ADVANCED MUSCLE-RELAXING INJECTABLES

Wrinkle relaxation was first approved for cosmetic use in 2002 in America and 2006 in the UK to temporarily improve the appearance of frown lines. It then became approved for use in the crow’s feet and forehead lines. It had previously been used for these areas since 1996, but ‘off label’, meaning that the approvals came later. It has been used since 1977 to treat strabismus, a problem with the eye muscles.

Yes, wrinkle relaxation is classified as a drug.

Wrinkle relaxation blocks the signals from the nerves to the muscles, so they can no longer contract. For a muscle to contract, a nerve must release a chemical messenger called acetylcholine at the junction where the nerve ending meets the muscle. Acetylcholine attaches to the muscle cells and causes the muscle to contract. Wrinkle relaxation stops the release of acetylcholine.

Bell’s palsy, strabismus, cervical dystonia, strabismus, migraines, overactive bladder… the list goes on. There are lots of ways wrinkle relaxation can treat a wide range of issues such as the treatment of migraine, tooth grinding, crossed eyes, uncontrolled blinking, muscle stiffness and spasms.

Wrinkle relaxation by Allergan and Merz contains no animal products. Allergan and Merz use a cell-based potency assay to replace an animal-based assay for the ongoing manufacture of wrinkle relaxation, although in some markets (for example China), animal-based testing is still required to gain regulatory approval. Both brands do contain a tiny amount of human serum albumin.

Yes, many men have wrinkle relaxation injections. The trick is to slightly reduce the muscle movement, rather than eliminating it completely, which keeps a very natural and masculine look.

With age, we develop fine lines and wrinkles for several reasons. If we frown a lot, eventually a vertical line forms and stays between the eyebrows. In the case of the horizontal forehead lines, these come from raising the eyebrows – but what many people don’t know is that the skull naturally changes shape with age, which makes it necessary for the forehead muscles to work extra hard to keep the eyelids up… hence the forehead lines. In addition, the muscles in some people become tenser with age – while with others they become looser – so we have to assess which, and whether it would look better being relaxed with wrinkle relaxation. Even if the muscles become looser, it may be possible to use wrinkle relaxation in a way to get some eyebrow lift. Around the crow’s feet, we develop fine lines around the eyes due to expressions like smiling. We can also use wrinkle relaxation in the lower face to stop certain muscle pulls – for example, to make the corners of the mouth go back up, or to stop the chin dimpling. We can also use it to help stop the neck muscles pulling the jawline and lower face downwards, thereby helping to soften early jowelling in some patients.

Yes, because it can stop a muscle before it pulls on the skin, preventing wrinkles from forming, or getting worse.

There is no cream which will give the same blockage of muscular action as wrinkle relaxation will. A peptide called argireline, which is available in some skin creams, can provide an extremely mild effect according to some reports, but it’s not as effective as the injections.

Unfortunately, clinical trials of topical wrinkle relaxation have so far not been successful.

This is such a versatile treatment. The common areas you probably know about are the frown lines, horizontal forehead lines and crow’s feet. We can also treat the bunny lines (those lines underneath the eye, to prevent the eye from closing up a lot when smiling), a gummy smile, reduce nasal flare, an ‘orange peel’ chin and a downturned mouth. We can also use wrinkle relaxation to prevent the lower lip coming down on smiling, as well as to remove small lines around the mouth, vertical neck bands, jaw clenching and grinding (we can weaken the muscles that cause this). It can slim the face too if the chewing muscles are large, and reduce excessive sweating in the armpits, on the forehead and sometimes on the hands. It can also be mixed with hyaluronic acid and used in a diluted form to reduce sebum production on the face.

Yes, you can achieve a mild brow lift using this treatment. The exact areas treated will depend on the patient’s anatomy, but could include around the eye, along the eyebrows or in the forehead. There is usually a limit of 2-4mm when having a wrinkle relaxation brow lift.

This is a treatment to the muscles of the neck and jawline to allow the muscle to fall back flat against the underlying tissue of the jaw. It doesn’t work for everybody and is only suitable for those who have prominent muscles in this area which prevent them from having a strong jawline.

By treating the chewing muscles, you can reduce the strength of your clenching. Often, for people who grind their teeth, this is treated by injecting the masseter muscles but, for people who clench, it may be necessary to also treat the muscles in the temple and neck to achieve the best results.

Yes, in people with enlarged masseter muscles wrinkle relaxation can be used to prevent these muscles from activating as strongly, causing them to temporarily shrink and slim the lower part of the face. Sometimes wrinkle relaxation can also be used to shrink the parotid gland which is a salivary gland in a similar area to the masseter muscle.

Due to the changes in the bone of the skull with age, sometimes it’s not possible to treat the horizontal lines above the outside parts of the eyebrows without dropping the brow. We do have other methods which can be used here however; for instance, dermal filler can be used to reduce these issues. It’s important to remember too that the point of this treatment is not to remove movement, its simply to cleverly reduce it in some areas to give a refreshed look – and unfortunately, even if desired, it’s not possible to completely eliminate every line, wrinkle and fold. We just want to make sure we give our bodies a helping hand and grow older as gracefully and naturally as possible.

