Background

Anti-wrinkle treatment is a nonsurgical cosmetic technique that utilizes medication known as neurotoxins ("Tox") or neuromodulators like Botox®, Dysport®, or Xeomin®. These products are all derived from Botulinum Toxin A, the same compound responsible for the condition known as Botulism. Don't be frightened because the safety margin for "Tox" is 100:1, meaning it would take 100 times the therapeutic dose to poison someone. Compare this to other common medications like Acetaminophen and Aspirin which is 20:1. Commonly used dosages (0.5-1.5 vials) are low compared to the what is required for a fatal dose.

"Tox" is used to relax muscles of facial expression preventing them from forming their associated wrinkles. There are dynamic and static lines/wrinkles. Dynamic lines are characterized by smooth skin at rest but appear when muscles contract. Static lines, however, are present at rest but deepen when muscles contract. "Tox" works best with dynamic lines and may prevent static lines from forming with continued use. "Tox" may soften the appearance of static lines and may prevent them from worsening with continued treatment.

Muscle relaxation may become apparent at 5-7 days and peaks at 12-14 days. The muscles regain strength over several weeks such that you may notice lines reappear at about 2-3 months depending on the dose and product. With regular treatment every 3 months, muscles remain weak for a prolonged period of time such that the duration last longer or a lower dose is required for the same period of time.

What is the ideal age to start Anti-wrinkle Treatment?

Patients in their mid to late 20s can begin as a preventative measure. This is known as "prejuvenation". A lower dose is used to target strong muscles. Often patients in their late 30s to late 40s initiate treatment to appear more refreshed. Those who begin later in life may have static lines that have formed from years of unopposed muscle activity. Depending on severity, they may have a satisfactory result. If not, there are other treatment options available but they may be more complicated and require more sessions to achieve their end result.

Will I look fake?

Long gone are the days when the goal was to have a completely expressionless appearance. Nowadays, the focus is to achieve a natural refreshed appearance where one can express as they normally would, but with fewer wrinkles.

For first time patients, it is important to return for their follow up appointment usually scheduled 2 weeks after treatment. The goal of this appointment is to assess the success of treatment. Did we reduce the appearance of the wrinkles to the patient's satisfaction? Often, we do not have to eliminate every single line to look more refreshed. If the patient wants more relaxation, we can inject more product and tally up the amounts so that we can inject the optimal dose on the next treatment which is 3 months after the previous appointment. Are there any unexpected weird-looking outcomes? This rarely happens but is always possible. If inadvertent pressure is placed on the injection sites immediately after treatment, the product may be displaced causing asymmetry or other aesthetically unpleasing results. Often an easy correction can be made during the follow up appointment such that the problem will resolve after 5-7 days.

What areas can be treated?

• Frown Lines "11 Lines": the area between the eye brows when looking angry.
• Forehead Lines: horizontal lines that form on the forehead when raising the eyebrows.
• Crow's Feet: lateral to the eyes when smiling.
• Bunny Lines: area next to the nose when scrunching the face.
• Smoker's Lines: are above the upper lip when puckering.
• DAO (Depressor Anguli Oris): results is a resting gentle smile.
• LLSAN: addresses the "gummy smile" by dropping the upper lip slightly.
• Masseter Muscles: causes a slimming effect by weakening strong bulky muscles that may be hyperactive particularly in those suffering from Bruxism.

What can I expect during my appointment?

You are required to provide pertinent medical history which the staff will review prior to meeting with you. A set of photos will be taken as part of your medical record. You will be asked to perform various facial expressions which will be photographed from different angles. Our provider will discuss the findings with you and formulate a treatment plan.

Ideally, the face should be free of makeup, but we can clean and disinfect the areas of interest. There is minimal discomfort during the treatment. A small gauge needle is used to administer the product. Your provider may apply gentle pressure to stop minimal bleeding to prevent bruising.

Follow Up appointments are scheduled 2 weeks after treatment. Photographs will be taken with the same facial expressions as during consultation for comparison sake. Adjustments are made if necessary.