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Botulinum toxins have revolutionised our approach to facial ageing, particularly in the upper face.
They work by blocking the signals traveling from nerves to muscles, stopping the muscle from being able to contract. Contrary to popular belief, botulinum toxins do not paralyse muscles but rather relax them.
The art of injecting botulinum toxin lies in altering the delicate balance between the muscles of facial expression. These muscles can broadly be divided into two main groups: those which lift the face up and those which pull the face down. The goal of botulinum toxin treatment is to weaken the muscles which pull the face down, enhancing the effect of the muscles which lift the face up.
Brands of Toxin
There are currently three different brands of botulinum toxin licensed for cosmetic use in the UK. The first, and oldest, is called Vistabel, the next is Azzalure and the most recently introduced is called Bocouture.
There is great debate over which brand is best although my feeling is that it is not a simple case of one brand being better than the other: they are simply different drugs and have different clinical effects. This is especially true for Azzlaure which has a much broader zone of diffusion in comparison to the other two brands.
I find this really useful in areas where I want to have a broad effect, for example around the crow’s feet and in the frown lines. In other areas however, where I want to have a more restricted effect – especially on the forehead – Vistabel or Bocouture is my preferred choice. As a result, in any given patient I will sometimes use two different brands of toxin on different parts of the face to achieve the best result.
How often should I have treatment?
Most people will find the muscle relaxation begins to wear off at around 3 months. However, when the muscle movement begins to increase, there is often a lag period of another month or so before the lines and wrinkles begin to re-appear. It is when the lines and wrinkles begin to re-appear that you should think about having further treatment.
In the first year of a treatment program you will most likely find that you need to have the treatment done approximately 3 times (ie not much longer than 4 months per treatment). In the long term however, you should aim to have the treatment no more than twice per year, allowing muscle recovery in between treatments to mimise long term muscle atrophy. In the very long term, after you have been having treatment for a number of years, you may find you only need to have the treatment carried out once per year.
Side effects and complications
Treatment of the upper face is, usually, an almost pain free procedure. The needles used are very small and with good technique it is almost always possible to avoid causing bruising.
The most common side effect from botulinum toxin injections are headaches. These can affect up to 1 in 10 people. For most people it settles down within a day or two, however in some people it can take up to a couple of weeks and I have seen one or two patients who have found the headaches lasted the whole three month duration of the treatment. For most people however the headaches are very mild, self limiting and it is unusual to require any type of pain killer for them.
Complications from botulinum toxin can occur by the toxin spreading to near by muscles that were not intended to be targeted by the treatment. In the upper face this can cause temporary drooping of the eyelid or eyebrow. Because this usually happens as a result of a small amount of toxin spreading to the wrong area, rather than a direct injection into the wrong area, it tends to wear of quite quickly – usually within a couple of weeks. In the lower face and neck, it is possible for the toxin to diffuse into muscles which help to move the mouth resulting in a lop sided smile. Rarely, toxin treatment in the neck can affect speech and ability to swallow.
A SELECTION OF SHOTS FROM OUR BEFORE AND AFTER GALLERY
If you could like to know any more about Botolium Toxin treatment please feel free to call us on 0800 011 2729.
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Upper face treatment £250
Upper and lower face treatment £300
Neck treatment £250
Full face and neck £450
Excess sweating £450