Thinking about Botox?

Cosmetic Injectables are on the rise. This week, a high street beauty store has announced they are planning to introduce a budget service into their stores (the jury is still out on that for me) and you can’t open a magazine, or social media app, without being faced with flawless, filtered faces. So what is botox? How does it work? And most importantly, what are the risks?

My desire for wrinkle – free skin, was how I got into aesthetics in the first place. I put a request out to Facebook for a decent eye cream, as I’d noticed the fine lines getting worse. Almost everyone who replied said “Just get botox!” I had no idea everyone was doing it, just no one was talking about it (a bit like internet dating!) I looked into it, and the more I read about poor practice and standards, for example in the Department of Healths Review of the Regulation of cosmetic interventions, available here, I decided I could train and be one the many practitioners who work to a high standard.

In this post, I’m going to tackle some of the myths surrounding one of the most popular non – surgical cosmetic treatments, and what you should know as a client.

So, what is it?

Botox is actually a brand name. Cosmetic toxins are largely Botulinum Toxin Type A. It is a neurotoxic protein, derived from clostridium botulinum (yep, a bit like food poisoning) And yes, it is technically a lethal toxin. However, in the doses used for cosmetic and medical indications, are largely safe for the majority of people. The boring science – type bit is that the toxin binds to nerves which use acetylcholine (neurotransmitter) and blocks that effect, causing paralysis of the muscle. This is temporary, as the toxin gradually wears off, and movement returns, usually after 12 – 14 weeks.

Botulinum Toxin is well researched and used in a wide range of medical problems including over – active bladder, oesophageal (gullet) spasm, muscle spasticity, anal fissure, migraines and excessive sweating. Different toxins are licensed for use in different areas, but often used “off licence”.

You don’t need that – you don’t have any wrinkles

First up, no one needs wrinkle relaxing injections – it’s always a luxury, and there’s nothing wrong with a few lines showing your life stories and smiles. However, if like me, you want to have smooth skin, botulinum toxin is actually most effective as a preventative measure. It is licensed for the treatment of dynamic lines of the upper third of the face. Dynamic lines are those lines you see when you move your face i.e; raise your eyebrows, or frown. It does help to reduce the appearance of static lines, which are the lines you can see all the time, and that can take a little longer, depending on how deep set the lines are.

It’s permanent/once you’ve had it, you have to keep having it.

Nope and nope. Botulinum Toxin type A usually starts to work after 2 or 3 days, with optimal results at 2 weeks post treatment. The effects will gradually wear off over the next couple of months, and generally you can expect the results to last around 10 – 14 weeks, up to around 4 months for some clients. The more you have treatment, generally the less apparent your lines are. This is partly down to the treatment, and partly down to the fact that you start to move your face differently. For example, I was a BIG frowner. I’ve been having botulinum toxin injections for around 2 years and now frown very little, because I haven’t been able to for a lot of that time! My team at work asked me to swear more because they couldn’t tell when I was annoyed with them anymore. My boyfriend quite likes this effect though!

Once it does wear off, your face will droop to somewhere near your shoulders. No, I’m kidding! Imagine it a bit like stopping a clock. You essentially freeze time – your muscle movement will return and your face will pretty much be as it was before you had treatment. So, if you have it, and you hate it or don’t like the reduced movement, you don’t have to have it again.

It makes you look startled/frozen/weird!

It doesn’t if it’s done well (or unless you want to look frozen)  It paralyses the muscles that are injected, so movement and expression are reduced, but it doesn’t have to make you look frozen. When it’s done well, the results are subtle and effective and you’ll find most people won’t even notice you’ve had it done. Doses can be tweaked and adjusted for the result you want. You can get a brow lift, a more relaxed jaw or a less gummy smile – it’s so versatile. It is a very safe and reliable treatment, when done by the right people. You may find your treatment needs tweaking, particularly if it’s your first time.

Who can give wrinkle reducing injectables?

Botulinum Toxin A is a prescription only medicine (POM) which means it has to be prescribed for you by a Doctor, Dentist, or Independent Non Medical prescriber. You should always have a face to face consultation with the person prescribing for you, to ensure it is safe for you to go ahead with the treatment. Without exception. After that, there is really very little regulation as to who can inject you. The government are working on this, and many regulatory bodies are working together, to devise an assessment process to ensure everyone is working to the same standard. Much like dermal fillers, because they have become so common and popular, it is easy to forget this is a medical procedure, with risks associated.

