Lines and wrinkles

What is Botulinum toxin type A?

Botulinum toxin type A is a neurotoxic protein, which is produced by the bacterium Clostridium botulinum. There are various subtypes of the toxin from type A through to type G. However, it is the type A toxin that is used in clinical and aesthetic practice. C.botulinum can be found in the environment including in soil, rivers and sea-water. Foods infected with C.botulinum, if ingested can cause botulism due to the toxin produce by the bacterium and can be fatal.

In clinical and cosmetic use, the C.botulinum strain is fermented and the botulinum toxin type A is purified from the culture solution to produce a dry powder form of the toxin. There are many different brands of botulinum toxin type A of which Botox® is perhaps the most well known.

Botulinum toxin type A is a prescription only medicine and has been used safely for over twenty years to treat medical conditions such as blepharospasm, strabismus, cervical dystonia, migraines, hyperhidrosis, and muscle spasticity.


How does it work as an anti-wrinkle treatment?

Botulinum toxin type A blocks the release of a neurotransmitter, acetylcholine, from nerve endings. In doing so, the toxin causes paralysis of muscles and prevents muscle contraction.

By injecting botulinum toxin A in to muscles of facial expression, such as the forehead and glabellar region, the muscles are effectively relaxed. It is the repeated contraction of facial expression muscles, which gives us expression lines and over time these may become static and are visible as wrinkle lines.

This relaxation of the facial expression muscles reduces wrinkles around the areas injected. Areas that can be treated include frown lines (glabellar region), forehead lines, crows feet, bunny lines. The effect is reversible and injections must be repeated every three to four months to maintain the anti-wrinkle effect.

How long does the anti-wrinkle effect last?

Following treatment, you may start to notice a difference within a few days, but it may take two to three weeks for the full effect to develop.

As an anti-wrinkle treatment, the effects of the toxin typically last between 3 to 4 months. However, response may vary from person to person. With regular treatments, wrinkle lines are likely to soften and the effects will last longer.

Clinical studies have shown that some people can form neutralising antibiodies to the toxin, which inactivates the toxin or makes it less effective. This has been shown in some studies as a result of frequent injections at higher doses. For your safety, we will only administer doses appropriate to you and at intervals of no less than three months.

What are the side effects?

Most patients experience minimal side effects and you will be provided with detailed information during your consultation. You may feel a slight sting from the injection needle and there may be small bumps and swelling at the injection sites following injection, but these will disappear quickly following treatment.

A small number of patients may experience a headache and slight bruising, but this does not last more than a few days. Though extremely rare, some people may have an allergy to the toxin. Other rare complications include eyelid ptosis (droopy eye), rash, itchy skin, sensitivity to light and dry eyes.

Is the treatment painful?

Pain is subjective and will vary from person to person. You may feel a pin prick as the needle is injected. However, this pain does not last and you should not feel any pain following treatment.

What is the recovery time?

There is no down time and following treatment you can resume most of your normal activities. You will be given information on aftercare to maximise results and reduce any complications.

Can anyone have botulinum toxin type A anti-wrinkle treatment?

No, botulinum toxin is not suitable for all people and it is our clinic policy not to treat anyone under 21 years old.

Treatment is contra-indicated if you:

  • Are pregnant or breastfeeding.
  • Are on certain types of medications such as aminoglycoside antibiotics.
  • Have a current or recurring infections in the area of treatment.
  • Have had recent surgery to close to the treatment area(s).
  • Are prone to keloid scarring

Caution is advised in people who:

  • Have existing cardiovascular problems.
  • Take aspirin, steroids or anti-coagulants (blood thinning medication).
  • Have neuromuscular disorders such as myasthenia gravis or any condition that affects the muscles or nerves.

We will assess your medical history and advise you on an individual basis. In some cases, it may be necessary to refuse treatment or refer you to a medical expert.

It is also our clinical policy to ensure your psychological wellbeing and if you are suffering from body dysmorphic disorder (BDD) or are showing signs of this or any other mental health problem, we will not be able to treat you. We will give you appropriate advice and refer you for further support and help.

How to prepare for treatment?

Pre-treatment Advice

Some medicines and supplements can increase your risk of bruising and before your treatment we advise the following:

  • Stop taking medicines such as ibuprofen or aspirin about three days before treatment.
  • Stop any supplements such as Vitamin A, C, E, Gingko Biloba, Garlic, fish oils, St John’s Wort.
  • Not drink alcohol in the 24 hours before treatment.
  • Remove any make up to reduce the risk of infection
  • Inform the practitioner if you are feeling unwell or there is a change in your medical history since your initial consultation.
  • Be available two to three weeks after treatment for a follow-up.

Post-treatment Advice 

  • Keep the target muscles active for a few hours after treatment
  • Do not touch, rub or massage the treated area
  • Avoid make up around the injection site(s) for 12 hours after
  • Remain upright after treatment and avoid lying down for at least 4 to 6 hours
  • Avoid vigorous exercise.
  • Avoid extremes of heat after treatment including hot baths, showers or sauna.
  • Avoid alcohol for at least twelve hours after.
  • Report any unexpected or rare side effects.
  • If you experience the symptoms of a severe allergic reaction, which is life threatening and requires immediate medical attention, you must go to Accident and Emergency or dial 999 for an ambulance. Symptoms include: shortness of breath, wheezing, difficulty swallowing, coughing, swelling of tongue, eyelids, lips, hoarse voice, stomach pain, nausea or diarrhoea.
  • Ensure you attend your follow up appointment for a review two to three weeks following treatment.