Anti-wrinkle injections are currently the most common medical cosmetic treatment. There have been 17 million injections that have been safely administered for cosmetic purposes alone since 2002. It is currently approved for treatment of glabella wrinkles, which are the frown lines between the eyebrows. Any other treatments are considered “oﬀ-label” (a common and legal practice in which a drug is used for a purpose other than the oﬃcially approved one).
Here are some other interesting facts you should be aware of:
- Clostridium Botulinum (the bacteria that causes food poisoning) was ﬁrst identiﬁed at the University of Gent, Belgium, in 1895.
- Anti-wrinkle injections consist of Botulinum toxin type A, which was isolated in the puriﬁed form by Dr. Herman Sommer at the University of California in the 1920s.
- Botulinum toxin type A stops the release of certain chemicals at the junction between a nerve and a muscle, so the message for the muscle to ”work” is blocked and therefore relaxes. Its anti-wrinkle properties were discovered in the 1980s by Dr. Jean Carruthers (an ophthalmologist) and her husband Arthur (a dermatologist) when patients being treated for crossed eyes and facial spasms told their doctors that their lines and wrinkles had vanished since starting the injections.
- Anti-wrinkle injections are approved in more than 75 countries for 20 diﬀerent neurological indications and approved for cosmetic use in more than 40 countries.
- In the 20-year history of using the drug for cosmetic treatments, there is no anecdotal evidence of any long-term problems because any muscle weakness from the injections is reversible because Botulinum toxin type A ’s action is temporary.
- Botulinum toxin type A has been used in other conditions such as migraines, excessive sweating, incontinence, hemorrhoids and has even been used on patients with gallstones.
- The cosmetic formula on uses a much lower dose of the toxin than the one used to treat major muscle spasms.
- Anti-wrinkle injections are not a panacea for every facial wrinkle. Those caused by other mechanisms such as hereditary, smoking, sun exposure, and the eﬀects of gravity, do not respond adequately. Nor are anti-wrinkle injections particularly eﬀective for wrinkles around the mouth. Other treatments (such as Retin-A, chemical peels, collagen or fat injections, laser therapy, or facelifts) may help for people who wish to minimize these types of wrinkles.
A U.S. consumer advocacy group called Public Citizen has recently asked the Food and Drug Administration (FDA) to reconsider the safety of anti-wrinkle treatments. However, my main issue with them is that they have grouped together adverse events from both the medical and cosmetic uses of the drug. They pointed to 180 cases of serious complications like pneumonia and diﬃculty breathing or swallowing, which included 16 deaths (collected from 9 full years of data). Earlier in 2005, The Centers for Disease Control and Prevention reviewed 1,437 adverse reports: 406 after medical use of the toxin (217 of them were serious eﬀects) and 1,031 after cosmetic use (36 of them serious). The proportion of serious reports was 33-fold higher for patients treated for medical problems than for those receiving cosmetic treatments and the worst disasters have occurred when unqualiﬁed practitioners administered the drug. The FDA has also conﬁrmed that there has never been a reported death where a causal link to the cosmetic use of anti-wrinkle injection was established.
Don’t forget that many cancer medications are derived from substances that in other contexts would be considered dangerous. And many other drugs that are licensed for a particular condition are used “oﬀ label” to treat other problems. Remember, all drugs have unwanted side-eﬀects, so that with more people using anti-wrinkle injections, the list of unwanted eﬀects may be growing.
Earlier this year, the Food and Drug Administration (FDA) which reviews the continuing safety of anti-wrinkle injections, notiﬁed the public about reports of their serious side-eﬀects. Most of these, however, resulted from medical, not cosmetic uses of the toxin. Medical treatments typically require much larger doses, and many of the patients have other health problems that increase their risk. For e.g. to treat the furrows between the brows, a typical dose consists of 20-35 i.u.’s (intramuscular units) compared to over 200 for neuromuscular disorders. The reactions included respiratory failure (which sometimes was fatal) in a range of doses and use, many of them “oﬀ-label” e.g. limb spasticity associated with cerebral palsy in children.
So, my advice to patients and clients seeking anti-wrinkle injections would be:
- Choose your doctor or nurse injector carefully. They should be both experienced and competent and make you feel safe and at ease.
- Injectables should be performed in an approved medical oﬃce or medical spa.
- Ques on the authenticity of the injectable. Ask to be shown the brand packaging.
- Pay close attention to the potential complications which should be thoroughly discussed during the informed consent process.
Thanks for reading!
Dr. Tim – Sydney Cosmetic Plastic Surgeon
Although the hands of time cannot be completely turned back, facial rejuvenation can slow down or even reverse some of the natural aging processes which produce lines and wrinkles, age spots, broken capillaries, dull skin, and uneven tone and texture. Other ﬂaws include loss of collagen and elastin, resulting in sagging skin, gaunt faces, dark circles and puﬃness under the eyes. Open pores and acne scars also appear more visible.
There are 4 things that happen to our face as we age:
- Volume loss (mainly fat)
- Sagging tissues because of gravity
- Facial bones thin out and become lighter
- Skin thins, develops ﬁne lines and wrinkles, as well as, brown patches
I think of skin and facial rejuvenation in terms of the 5 Rs:
- Relax: refers to using anti-wrinkle injections which so often wrinkles caused by muscle movement. The facial muscles of expression, if used too much, can result in “frown lines” between the eyes, “worry lines” of the brow or “crow’s feet” beside the eyes. By relaxing the muscles responsible for these expressions, we are able to interfere with the development or progression of such lines.
