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Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum. Botulinum Toxin is a prescription medicines that can be used to treat skin wrinkles which are the result of facial movement. It is also used to treat migraines, over active bladders, skin fissures, excessive sweating, swelling difficulty, occasionally acne and a whole host of other medical conditions. When it is injected into a specific muscle in the face it blocks the signal from the nerve to the muscle. This means that the nerve ending cannot tell the muscle to move, hence there will be less wrinkling of the skin in the areas treated. The upper third of the face is where the best treatment results are obtained, commonly for the reduction in crow's feet around the eyes and wrinkles on the forehead and between the eyebrows. Depending on the area treated, dose used, and how you respond, repeat treatments will be required around every 3 - 4 months. 

 

What are the risks and potential complications from Botulinum Toxin treatment?

 

Most patients find that botulinum toxin injections cause a little discomfort. Many compare the feeling to an insect bite! As the treatment is very quick and the needles used are tiny and only minute amounts of liquid are being injected into the skin; few patients experience any significant pain.

A few patients do, however, prefer to have an aesthetic cream applied half an hour or so prior to treatment to help numb the skin.

Other risks or side effects include a small amount of temporary bleeding or mild swelling which may occur at the injection site. In some cases more extensive bruising may occur, especially around the eyes, but this can usually be covered up with make-up, and is only temporary.

Occasionally, patients experience a headache after treatment, and, very rarely, double vision. 

When botulinum toxin is injected into the forehead area, there is a very slight possibility that it may cause weakness of the muscle holding up the eyelid causing a “partial ptosis” or drooping of the upper eyelid.

In experienced hands this tends to happen in less than 1% of patients and will disappear over a period of 2 - 10 weeks. Some doctors also use an eye drop called apraclonidine to help to speed up the recovery if this effect occurs.

If the forehead muscles are relaxed too much, especially in patients with looser skin, the treatment may cause the eyebrows to drop slightly. Again, this is only a temporary condition and will vanish usually within 10 weeks. 

Sometimes, the eyebrow position may alter so that the edges of the eyebrows become elevated. Some women like this effect, but it is generally unwanted in men. It is easily corrected with a small amount of botulinum toxin injected above the raised area of the eyebrow to help change its position.

All patients should remember that because the results of botulinum toxin are not permanent, any unwanted effects will disappear usually within a 3 month period. 

 

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What should you do after a Botulinum Toxin treatment?

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As we have said, your life can proceed as normal following an injection of botulinum toxin, but as with all medical procedures, it is wise to observe the advice of your practitioner as closely as possible to ensure that you get the full benefit of the treatment, free from complications.

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Post-treatment advice may include:

• For a few hours after injections do not rub, or massage the treated area, or undertake vigorous exercise. Avoid any form of facial treatment, waxing or massage to reduce the risk of the botulinum toxin spreading to adjacent muscles where it might cause the eyelid to droop

• Wait for up to two weeks for the treatment to work fully, so be patient! Most people will find that, even after this period, if they try really hard, they can still move the muscles to a small extent in the area treated. This is quite normal. The aim of the treatment is not to prevent you from moving the muscles in your face, but merely to reduce the number of times that your muscles contract as this is when wrinkles occur.

• Contact you Bellissimo Clinic after 14 days, if you find that you can still use the muscles treated to the same extent as before the treatment and you cannot see any apparent improvement, contact your practitioner and they can invite you in for a review. 

• Side effects from botulinum toxin injections are very minimal and normal. We expect some swelling initially after the treatment (raised bumps, often described like bee-stings) where the product has been injected. This generally goes down after an hour or so.

• Bruising is also very common, mainly around the eye area where the skin is more delicate, however bruising can happen anywhere that has been injected. This is normal and any bruising will gradually disappear like a bruise elsewhere on the body. You can use make up to cover this 12-24 hours after the treatment.

• Bleedingvduring the procedure is also likely due to the sharp nature of the needle piercing the skin. Often you will not see this as the Dr Domenic will clean the area thoroughly during and after the procedure.