- Dr. Liz Kelleher, manager@elanamie.ie (021) 4219113

FAQ's on Anti Wrinkle injections (AWI)

What are AWI and how does it correct wrinkles?

Not long ago, the so-called "dynamic" wrinkles; wrinkles caused by facial expressions, such as crow's feet, glabellar or frown lines, and forehead lines were the source of much consternation for patients and doctors alike because they were difficult to treat even with surgery. These wrinkles do not also respond well to laser resurfacing or dermal fillers. Currently, botulinum toxin type A, commonly known as Botox, is the most commonly injectable used in the management of these wrinkles. A tiny amount of medicine when injected into tense facial muscles inhibits contraction of the targeted muscle, causing it to relax. With less muscle movement, wrinkles on the overlying skin begin to soften. The cosmetic outcome of AWI are typically visible within 3-7 days and lasts for 3-6 months, depending on the brand and the dose of the product, the type and size of the muscle that is injected, and the quality and the age of the skin overlying the muscle.

The word Botulinum in Botulinum toxin, the neuromuscular blocking toxin, comes from the Latin word botulus, meaning sausage. A widespread illness during Napoleonic wars, now known as botulism, was then found to be associated with the ingestion of a toxin, now known as Botulinum toxin, secreted by the bacteria present in spoiled sausages.

Botulinum toxin type A found in Botox is one of the 7 distinct toxins lettered A through G, produced by Clostridium botulinum bacterium. Botox was the first commercially available diluted and purified botulinum toxin type A product that had received the approval of Food and Drug Administration (FDA) for cosmetic use. Botox is produced by Allergan. It is the most studied brand of botulinum toxin type A in the world.

What is the difference between AWI and fillers?

While Anti Wrinkle Injections temporarily corrects or eliminates dynamic wrinkles by blocking the chemicals that cause the underlying muscles to contract; dermal fillers smooth out wrinkles that exist in the absence of any facial expression; that is, "static" wrinkles. Moreover, dermal fillers can plump up hollows and depressions, such as under eye hollows and sunken cheeks, caused by aging and dieting. There are a large number of available fillers. We use fillers from Merz, Teoxane and Allergan.

Can AWI be combined with dermal fillers?

In cases where untreated wrinkles have become permanently etched in and appear even at rest, or when wrinkles are caused by the looseness of the skin, AWI can be administered in conjunction with other treatments, such as dermal fillers, or fractional laser resurfacing.

How to get prepared for Anti Wrinkle injections?

During your initial consultation, be sure to mention all of the medications, vitamins, and herbal remedies that you are taking. In addition describe any complications you have experienced during previous neuromuscular blocking toxin injections. To minimise the chance of bruising it is important to avoid alcohol, anti-inflammatory medications like Aspirin or Ibuprofen (i.e. NSAIDS) as well as certain herbal preparations and vitamins like Vitamin E, Ginkgo Biloba etc. known to increase bruising.

What to expect during Anti Wrinkle injection Treatments?

You will be asked to remove any makeup before Dr. Kelleher starts injecting the medicine. This will help Dr. Kelleher identify and avoid the veins at injection sites that are prone to bruising, like the crow's feet area.

During the actual procedure, you will be placed in a sitting position. The areas to be treated will be cleansed. Just before the injections, Dr. Kelleher will ask you to repeatedly contract and relax your problematic muscles. Dr. Kelleher will then assess the thickness and quality of your skin, the thickness and size of the underlying muscles, and determine the most appropriate dose and point suitable for the injections. Finally, Dr. Kelleher injects the targeted muscles with the finest possible needle, thus minimizing discomfort and bruising. In the unlikely event that skin bleeding occurs, you will be asked to apply manual point pressure. This helps minimize the extent of bruising.

what is the aftercare like?

For most practical purposes injections are considered lunchtime procedures, where people can return to normal activities immediately after the treatment. However, it is advisable for patients to avoid lying down for 2-4 hours after a treatment, as well as avoiding vigorous exercise, hot showers, sauna and bathtub. These activities may lead to excess blood congestion in injected areas and wash out the medication before it has a chance to interact with the targeted muscles. Furthermore, manual pressure should not be applied on certain injection sites, like the frown line (glabella), in order to avoid diffusion of the injected medication toward the upper eyelid area which may consequently lead to droopy eyelids. Currently, most physicians do not consider exercising the injected muscles after a treatment to be necessary to achieve the desired effect.