- Reﬁll: various products, from ﬁllers to one’s own fat, can be used to address facial volume loss. Such techniques are used in the treatment of deeper wrinkles, folds and expression lines that are too deep to be adequately aﬀected by resurfacing.
- Resurface: refers to methods that remove the outer layers of the skin to yield a smoother, more even-coloured texture. These techniques are used to treat sun-damaged, weathered, or aged skin. These are useful for dealing with wrinkling of the skin, blotchiness, roughness and loss of lustre e.g. facials, microdermabrasion, chemical peels, and lasers.
- Redrape: refers to traditional surgical interventions that improve areas of redundant skin. Overtime and with accumulated sun damage, the skin loses its elasticity and may begin to sag. This is especially true in the lower face and neck although laxity of the brow skin and eyelids is also common. Most treatments for signiﬁcant sagging of the face require surgical interventions e.g. facelifts, brow lifts, eyelid lift surgery.
- Removal: It is not uncommon to develop unwanted bumps, broken blood vessels, brown spots or tags on the skin, especially on the face and neck. All of these can be treated by simple removal techniques. In many cases, liposuction (removal of fat) can tighten the neck adequately without actually removing skin surgically.
Today, in the ﬁeld of cosmetics, reﬁll is much more appreciated in our approach to facial rejuvenation. Temporary ﬁllers like hyaluronic acid (HAs) are considered the gold standard. Fillers are often combined in diﬀerent areas of the face to recreate youthful contours, sometimes referred to as a “liquid facelift.” My go-to ﬁllers for correcting hollows under the eyes, cheekbones or lips are HAs or fat. Vertical lip lines are treated with a combination of HAs and anti-wrinkle injections or laser resurfacing.
Fat transfer can be used to replace volume in most areas of the face including the temples (a much-neglected area until recently), cheeks, jawline, nasolabial folds, and marionette lines. It gives reliable, natural-looking results, and even improves the texture of the skin. Fat transfer is an easy, economical, safe, and comfortable means of volume replacement for the face. Fat is harvested from an area of excess fat such as the hip, thigh, or abdomen.
The fat is then processed and placed in small amounts to resculpt the facial contours of the face. Fat transfer is usually done under general anaesthesia. Fat is also an excellent choice for rejuvenating the hands, as it camouﬂages the appearance of visible tendons and dilated veins.
There are so many choices available for skin and facial rejuvenation. One can create a natural and gradual volume replacement. The “cookie cutter” approach to ﬁllers is out. Discussing the 5 Rs and how the various techniques are used in combination for skin and facial rejuvenation can aide in maximising outcomes.
Question: What signs of facial aging trouble women the most? You can leave a comment below.
Often, I’m asked by my Facial Rejuvenation patients about how long their face lift may last. I’m reminded of the French surgeon Dr Vladimir Mitz, a pioneer in anatomy regarding facelift surgery, who told me once he had a crystal ball on his desk to answer such a question! At the time, I hadn’t appreciated how profound this idea was. It makes a lot of sense to me now. Why?
There are several factors to take into account when thinking about treating patients for facial rejuvenation. I call these “the 5 S’s” and they aﬀect your skin and thus the face. These are:
- Sleepless nights
Let’s just take stress’s terrible toll on the skin:
- Wrinkles: tensing and tightening facial muscles squeezes and pinches the overlying skin, creating wrinkles and lines.
- Acne: hormone receptors connected to the oil glands are triggered by stress hormones, so once they’re stimulated, the gland increases oil production, causing pimples and breakouts.
- Hair loss: normally, hair follicles are small and resting, or active and growing, but stress shocks the system, throwing the cycle into chaos and causing follicles to sleep longer rather than produce new hair. Once they wake up, the old hair falls out
- Grinding teeth: jaw tension will create lines and wrinkles as skin is pinched and collagen is broken down.
- Increased free radicals: stress causes blood vessels to clamp down, causing a shunting of blood away from the skin as blood focuses on internal organs.
Lack of blood leaves skin vulnerable to assault from the sun, cigarette smoke and other outside pollutants that create free radicals. As an example of what stress is capable of, we have all seen people who have lost their loved ones and 6-12 months down the track they’ve seemed to have aged 5-10 years; their skin is more wrinkled, dry and sallow looking. Imagine if you throw in the other factors like sun exposure and smoking and you can see how they can aﬀect the longevity of a face lift. That’s why it’s like looking into a crystal ball. I say to patients that a face lift usually lasts 7-10 years if you are lucky and maintain it with regular microdermabrasion, skin peels and laser skin tightening.
Things that you can do for facial rejuvenation to improve the health of your skin is to:
- Use regular sunscreen to protect your skin from free radicals from the outside world.
- Use antioxidants either applied topically or consumed orally such as vitamins A, C, E, lycopene, CoQ10, idebenone, green tea and grape seed extract.
- Take Vitamin B to stimulate hair growth.
- Relax. Calming your central nervous system and mind to give stress hormones a chance to switch oﬀ is a good thing. Try meditation, some quiet time or exercise.
- Anti-wrinkle injections. These injections not only make you feel better when you look your best, but medically they help muscles relax. There is a biofeedback between muscles and the brain, so if muscles aren’t tense, the brain interprets the quietness as calm and lets its guard down.
Question: What do you do for facial rejuvenation to prevent facial aging? You can leave a comment below.