Wrinkles are inevitable part of the ageing process. They arise from a long term and combined effects of sun exposure, gravity and muscle contraction during facial expressions, frowning, laughing etc. Many creases created by gravity and natural sagging and folding of tissue can often be notably improved only by the surgical tightening procedures. Finer lines caused by muscle contraction such as frown, forehead and periorbital (crows feet) can be however, particularly successfully treated with  botulinum toxin injections.

Botulinum toxin is produced by bacteria called Clostridum botulinum. Several types of toxins have been identified but type A, which is used commercially, is the most potent. Botox and Dysport are the commonest trade names used, but there is a wide variety of commercial products available. Botulinum toxin acts by blocking acetylcholine, a chemical that is responsible for transmitting electrical impulses that cause muscle contraction. Acetylcholine blockage results in muscle paralysis. The resultant paralysis, however, is temporary, as the new growth of nerves will re-innervate the muscles eventually. Botulinum toxin was first used in 1978 to weaken over active muscles in the eye, followed by other neurological conditions such as dystonia and hemifacial spasm with good effects and little side effects. Botulinum toxin was first used cosmetically in 1990, to reduce facial wrinkles arising from muscle contraction.

Botulinum toxin in injected directly into the muscles that cause the wrinkles, using a very small needle. Several injections are usually needed at specific sites, depending on the area treated. Localised discomfort and bruises can occur but no sedation or local anaesthetic is generally required. Normal activities can be resumed immediately.

Botulinum toxin usually takes effect 24-72 hours after injection, with maximum effect at about 2 weeks. Its effects generally last for approximately 4-6 months, but in some patients effects can be notable up to 12-16 months. Temporary paralysis of muscles that are responsible for expression wrinkles, leads to more relaxed and smoother appearance of the facial skin. When a gradual fading of treatment effect is noticed you may return to have another treatment.

Whilst Botulinum toxin can be very effective in reducing wrinkles due to muscle contractions, it has no effect in reducing the fine lines on the face caused by sun damage and lines due to sagging of facial skin. In those patients with very heavy lines, repeated treatments may be needed for maximum effect. Too frequent or excessive dosing for Botox may lead to patient’s resistance to treatment due to antibody formation and Botulinum toxin treatment may exaggerate any facial asymmetry.

The use of Botulinum toxin is contraindicated in people with neuromuscular disorders such as myasthenia gravis, those who are taking certain muscle relaxants and antibodies such as aminoglycosides, pregnant or breast feeding women, those with infection or inflammation at the proposed site of injections and bleeding disorders.

No severe complications after cosmetic use of Botulinum toxin have been reported in the literature. Very rarely excessive weakening of the target muscles and paresis of adjacent muscles can occur, resulting in facial weakness, this is self-limiting. When injecting above the eyebrows, upper eyelid ptosis or slight drooping may occur but this is very rare. This can be corrected with eye-drops but will also improve as the effects of the Botox wears off.