When are results seen and how long do they last?

Patients usually notice the clinical effect 3-7 days following injections, and the effect is maximal by 1-2 weeks. The clinical results can vary depending on the skill of the practitioner, the nature, dose and concentration of the product, the frequency of the injections, the nature of the injected muscle, as well as the quality of the skin. For instance, a higher dose for a particular area might be needed if the interval between treatments is much longer than recommended.

The benefits of treatments typically last 3-6 months, except when used for jaw reduction. Surprisingly, jaw line reduction results are slow to show, but usually last more than a year. Younger patients may also experience longer lasting benefits due to the better quality of their skin. Treatments can be repeated as the effects wear off. Deeper wrinkles may require 1 to 2 additional treatments before the best results are seen. In select cases, it may be necessary for the patient to have additional procedures, such filler injections, for optimal results.

Who can administer Botox injections?

In Ireland only Doctors or Dentists are legally permitted to inject the AWI medications. Accordingly, it is very important to have the treatment at a Clinic where a doctor performs the procedure.

What are the conditions that can be treated?

AWI drugs are commonly used to correct the following:

• frown lines

• forehead lines

• crow's feet

• bunny lines

• corners of the mouth

• brow lift or brow balance

• smokers lines

• wide jawline and square face

• gummy smile

• teeth grinding

• wrinkled and dimpled chin

• nasal flare

• excessive sweating

• chest rejuvenation

What are the contraindications and complications associated with AWI’s?

Although Botulinum, the neuromuscular blocking toxin is associated with botulism, there is no danger of botulism, because botulism is caused by very large amounts of the toxin in the system, usually from eating contaminated food. Very high doses, often 100 times more than would normally be used, would have to be injected to cause harm and botulism.

In fact, risks are very minor when anti wrinkle drugs are used for cosmetic purposes. As of today, no serious issues have been reported among adults who have received botulinum products for cosmetic uses. Adverse effects are usually mild and transient. The most common substantive complication is excessive weakness of the treated muscles, and this resolves as the action of the toxin wears off. Complications such as brow ptosis, eyelid ptosis (Eyelid sagging), neck weakness are usually due to injector error or lack of injector experience. All of these effects are reversible, and fade with time. If you have eyelid drooping after a procedure, it is a good idea to let the Doctor know because there are medicines available that may alleviate this condition. Ptosis can be treated with apraclonidine 0.5% eyedrops. Phenylephrine (Neo-Synephrine) 2.5% can be used when apraclonidine is not available. Note that Neo-Synephrine is contraindicated in patients with narrow-angle glaucoma and in patients with aneurysms. Any other difficulties, such as difficulty breathing or rashes, should be reported to the doctor.

The most common side effects of botulinum toxin used in cosmetic surgery are temporary soreness or mild bruising around the injection sites. Bruising can occur, particularly if a small vein is lacerated or a patient has taken aspirin, vitamin E, or NSAIDs, or has consumed alcohol on the day of injections or the few days preceding the treatment. Ideally, patients should stop taking these products 1 week before the procedure. Applying ice to the injection sites before and after treatment may decrease the pain and the risk of swelling and bruising. Some people may experience a slight headache that lasts for several hours after treatment.

Contraindications include prior allergic reaction and injection into areas of infection or inflammation. Injections are contraindicated for patients with allergic history to egg albumin. Injections are not recommended in pregnant or breastfeeding women. However, many patients have been unknowingly injected during pregnancy and to date no foetal injury or birth defects have been reported in these cases. Nonetheless, to be on the safe side, delay of injections is recommended until pregnancy is complete and breastfeeding has ended.

Botulinum toxins should be used with caution by patients taking certain medications that decrease neuromuscular transmission, such as aminoglycosides, penicillamine, quinine, and calcium channel blockers. Ask your doctor about possible interaction with these medications before a treatment. Patients with certain neurological disorders, such as myasthenia gravis, ALS, or LAMBERT-EATON syndrome could be at an increased risk of side effects.