Anti-Wrinkle Injections

The cosmetic form of botulinum toxin, often referred to by its product name Botox®, is the most popular non-surgical cosmetic product. Delivered by injection it temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralysing the muscles that cause wrinkles, giving the skin a smoother, more refreshed appearance.

It can also help to correct facial symmetry and reshape features without surgery in the forehead, around the eyes and mouth and in the neck. For example, Botox can help to raise an eyebrow or prevent your mouth turning down at the corners by paralysing the muscles that drag features down.
The injections are usually painless, and unless you get a bruise, invisible. The Botox starts to work after the first few days and reaches maximum effect by 2 weeks. For most people Botox lasts for 3 to 4 months. As it wears off you will start to be able to frown more deeply again. By 6 months the Botox will have fully worn off. 98% choose to repeat the treatment.

It is often used in conjunction with an eyelid lift (blepharoplasty) or fillers.

Before it was adopted for aesthetic procedures, Botox had been used for many years to treat tics and other medical disorders. As well as using Botox in cosmetic procedures, Mr Kamalarajah administers Botox in his minor ops sessions at the Royal Victoria Hospital, where he treats patients with:

  • Involuntary blinking of the eye (blepharospasm), repetitive twitching of the muscles on one side of the face (hemifacial spasm) and related facial spasms (facial dystonias).
  • Aberrant facial nerve regeneration.
  • Corneal exposure (therapeutic ptosis).

Your initial consultation is crucial to the success of any treatment.

It is your chance to explain and discuss your hopes and fears, so it may help if you write down a list of ideas and questions in advance. You may want to bring along a friend or family member for moral support or to ask additional questions.

It allows Mr Kamalarajah to review your medical history and lifestyle, photograph you (with your permission), assess your suitability for treatment and explain your options.

Finally, you can discuss possible procedures together so that you have a thorough understanding of what can be achieved and what risks there might be.

After the consultation, Mr Kamalarajah will write to your GP summarising the consultation.

Botox is injected into a muscle with a fine needle, causing a temporary paralysis that allows lines to soften. Effects are usually seen between three and five days and last for approximately six months. Repeated injections lead to a gradual weakening of the muscles.

Cooling with ice packs helps reduce any discomfort.

  • Side effects are uncommon — you may feel a mild burning sensation with the injection or experience some tingling for up to two or three days after treatment.
  • Minimal bruising may occur.
  • There may be some mild redness of the skin — this usually lasts only one or two hours.
  • Rarely, there may be weakness of nearby muscles if Botox spreads unexpectedly.
  • If treatment is being given for medical reasons to the deep areas of the eyelid, there may be temporary double-vision if the Botox spreads unexpectedly.

The risks of Botox are minimal but include:

  • 
Bruising from the injection.
  • The lateral brow peaking. This is comparatively common and is essentially an overactive frontalis muscle pulling the lateral eyebrow too high. The cure is to place a tiny amount of botox at the apex of the peak.
  • A lower resting eyebrow position. This can occur when the forehead is treated to eliminate horizontal forehead lines. As the frontalis muscle is no longer pulling the eyebrows upwards they slip down into their resting position. There is a risk that this resting position is considered too low, making the upper eyelid more hooded. This risk increases with age. This risk can be minimised by reducing the Botox dose delivered to the forehead, and making sure the muscles that pull the eyebrows down are fully treated. If this eyebrow drop occurs there is unfortunately no quick fix. The Botox to the forehead will wear off and the frontalis will start to pull the eyebrows upwards again in a few weeks. The key is to use less Botox to the forehead in the future, but there is therefore an inevitable trade off between a smooth forehead with lower eyebrow, and a higher eyebrow but with more horizontal forehead lines.
  • Mickey mouse smile. This occurs when the Botox at the crows feet area prevents the orbicularis muscle tightening when you smile. The deeper smile muscle that lifts the corner of your mouth then lifts your cheek against a smoother lateral eye area, generating a single deeper “mickey mouse” crease. There is no quick fix for this. The appearance will improve as the Botox wears off and the key is to use less Botox to the lower parts of the crows feet in the future.
One of the reasons Botox is so popular is that there is no long term risk. The Botox effect will wear off leaving you totally back to normal in 6 months.