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Background
Injectable treatments have been used for many years to treat muscular problems including eye deviation, eyelid spasm and facial spasm associated with conditions such as Parkinson's disease. There is a very long history of safe, effective use of these treatments but they have only been used for cosmetic purposes, and more specifically for the treatment of wrinkles and lines on the face, in the last few years.
The Ageing Face
The main factors responsible for the ageing process are hereditary, smoking and exposure to ultra violet radiation. The skin changes associated with the ageing process are skin sagging, fine wrinkling, and deepening 'animation' lines caused by repeated muscle movement.
This pattern of facial movement is predetermined during childhood and carried on subconsciously throughout adulthood.
Which areas can be treated?
Wrinkle injections lead to a temporary relaxation of the target muscle. This produces a reduction in wrinkling of the skin surface above the target muscle.
Examples include: the deep crease between the eyebrows (glabella lines), crow's-feet, wrinkles around the eyes and horizontal forehead lines.
Injection into frown lines can be very successful. Good results may be obtained after a single injection and can last for six months or even longer. The effect of the injection may take between 5 and 7 days to work. Some patients with very powerful muscles may not see a complete relaxation of the targeted area, but subsequent injections will further weaken them.

Injectable techniques can also be used to paralyse the muscles that control sweating and is an effective treatment for hyper-hydrosis.
What does it feel like?
The treatment involves a small number of painless injections into the muscle groups that cause the wrinkling. Immediately after the injections there may be some mild swelling that usually subsides within 24-48 hours.
Can these treatments be used with Restylane, Perlane or laser treatment?
The treatments are complementary and it has been reported that Restylane or Perlane lasts longer when associated. This is because the continuous movement of the muscles is eliminated, slowing the body's breakdown of the injected product.
Note: It is not possible to carry out both treatments at the same time; it would be necessary to carry out the muscle-relaxing treatment first, followed by Restylane or Perlane one month later.
How many treatments are required?
Repeat treatments are usually needed every 3-9 months. Clinical trials report that some patients, who have had treatment over 12 months, are only requiring further treatments twice a year. Please note it takes 5 -7 days for the treatment to work. Vigorous use of the muscles for 2 hours after treatment helps speed up the onset of effect.
Possible side effects
Side effects of this treatment are infrequent. Mild bruising may occur around the injection site and if you are prone to cold sores at the injection site, treatment may bring out another eruption. A number of very rare side-ffects have been reported including:
• temporary drooping of the eyebrow or eyelid (ptosis).
• transient numbness in the treated area.
• A mild, transient headache
• allergy. This is more likely in the case of multiple treatments as the body's immune system is provoked into an intolerance of the serum.
• An extremely rare side effect may be a more generalised weakness and fatigue.

In 8 years, we have had 1 example of ptosis and a single batch of the solution that caused a mild headache in a number of people.
Finally, any injection carries a small risk of infection. If you are pregnant or breast feeding, the treatment is not recommended.
Who would carry out the treatment?
We employ a consultant plastic surgeon, Mr Mark Henley MB ChB FRCS(Ed) FRCS(Plast), an expert, medical practitioner, Dr Helen Fernandez and our own clinical director, Jo Martin to carry out these treatments.
Photography Acknowledgements: Allergan
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