Anti-wrinkle injections used to be the domain of Hollywood celebrities, but now the number of people having treatment has really increased over the past few years, as it continues to become more and more mainstream.
I meet a lot of people who are interested in taking the first step but aren’t really sure where to start. They often wonder if they are suitable or are very keen but afraid to take the first step for a variety of reasons.
If this sounds like you, read on and see if I can answer your questions in this “introduction to anti-wrinkle injections.”
Let’s begin with the most commonly asked question.
What are the different brands of anti-wrinkle injections? Are they different?
I get asked these questions all the time.
The law in Australia doesn’t allow the brand names of prescription medications to be advertised, and anti-wrinkle injections are prescription medications.
There are two major brand names out there, and one of them is so famous that it has almost become synonymous with anti-wrinkle injections in the same way that the brand name “Kleenex” has become synonymous with “tissues”.
All of the anti-wrinkle injection brands out there all contain the same active substance though, and all of them work in the same way.
Some people may find that one brand seems to work better for them than others, or may last slightly longer, and some people may find that one brand works better in the forehead and the other brand works better in the crow’s feet.
All of these subtle differences may or may not be relevant in practice, and certainly I’ve never found any noticeable difference between the two main brands.
That said, if you prefer one brand over the other, a good skin care clinic should have both options.
What does anti-wrinkle injections do?
Anti-wrinkle injections work very simply.
The injected molecule acts at the junction between nerve and muscle cells, known as the neuromuscular junction, and blocks the action of the nerve impulse which would otherwise tell the muscles to contract.
In fact, this mechanism of action is also very useful in people who suffer from severe muscle spasticity and contractions following strokes, or in people with cerebral palsy.
The doses are much larger (because the muscles involved are much larger), but the same principle applies: the muscles are weakened and aren’t able to contract as much.
So that’s the science, but there’s an art to it too.
When certain facial muscles contract, they cause the overlying skin to bunch up and wrinkle, and that’s where the skill of the injector comes in.
It important to choose an injector with a good understanding of the anatomy and the muscles under the skin so you can achieve the best result possible!
Types of Wrinkles: What are “static lines” and how do they compare to “movement lines”?
When I talk to my clients about wrinkles I divide them into two types: movement and static.
As the name suggest, movement lines are the wrinkles that appear (or worsen) when the underlying muscle contracts.
To put it simply: stop the muscle moving and you stop the wrinkle forming (or getting worse). It’s not magic, just science! The most common movement lines treated are the forehead, the frown and around the eyes (“crow’s feet”).
And then there’s static lines. These are the lines that are always there, movement or no movement.
Anti-wrinkle injections won’t get rid of these, although if your static lines worsen or deepen with movement, then the worsening appearance can be greatly reduced.
Over time, as you move your muscles thousands upon thousands of times, the movement lines eventually turn into static lines.
It’s not just repeated movement which does it though: as we age our skin produces less collagen, which is the protein in the skin which keeps it firm and elastic.
Less collagen plus lots of movement over the years equals movement lines turning into static lines. Your body is still producing collagen though, even if at a slower rate than when you were younger.
So over time, especially if we eliminate movement with anti-wrinkle injections, those static lines may repair themselves.
That’s not the main purpose of anti-wrinkle injections of course, and it may not always happen, but it’s a nice bonus if it does happen!
The growth of new collagen can also be enhanced by various other treatments including Laser Genesis, Vitamin A peels or regular use of Vitamin A cream.
So, to summarise, anti-wrinkle injections paralyse or weaken the specially targeted facial muscles which cause and worsen wrinkles.
When to start? Before or after the wrinkles appear?
Another common question is, “When should I start”? This really depends on you.
Some people like to start with their anti-wrinkle injections at a younger age, as a preventative measure to stop wrinkles forming at all.
This goes back to the concept of movement lines eventually turning into static lines: eliminate the movement early on, and you eliminate the appearance of the lines.
Other people start when they notice a few new lines that they never really noticed before.
“I just saw a photo of myself smiling recently, and it’s the first time I’ve ever noticed crow’s feet”, is something that I hear quite a lot.
For others it may be a new milestone like a fortieth or fiftieth birthday that leads to a newfound awareness of fine lines and wrinkles.
Of course, there’s lots of other ways in which you can minimise the appearance of fine lines and the development of static lines.
Far and away the two best methods are being sun-smart, and not smoking. The ultraviolet light in sunlight damages collagen, which worsen wrinkles (as we discussed above).
Cigarette smoke has a similar effect.