It’s important that any wrinkle-relaxing treatment is performed after a consultation to make sure it’s right for you. A picture will be taken of you in 3D to see any areas of asymmetry, and then we’ll take pictures of you moving your face in a frown, raising your brows, smiling, pouting, turning the corners of the mouth down to see how your muscles work, as no two people are the same. We’ll discuss what you’re looking to achieve from any cosmetic treatment, and how the outcome should look. Sometimes we mark up the skin and take a photo in order to record exactly where the injections were administered for later reference. We usually use a Juvapen, an automated injector device which administers a set amount of product at each activation – thus making the procedure more accurate, as well as reducing any pain. After the treatment, there will be a small bump on the skin where it was injected, but this will only last for about 20 minutes.

It’s helpful if you don’t wear any makeup when you come in for the procedure in order to reduce the risk of infection – but don’t worry, we can take it off for you. If you’re prone to bruising, you may want to take some arnica or bromelain before and after treatment. If you have an important event coming up, you should schedule your treatment carefully, so you have an appropriate amount of time between the procedure and your commitments. Ideally you would treat at least one month of any events in the event that a two week touch up is necessary, in order to see the results of the touch up.

If you are prone to bruising, you may wish to use arnica or bromelain to help reduce any bruising. For areas such as the crow’s feet and neck, where there may be a large number of small veins, we use a small device to help us visualise these veins through the skin more easily. Most people will experience either no bruising (or a very small amount), which can easily be covered with makeup.

For some people a check-up after two weeks can be necessary, and we often offer this as a normal part of the procedure, especially if we haven’t treated you before. As part of the ‘start low, go slow’ philosophy, it may be necessary to add more solution to obtain the optimal result. If we don’t feel you need one, for any reason (which we will explain at the time), then you won’t have to come back.

The treatment is a very sharp scratch, and we have various tricks to minimise any pain sensation at the time of treatment. For example, from using the Juvapen device, to using extremely fine imported needles, we make great efforts to minimise discomfort. Topical anaesthetic is not necessary for wrinkle relaxation injections, because we take so many precautions to minimise pain. Most patients tell us that they barely feel a thing.

You won’t have any loss of sensation after this treatment, because there are two types of nerves; one transmits feeling and the other makes motion. Wrinkle relaxation tackles the latter.

Immediately after treatment you can apply surgical makeup if desired; we have some in the clinic. You can apply regular makeup from the next day onwards.

You won’t see anything happening until about day five; then you’ll slowly start to see the effect. It takes around two weeks for the final results to appear. If you are having treatment for a special event, please plan to have your treatment no less than one month prior to the event in order to account for the possibility you may need a two week touch up for the best results.

Yes, you can return to work after the treatment, but please do not go to the gym or exercise until the following day. Avoid bending down for a few hours, and don’t rub the area aggressively or get a facial massage for a couple of days afterwards.

This treatment is not approved for use during pregnancy or whilst breastfeeding.

This is variable depending on the individual, and can be anywhere from two to six months, although the average is three months. It’s important to remember that if a more natural look is desired, the effects don’t last as long, and more frequent treatment may be necessary to maintain the desired results. In the case of wrinkle relaxation for sweating, this tends to last longer: up to four to six months. In the lower face, as the doses must be smaller, the effects last around two months. You don’t build up a tolerance to it either; your body never gets used to wrinkle relaxation.

This depends on several factors. For most people you would have treatment every 3-4 months to maintain your results, however some people prefer to let their results completely wear off and have treatment every 6-12 months. The choice is entirely yours. If you are having Baby wrinkle relaxation then treatment will need to be carried out more frequently as it does not last as long. Treatment carried out in the lower face does not last as long and may need to be repeated every 2-3 months. Wrinkle relaxation for sweating tends to last longer, at around 6 months. Treatment for clenching or grinding can last 3-6 months.

The neuron re-sprouts endings which can release acetylecholine, and movement slowly comes back to the muscle.

Nothing, you simply return to your pre-treated state – although the fact that you’ve had decreased movement in this area for some time usually means that the wrinkles will look a little better for a period of time after the wrinkle relaxation has worn off.

There is no “antidote” to wrinkle relaxation, and the treatment cannot be reversed. Many people are nervous the first time they have wrinkle relaxation so please be assured that the effects of the treatment always reverse with time!

It’s a common misconception that having wrinkle relaxation will make the skin age more quickly. As time goes by, the muscles of the forehead naturally atrophy and the bone changes shape, which means we use less in most people as they age to maintain a natural result (and sometimes combine this with filler to disguise the bony changes of ageing). There is nothing to suggest that having wrinkle relaxation will in fact make you look older.

