Facial rejuvenation is gaining in popularity whilst the array of available clinical options is increasing. One of the signs of ageing is dynamic wrinkles which are created by many years of muscular activity in the face, especially in the brow, next to the eyes (crow’s feet), above the mouth and around the neck. One of the most clinically proven options to treat dynamic wrinkles is Botulinum Toxin Type A (BOTOX®).

Wrinkle-relaxing treatments, are available by prescription only in Ireland and so must be administered by a medically qualified person.
What is BOTOX® ?

Since its discovery in the 1960′s as a non-surgical treatment for children suffering from squints, it has gradually received approval to extend its application for many other uses including facial rejuvenation and especially for the elimination of dynamic wrinkles.

BOTOX® belongs to a class of drugs called botulinum toxins, which derive from the bacterium Clostridium botulinum. Although there are seven different types of botulinum toxin (A, B, C1, D, E, F, and G), most of the research conducted to date has focused on type A.

It works by impeding the messages sent from nerves to muscles. The bacterium produces a protein that blocks the release of acetylcholine, which normally transmits messages from the nerves to the muscles to make them contract and move. Once transmission has been blocked, muscles relax, providing relief to patients with overactive muscles, reducing spasms and pain. The effect is completely reversible and generally lasts for three to six months in most clinical uses.

BOTOX® can be used primarily to treat the following facial areas:

• The glabella lines between the eyebrows and forehead
• More pronounced horizontal lines on the forehead
• The lines on the outside or lateral of the eye (Crow’s Feet)
• Downturned lips
• Mild level of eyebrow droop

BOTOX® cannot be used to support sagging face and neck skin, increase the volume of thin lips, or help skin imperfections, such as thread veins.

To get the best results from your facial rejuvenation treatment you can combine it with dermal fillers or other cosmetic procedures including light and laser rejuvenation. For example, wrinkle-relaxing treatments may be used on your forehead wrinkles while adermal filler may be better used to treat lines at your mouth.

It is important to note that in Ireland BOTOX® can only be administered on prescription and hence only medically trained doctors and surgeons can prescribe and perform this treatment.

Your concerns about safety

Many people are concerned that wrinkle-relaxing treatments may ruin their facial expressions or lead to a frozen-looking forehead that doesn’t move when they laugh, smile or frown. However, Mr Meagher will try to make sure that wrinkle-relaxing treatments affect only the tiny muscles being directly treated and not the surrounding muscles. This way, when you laugh or frown, the untreated muscles work normally so your expressions still look like you.

Potential complications

BOTOX® is a prescription treatment in Ireland and may have some side effects. The risk of side effects is generally reduced by being treated by Mr Meagher.

Prior to your treatment you should discuss your medical history and detail any medicines you are currently taking, with Mr Meagher. Similarly you should ensure that we are aware of your expectations for the treatment. If you have a history of previous allergies to botulinum toxins, or currently have an active infection such as acne around the injection site or a history of disease affecting your nerves and muscles you may not be a suitable candidate for this treatment. Patients who are pregnant or who plan to try to become pregnant soon, or are breastfeeding, should also seek advice on the suitability of this treatment.

BOTOX® is one of the most studied medicines in the world and has been the subject of many clinical studies whose results have been published in respected medical journals worldwide. According to some of these studies the most common side effects of injections around the eyes and in the face include temporary bruising, eyelid drooping (ptosis), dry eyes and double vision. Facial droop can occur with injections into the cheek area. In the hands of Mr Meagher, these side effects are very rare.

In a study of 65 patients who received repeated injections for 10 years, side effects were all temporary and mild and decreased after repeated injections. Examination of the eye muscles has shown that repeated injections do not cause irreversible muscle atrophy (wasting) or any other degenerative changes and muscle function after injection reverts to normal.

BOTOX® should never be injected into muscles used for motoric functions such as the eyelids and the lips. It is particularly effective for dynamic wrinkles but not for static wrinkles such as the nasolabial folds on either side of the nose.

In general, any side effects occur within the first few days following injection and are temporary. As expected for any injection procedure, pain, burning, stinging, swelling and/or bruising may be associated with the injection. The most common side effects are headaches, drooping eyelid (this should be temporary and should go away when the effects of the injection wear off), face pain, skin redness and local muscle weakness.

Before starting treatment you will want to discuss your medical history and what you can expect from your treatment with Mr Meagher. Wrinkle-relaxing treatments should not be used if you have a history of previous allergy to botulinum toxins. They may not be suitable for those with an active infection such as acne at the injection site or a history of disease affecting your nerves and muscles.

In summary, any side effects occur within the first few days following the injections and are temporary. The risk of side effects may be reduced by going to Mr Meagher.

During treatment

The injection is relatively quick and will usually take only 10 to 15 minutes. The injection site is usually numbed by application of a topical anaesthetic approximately 15 minutes before the treatment, or a bacteriostatic saline may be used.

Small volumes (0.05ml to 0.1ml) of BOTOX® are injected by a needle with a small gauge into the muscle or muscle area over a short period of approximately 20 seconds. The contractions of the area treated can greatly reduced to eliminate wrinkles. The insertion of the needle should only provide a tiny pin prick sensation as very small gauge needles are used.

For the brow area usually only 5 injections are made, for the eye area only 2 or 3 injections are needed.

The effect is usually noticed after 2 to 5 days and should last from 6 to 6 months. The effects of subsequent injections may be apparent for slightly longer.

After treatment

To increase the effectiveness of the treatment you should try to use the muscles as much as possible for approximately 30 minutes after the injection. We advise you abstain from touching or massaging the injection area for 24 hours. The anaesthetic is purely localised and you can return to work immediately.

You will need to repeat this treatment for the best results every 4-6 months.

Please note that wrinkle-relaxing treatments, are available by prescription only in Ireland and so must be administered by a medically qualified person.