Guide to Botox®

Botox® is actually a brand name for a substance called Botulinum Toxin Type A. It has been used in medicine for decades and it actually a naturally-occurring protein. This super-strength neuro toxin is extremely potent and blocks the nerve receptors, responsible for muscle movement. Hence why only qualified medical practitioners are legally allowed to use it! When injected in tiny doses in to the facial muscles, Botox® temporarily relaxes these muscles by blocking nerve impulses. This in turn, temporarily smoothes the dynamic expression lines that are caused by making facial expressions.

Only doctors, plastic surgeons, nurses and dentists are legally allowed to administer Botox®. It is a prescribed drug and if in the hands of a non-medic, could be extremely dangerous. Therefore NEVER accept the services of a non-medical professional for your Botox® injections. Always check a practitioner’s credentials and ask to see their medical certificates as well as the certificates for specific Botox® training, which is undertaken after their medical status has been achieved.

Botox® can treat a myriad of concerns in various areas of the face. However, the most regularly treated indications are:-

• Forehead lines
• Glabellar lines (lines between the eyebrows – otherwise known as ‘elevens’)
• Crow’s feet
• Bunny lines (lines down the sides of the nose)
• Cobbled chin
• Masseter muscles for jawline slimming and reducing teeth grinding

Results vary from patient to patient, depending on their individual responses to the treatment, certain lifestyle choices and sometimes, the brand of Botulinum Toxin used. However, on average, a Botox® treatment for forehead lines and crow’s feet lasts between 4 and 6 months. A good Botox® clinic will never offer more than 3 Botox® treatments for the same facial indication in one year, as this can weaken facial muscles and encourage surrounding muscle movement to create facial expressions.

The treatment itself is pretty straightforward and in most cases, a topical anaesthetic isn’t needed. This is because the needles used are very short and extremely fine. However, if you’re really squeamish or nervous, you can ask for a topical numbing cream to be applied. Be prepared however, to wait around for about 30 minutes for this to take effect before your Botox® treatment. Your skin will then be sterilised with an antiseptic wipe and the doctor will make you pull some very strange expressions, depending on where on the face the injections are to go. This can include raising your eyebrows, frowning and smiling like the joker! Don’t worry though, you’re not on candid camera, this just highlights the wrinkles that need addressing. As you pull your strange faces, the doctor will mark your face with a white makeup pencil, the exact points for injection. Once this has been done, the doctor will commence the treatment. Depending on how many areas you have treated, this can take between 5 and 10 minutes but is over before you know it. After which, the white marks will be wiped off and you will be given some aftercare advice to follow for the hours and days after your Botox® treatment.

Downtime can be defined by 2 categories. Clinical and cosmetic. Clinical downtime is where a patient is partially incapacitated after a procedure (such as a nose job or boob job) and has to take time off work to rest and recover. Cosmetic downtime means that you can continue your daily activities but there may be some evidence of a treatment having taken place, such as pin pricks, skin redness, bruising or swelling. With Botox® there is no clinical downtime and little-to-no cosmetic downtime too. You may get the odd small bruise or some very mild tenderness at the sites of injection, but these are extremely minor and will not stop you from continuing with your day.

There are a few aftercare instructions you will need to follow in the hours and days after your Botox® treatment and these include not rubbing the treatment areas for at least 4 hours after the procedure. Old advice including avoiding bending forward for 4 hours after the procedure and avoiding strenuous exercise for around 48 hours after treatment has largely been disproven, 4 hours before exercise should be adequate. This all minimises the risk of the Botox® product ‘migrating’ to unwanted facial areas and maximises optimum, natural-looking results without complications.

Side effects from having wrinkle-smoothing injections are extremely rare, but can include the following:-

• Tenderness, swelling or slight bruising at the site of injection.
• Headaches or flu-like symptoms.
• A dropped eyebrow or droopy eyelid
• Eye dryness or excessive tearing.

Adhering to the aftercare your doctor advises you, after your Botox® treatment, should minimise any negative side effects. However, for a headache or flu-like symptoms, a mild pain killer such as Paracetamol can be taken. For a drooping eyelid, some drops may be prescribed. All side-effects are temporary and will subside.

It’s important to know that Botox® is a prescribed drug and one of the most powerful and toxic substances on the planet. Sounds scary, but in tiny doses and administered by a medically-qualified and fully-trained injector, Botox® is considered extremely safe and has possibly the least amount of downtime or side-effects of any injectable facial treatment. The best place to go for Botox® injections is an aesthetic clinic which is regulated by the GMC and CQC. When researching, ensure that the practitioner is a doctor, plastic or cosmetic surgeon, dentist or prescribing nurse (they will need to be nurse prescribers and check this for sure, as remote prescribing of Botox® – essentially a doctor prescribing over the phone and the nurse then injecting – is illegal). If a doctor is on site to conduct the assessment and medical checks, the nurse can then administer, but both parties have to be in the room when you have your consultation and assessment. NEVER have Botox® with a non-medic, a beauty therapist or someone offering Botox® parties or ‘cheap’ treatments. Make sure they show you their medical certificates as well as their training certificates for Botox® injections, specifically.

