wrinkles in a new area. So it might be when you have your

frown you need a little bit injected around that central portions

as well if you're starting to recruit other muscle groups.

Then, we have our lower face. So from here down. Now we

can treat lip wrinkles, vertical lip wrinkles and we can treat the

sad lines that start to form down here, the corners of the

mouth. We can also stop the chin from curling up which

happens for some people as they get older. Other women will

get a flattening of the chin but many women will get a curling

up here and a drooping down of the nose. So we can actually

use anti-wrinkle injections at the base of the nose to lift it

back up, to lower the chin, to stop the sad lines from forming

and to stop the vertical lip lines from forming.

Pros and cons with treating these areas again are with the lip

wrinkle, I've had one person say that they got breathalysed a

few weeks later and they couldn't blow into the machine

because it reduces the strength of your pout. I think I've had

another lady said she had trouble spitting out her toothpaste

for a few weeks and another say she couldn't pronounce her

P's properly because someone had put an exceptionally large

those in the top lip. So I would always suggest starting small

in that area. The other thing is if you over dose the area you

can end up with a bit of a celebrity pout which not everybody

wants, so again it depends on what look you are looking for.

Treating the lower face area is a brilliant area to treat and it's

probably under treated in many cases. But it will help lift the

outer corner of your mouth that you will find will start to turn

down as you age. If done well it looks completely natural. It's

an area that I know that I need done because often at the

end of my sentence I’ll say ‘mm’ and draw in and down in that

area. If I don’t watch this as I’m getting older, that's going to

creep up and I’ll have those wrinkles to deal with.

In terms of the risks and the benefits, the main thing is if it

leaks into the next muscle you can end up with a wonky

smile. So one side of side of the lip will go up more than the

other when you smile. That's correctable at the two week

mark. So I certainly wouldn't let it discourage you from

treating that area because it's really a brilliant treatment. Only

small dosages are required to treat the lower face. So upper

face is where the big guns come out, lower face we're talking

usually two to four units for the top of your lip. Usually two

and a half for each side here, for the sad muscle and usually

between two and five to treat a chin.

The other area we can use anti-wrinkle injections is actually

in your jaw muscle. A lot of people jaw grind particularly

when they're sleeping. That causes really bad tension

headaches and they flatten their teeth out and they go to the

dentist and they get plates and all manner of things. A little

bit of Botox in the jaw actually will stop that from happening

because you can't clench down as hard.

The other thing we use it for is actually facial slimming. So a

lot of patients who might either workout a lot in the gym,

mainly women, men usually want that nice wide jaw, but

women either workout in the gym. A lot or typically a lot of

Korean or Asian patients don’t like to have that broad jaw

either. I don't think it's unattractive on them, but they want a

slimmer face. By injecting units into the jaw we can actually

just take the edge off and help create that sort of attractive

oval looking face. It can enhance your beauty in many

cases depending on how wide your jaw is.

The last area I'll talk about is we can use anti-wrinkle

injections in the neck to treat the horizontal neck bands. Not

a lot of people know about that use, but treating through

there means you can't go like this all the time. So the neck

looks a lot softer and the horizontal neck bands look a lot

of softer. Again you don't want a bad injector doing that

because you won't be able to get your head off the pillow. So

again probably it’s better to always start with less and put

more in later if it’s not doing what you want it to.

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injections.