This depends on the rate of facial ageing. Some people develop fine lines and wrinkles early in life, and if the lines are beginning to be ingrained into the tissue then it is appropriate to commence treatment. Ideally though, we prefer not to treat those under 25 without an exceptionally good reason.

One of the concerns we hear a lot about is that people worry they’re not going to look like themselves after having this treatment. Please don’t worry. The treatment can be customised how you want it, so you can look as natural as you want to be… you’ll still be able to raise your eyebrows for example. The great thing about this treatment is you get to choose the lines and wrinkles you want to keep.

As long as your expectations are to keep the results on the natural side, then someone would have to have an eagle-eye to detect there has been any change to your appearance. Most of the time, our clients tell us that others seem to sense something positive has changed within them, but without ever being able to put their finger on why they think this is the case.

The shiny forehead you sometimes see is caused by there being no muscle movement left, meaning a lot of wrinkle relaxation has been put in this area. It’s possible to prevent this by keeping a more natural look.

Yes, you can still raise your eyebrows and move your face as normal; however, the degree to which certain facial expressions are made (like frowning) is reduced.

Yes, you will still be able to raise your eyebrows following treatment although the amount will be reduced if the forehead is treated.

The term “Baby wrinkle relaxation” refers to the use of fewer wrinkle relaxation units in order to retain more movement in the muscle after treatment. Some patients for whom it is very important to be able to express a full range of motion e.g. actors and newsreaders, prefer to have this type of treatment. As the length of time the wrinkle relaxation lasts for is dependent on the amount of wrinkle relaxation used, usually the effects will last half as long with “Baby wrinkle relaxation”.

It’s helpful if you don’t wear makeup when you come in for the procedure – but don’t worry, we can take it off for you. If you’re prone to bruising, you may want to get some arnica or bromelain. If you have an important event coming up, you should schedule your treatment so you have an appropriate amount of time between the procedure and your event. Remember, wrinkle relaxation takes a couple of weeks to work, and you may need an adjustment at this time.

If you’re prone to bruising, you may wish to use arnica or bromelain. For areas such as the crow’s feet, where there may be a large number of small veins, we use a small device to help us visualise these veins through the skin more easily.

Whilst complications are rare, they can and do happen from time to time. This could be something like a bruise following treatment, or a drooping of the eyelid or eyebrow. This is very uncommon and can be caused by either using too much wrinkle relaxation, or it being placed in the incorrect area – or sometimes it can diffuse into the wrong muscle. We prefer a ‘start low and go slow’ approach, to minimise the risk of anything like this occurring. Side effects can include headache (which is not uncommon the first time after treatment), general tiredness or nausea, temporary drooping of the eyelid of eyebrow, double vision and neck weakness. Although it sounds strange, in some people an unusual eyebrow position can actually be caused by not using enough wrinkle relaxation and the muscle raising the eyebrow becomes over active! This can be easily remedied by adding more of course.

Some people are immune to the effects of wrinkle relaxation. This can either present itself the first time a person is injected, or can develop over time – normally, the second, third or fourth time they have a treatment. In this instance, the immune system neutralises the wrinkle relaxation. The manufacturer advises that the risk of antibody formation can be minimised by injecting the lowest effective dose and waiting the longest feasible time between injections. Around 1-3% of people who are injected will develop antibodies. If you find it doesn’t work for you over a period of time, then one way to prevent this from happening can be to take a break for six months and try again, as sometimes this will solve the issue. If wrinkle relaxation is not working, the most common are:

• The product may be old, fake or overdiluted. It needs to be used within a specific time frame in order to work. Some places will over dilute the product to make the injections go further, as it is mixed up at the time of injection and comes from the manufacturers in a powder format. There is also a problem with counterfeiting in some countries if the product is not purchased from a reputable pharmacy with clear lines of supply.
• If it is not injected in the right place, there will be no result.
• The dose might not be correct. We are all different, and the same dosage doesn’t work on everyone.

The wrinkles might be too deep for wrinkle relaxation to have an effect on its own. If the wrinkles are present at rest, it’s likely that wrinkle relaxation will only soften them, and you may need filler to get further improvement.

Both treatments do different, complementary things. wrinkle relaxation is used when trying to relax a muscle pull such as in the frown line area, around the eyes or in the lower face. Dermal fillers are used when there is volume loss in the face or when augmenting a particular feature. Take lip augmentation, for example. Lips cannot be made larger using wrinkle relaxation. There are times when the volume loss may not be obvious, such as when treating the forehead lines. Sometimes there will be loss of fat and bone in this region, meaning that for the best result it should be filled, as well as treated with wrinkle relaxation. Each is assessed on a case-by-case basis. It is also appropriate to use dermal fillers when performing skin improvement (although as an exception, wrinkle relaxation is used as part of a mesotherapy treatment to reduce sebum production). Dermal fillers have many applications, and your doctor will talk you through this at your appointment.

Please note that you are paying for the treatment only and no guarantee is made of any outcome. Refunds cannot be given under any circumstances, as the product has been used and the service has been delivered.