The safest thing to do, is follow the same advice I gave in my Thinking about Lip Fillers? post (shameless plug!) namely

  • Ensure your injector is a registered Nurse/Doctor or Dentist
  • Find out if they have emergency protocols in case of anaphylaxis or you becoming unwell during treatment
  • Find out if they are insured
  • Find out where they get their product from – is it a registered pharmacy or supplier, or an cheap online supplier with no regulations?
  • What are their after – care and follow up arrangements?
  • Have a look at their previous work either through their social media or website – my aesthetics page can be found here

What are the risks?

When attending your appointment, a full medical history should be taken, and a full consultation. On the whole, botulinum toxin injection is pretty safe, but as always, there are risks or potential side – effects. This list is not exhaustive, but some of the more common is effects are:

  • Asymmetry – occasionally, you may find one area takes the toxin quicker than others, and you may notice an uneven appearance for a day or two. This should settle and it’s important to wait a full 2 weeks for the effect to be assessed. However, if the asymmetry is still a problem, this can usually be adjusted and corrected at a follow up appointment
  • Ptosis – The P is silent. This means a droop and can happen either to the eyelid or eyebrow. It can usually be avoided by avoiding injection of “danger zones” but sometimes the toxin can drift from the area that has been injected. It is important to follow your aftercare instructions carefully and inform your injector as often this can be corrected or improved with treatment. Ptosis usually resolves itself after a week or two
  • Redness/bruising – Toxin is administered by a small injection, and as such, some redness and occasionally bruising can occur. The needles are pretty small, and any marks are usually quick to resolve
  • Headache – although people often find their headache improves with toxin treatments, a headache for a day or two after treatment isn’t uncommon
  • Twitching – you may notice some twitching of the affected muscles either after treatment, or as the movement is starting to return
  • Wrinkles and lines elsewhere – you may notice different lines become more apparent after treatment, as the movement focuses elsewhere, and as one area looks smoother and more flawless, you may focus more on small lines you hadn’t noticed before
  • Allergy or anaphylaxis – this is rare, but possible

Who is it suitable for?

Most people are suitable for toxin treatment. However, it is not licensed for use in people who are pregnant or breast feeding, as the potential side – effects are unknown. It is also not licensed for use in patients with neuromuscular disorders such as Myasthenia Gravis.

Occasionally, an injector may assess a client and decline to treat them because they do not think they are suitable for treatment mentally. This is pretty rare, but it’s important to ensure that clients are having treatment for the right reasons, and that their expectations are realistic. Cosmetic treatments are not good for everyone and it is important to see a practitioner who recognises when this is the case.

I want to try it – what now?

Find yourself an injector who is reputable, and safe. This isn’t always easy, and it’s not always the people with the highest amount of followers. Don’t make decisions based on special offers or reduced prices (both advertising prescription only medicines, and offering special deals, are against UK regulations) Often a recommendation is a good way to find someone, but don’t be afraid to ask lots of questions. Always have your treatment around 4 – 6 weeks before any major events, to allow time for it to work, and be tweaked if need be.

Make sure you have a full consultation, without obligation to proceed to treatment. Ensure that the injector takes a full, informed consent from you. Any good injector, and I cannot emphasise this enough, will be glad to spend time answering questions, find answers to anything they don’t know for you, and will never pressure you into a treatment you are not sure about. I always tell my clients they can change their mind at any time, and I never encourage them to have treatments they are not sure about. If in doubt, go away and have a think about it, and do some more research. Toxin is not reversible. Which means once it’s in, you have to wait for the effects to wear off.

And as a final tip – the best way to avoid and improve wrinkles, actually isn’t Botulinum Toxin at all. Baz Luhrmann was absolutely accurate when he said “WEAR SUNSCREEN!” Even during winter, you should wear at least an SPF 30, even under make up. Not least of all because skin cancer is one of the deadliest and most common cancers in the world. I’m planning a separate post around SPF and sun exposure in the future.

Two of the biggest contributors to wrinkles (and cancer)? Smoking and Sun exposure. So get off the cigarettes, off the sunbed and cover up! And drink plenty of water too. And for those wrinkles that need just a little chemical help? Give me a call.

I can’t thank you guys enough for reading my ramblings – please do leave me a comment or a like, and let me know if there is anything in particular you would like to know more about.

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