The injections use a neurotoxic protein which is produced by the bacterium Clostridium botulinum. In large doses, this is the same bacteria that can cause botulism, a rare illness leading to widespread paralysis. Cosmetic procedures use microscopic amounts of heavily diluted protein that is not dangerous and is able to weaken muscles in a controlled manner by carefully injecting small doses known as “units”.
There are two commonly used formulations of this protein; they are both equally effective, however, if one has previously worked for you or you have a preference, this can be accommodated. As each brand is differently formulated, units of one brand are not equivalent in number to units of the other brand. It you have had previous injections, it is useful to know which brand you had and also how many units you needed to achieve your desired effect. Men require more units than women.
Anti-wrinkle injections work by relaxing the muscles in the are of injection by blocking nerve impulses. This means the muscle contraction weakens and as a result this softens the appearance of wrinkles. It usually takes 48-72 hours to begin to see improvement but may take longer in some people. Effects last from 3-4 months. However, with each repeated injection most people find that when the wrinkles return they are less pronounced and also less frequent injections are needed. This is because repeated muscle contractions, which result in wrinkles developing and becoming deeper, have been prevented.
Anti-wrinkle treatments are administered by using a series of accurately planned injections into the muscles with an extremely fine needle. Discomfort is minimal and no anaesthetic is required. Ice is often applied briefly before each injection to reduce any pain and afterwards to minimise bruising. It is important to stop any drugs that may increase the risk of bruising such as aspirin, non-steroidal anti-inflammatory drugs and fish oil a week before the injections. The procedure does not take more than a few minutes and the redness around the areas that have been injected settles very quickly.
-brow furrow lines (glabellar lines)
-transverse forehead lines
-nasal creases “bunny lines”
-creases around the mouth “marionette lines”
-drooping of the corners of the mouth
-excessive dental show during smiling “gummy smile”
-masseter injection to reduce the width of the lower face
-neck bands “platysmal bands”
-excesssive sweating (hyperhydrosis)
The most commonly used fillers are those made up of a naturally occurring substance in the body, hyaluronic acid. It is a type of type of polysaccharide and found extensively in connective tissue. It binds water and can be thought of as the body’s internal moisturiser. When injected under the skin, filler draws water in, and by doing so, smooths out wrinkles and gives an appearance of fullness at the site of injection. It’s injection also has been shown to increase the body’s own endogenous production of collagen. This means over time, less filler is required upon re-injection.
It is an absorbable filler and depending on the viscosity of the particular product, it can last anywhere from 6 months to up to 2 years in certain areas. There are various formulations designed to be injected in different parts of the face. They are formulated with local anaesthetic, so injection is well tolerated, often without needing extra anaesthesia. For comfort during injections, strong topical local anaesthetic cream is applied for about an hour prior to injection.
Dr Matousek carries all the commonly used and tested brands of filler. Although it is non-permanent and eventually absorbed by the body, and reinjection is likely to be required in the future, it is a far safer option than some of the permanent fillers on the market. Permanent fillers carry the risk of irreversible complications that outweigh the benefits of not requiring repeat injection. These include lumps under the skin known as granulomas which are caused by chronic inflammation in an area, and can potentially become infected and need surgical removal. This can lead to permanent scarring and a distorted appearance therefore, Dr Matousek does not offer permanent fillers. The advantage of non-permanent filler is that there is a substance available to immediately dissolve any lumps if they form.
Most people only have mild swelling and bruising following injection, which settles in a few days. It is advisable to cease all medications such as aspirin, non-steroidal anti-inflammatories and fish oil all of which can make bruising worse. The degree of bruising and swelling can be somewhat unpredictable, so it is better to plan filler injections with a few days of recovery time. The majority of individuals are able to go out in public the next day, however, some areas may bruise more than others.
–deep lines not responsive to botulinum toxin eg forehead or glabellar area
-fine lines around the mouth, upper lip and chin (often best used here in combination with botulinum toxin)
-“tear trough” area under the lower eyelids
-rejuvenation of the back of the hands
Are injectables now replacing surgery? What about the liquid face lift?
Many people have been put off having injectables due to the strange appearances of certain individuals photographed in the media. Excessive use of fillers can lead to “pillow face” or “trout pout” whist over-injection of muscle relaxing agents can lead to a mask-like face or “bat brow”. This is avoidable if only small amounts of product are used and titrated to the individual’s needs. In many areas, it is advisable to space injections and do two sessions a few weeks apart to avoid the risk of looking overdone. In the case of filler, the product does draw water into the area over the few weeks following injection, which can be variable.
Inappropriate use of these products as a substitute for an area which would be better served by surgery can lead to a bizarre appearance where the person looks different rather than youthful. As well, many non-surgical treatments can end up looking more obvious than well-planned surgery. Ageing of the face is a combination of wrinkle formation, volume loss and descent or sagging of the tissues. Whilst filler is able to address the loss of facial fat, and muscle relaxing agents and filler can help with treatment of wrinkles, as ageing progresses, surgery is often a better solution. This is because lifting is required to achieve optimal results, especially in the lower face and neck, which cannot be achieved with injectables.