Botox® is a highly-potent substance and needs to be prescribed, mixed, administered and stored in accordance with medical guidelines and regulations. A clinical environment is vital, as if there are any unforeseen circumstances or reactions, you need to know that you are in the very best of care, where a doctor or medical professional can react accordingly and with the necessary equipment and protocols. A medical professional will also have extensive knowledge of the facial anatomy and will be able to avoid danger zones or areas where Botox® is contraindicated. When it comes to your face, your health and your wellbeing, don’t take chances!

Before any cosmetic treatment can take place, here at The Harley Street Clinic, West London, we will always ask that you attend a pre-treatment, no obligation consultation with your chosen practitioner. This will ensure that you understand everything you need to know about the treatment, can be assessed as to whether it would be beneficial for your specific facial or skin concerns and for the practitioner to check your medical history. This is our duty of care to ALL our patients and is vital, to ensure your absolute safety and eligibility for any cosmetic treatment. Beware of any practitioner who does not offer this service or who does not ask you to complete a questionnaire about yourself, your lifestyle and any medical conditions or medications you are taking. Make sure that you are given a consent form to sign, prior to a treatment too. If none of this is offered, politely decline treatment and find a reputable clinic, such as The Harley Street Face Clinic!

As a rule, anyone under the age of 25 looking to have Botox® might be in the wrong ball park. It’s at 25 that we start to see the very early signs of ageing and a treatment called ‘Baby Botox®’ where smaller doses are administered for our younger patients can be offered. Under the age of 25 and there may be other treatments, more suited to young skins. It’s important to remember that embarking on Botox® injections too young, can have an effect on the facial muscles and their tone. Weakening young facial muscles is not recommended, as this can lead to a more ageing appearance later on. Skin boosters are an excellent alternative for our patients under the age of 25, to help with the overall tone and elasticity of the skin. Using Botox® from around 25 is considered safe and can even prevent future wrinkles from forming, but it’s best to wait until this age before using toxins for wrinkle smoothing.

The simple answer is YES! Botox® can offer skin rejuvenation benefits for all ages. However, your expectations need to be realistic as you get older. If you have had no previous anti-ageing treatments by the time you’re in your late 40s to early 50s, you will probably be experiencing not only expression lines and wrinkles, but possible sun damage, volume loss, skin sagging, deeper-set wrinkles and skin dehydration. Botox® will ONLY work on dynamic lines (not static ones and definitely not volume loss). Botox® can offer some brow lifting benefits but if you are experiencing more significant signs of facial ageing (don’t worry, it comes to us all), your practitioner may advise of alternative or combination treatments such as dermal fillers, skin boosters or device-led skin tightening procedures. The magical age to start with Botox® is around 30, where future expression lines can be prevented, but always have realistic expectations and an understanding of what each cosmetic treatment can physically do, before embarking on your journey.

Botox® can treat a whole host of facial issues – from smoothing crow’s feet, forehead lines, bunny lines and frown lines to correcting a cobbled chin – even slimming a square jawline and preventing teeth grinding! Depending on your concerns, your results will be noticeable within 2 weeks but can also be seen in as little as 24 hours! For lines and wrinkles, you will notice less muscle movement (don’t worry, you can still create expressions, but the reduced muscle activity will mean that the lines and wrinkles will be temporarily-yet-significantly reduced). For a cobbled chin, the movement of the skin in this area will reduce, so that when you speak of create a lower facial movement, you won’t get that bumpy effect which can look unattractive. For jawline slimming and anti-teeth grinding, results may take slightly longer, but your masseter muscles (the muscles at the sides of your jaw) will become more relaxed and less protruding over time, hence the slimmer jaw contour and reduced teeth grinding or jaw clenching. Your teeth will also benefit from this Botox treatment, as they can be broken or chipped during the grinding or clenching action of the jaw. Results from Botox® can last anything up to 6 months and some patients have even claimed that their anti-wrinkle injections last up to 8 months! But everyone is different and lifestyle choices such as poor diet, over-exercise, smoking and sun exposure can lessen results times.

The Harley Street Face Clinic is led by Dr Julian De Silva, a leading facial plastic surgeon and with a team of highly-qualified and extensively-trained medical practitioners, offers state-of-the-art procedures and techniques in the heart of London’s Harley Street. The Harley Street Face Clinic offers the most advanced and revolutionary non-surgical treatment in luxurious and discreet surroundings. We are regulated by the CQC and GMC to ensure the absolute safety of all our patients in a clinically-professional environment. Our passion to offer beautiful results and to uphold excellent levels of patient care at all times makes us one of the UK’s most prestigious and exclusive cosmetic clinics.