So apart from all of the other health reasons to be sun-smart (skin cancer) and to quit smoking (lung cancer, heart disease…. damage to your entire body let’s face it), now you can add anti-ageing.
Other methods include, as mentioned above, Laser Genesis, peels and proper home skin-care.
What are the common places to inject?
Far and away the most common places to inject are the lines in the forehead, the frown lines and the lines around the eyes.
There’re a few other places too, and we’ll go through them all briefly.
And of course, don’t forget that not all places have to be injected at once, or at all. It’s very common for some people to only get certain areas which they see as a problem treated.
Or if you’re nervous, but interested, it may be better just to dip your toe in with one area of injections and see how you like it.
The forehead can be a nice place to start. It’s a muscle called frontalis, and it’s a thin “sheet” of muscle that causes the forehead to wrinkle and the eyebrows to raise when it contracts.
The number of units injected here depends on how high your hairline is, but I find it’s best to start with low doses across the forehead to begin with.
Especially as we age and the eyebrow’s “droop”, we may use this muscle to hold up the brows. Too high a dose in the muscle can therefore lead to a heavy or drooping brow.
It’s easy to come back in two weeks for a review and add a few more units if need be, and to me this is much preferred to a drooping brow!
The other common issue, and a dead-giveaway of anti-wrinkle injections to the forehead, is a pronounced arching of one of both eyebrows, called “Spocking” after Dr Spock from the television show “Star Trek”.
This means that the muscle hasn’t been injected far enough out to the side, and the non-paralysed part of the muscle is acting unopposed to lift the brows.
It can be fixed with just another small injection towards the edge of the muscle.
Another great place to start is the glabella, or frown lines.
These lines are also known as the “eleven lines”. They are the lines between the eyes, above the nose, that worsen when we frown.
These are some pretty big muscles, and therefore require pretty big doses. Some people find that these lines can make them look serious or even angry even when they are just at rest.
I also find that these lines worsen when I squint in the sun.
There are three muscles that are injected. One is in the midline above your nose and it’s called the procerus muscle.
Then there are two muscles in a pair that run over each eyebrow, called corrugator. The procerus gets an injection, and each corrugator gets an injection in its “head”, its “belly” and in its “tail”.
Seven injections in total for this area.
The third very common place for anti-wrinkle injections is probably the best known one, and that’s the lines around the eyes, also known as the “crow’s feet” or “smile lines”.
These are these are the lines which appear or worsen when we smile or tightly close our eyes.
These lines are caused by the contraction of a muscle called orbicularis oculi, which forms a ring around the eyes.
There’re two types of people when it comes to these lines: one type simply tells me to “nuke the lines” and completely get rid of them.
The other type of person simply like to have their lines softened somewhat, but to still have some movement.
There’s no right or wrong answer, and it’s up to what the individual wants to achieve. Depending on your goals we either use a larger or smaller dose.
There are a few other muscles that we can inject in the face, including the depressor angulari oris (to help give the corners of the lips a slight turn upwards), orbicularis oris (for a “lip flip”) as well as the cutely named levator labii superioris alaeque nasi (LLSAN) which can help with a gummy smile.
These are considered more difficult areas to treat, and you definitely want to make sure that your injector is very experienced and understands the underlying muscular anatomy before trying these injections.
How do I know if anti-wrinkle injections will work for me?
Anti-wrinkle injections work for movement lines in the face, especially in the forehead, frown and around the eyes.
If you have very deep wrinkles, or wrinkles which do not change at all when you move your facial muscles then perhaps anti-wrinkle injections are not the best option for you.
In these cases, you may require other treatments, for example replacement of lost volume with dermal fillers, or rejuvenation of the underlying collagen with laser genesis, peels or home care.
Your doctor or nurse will be able to discuss your goals with you and give you a realistic idea of how they can best be achieved. Your initial assessment is normally free.
How much do anti-wrinkle injections cost?
Anti-wrinkle injections are usually priced either per unit used, or per facial area treated. We find that a “per unit” method of calculating cost is a more transparent method.
A free consultation with a doctor or nurse will allow us to discuss your goals and budget and come up with the best, individualised plan for you.
What to consider before getting anti-wrinkle injections?
The most important thing to consider is the experience and knowledge of your injector.
Do your research, ask around, and don’t be afraid to get a few opinions from a few different injectors.
Find someone who you trust, and with whom you feel comfortable: it’s your face after all!
Don’t feel pressured into doing more than you are comfortable with. My general rule with anti-wrinkle injections is to start low and go slow.
Do you have any particular goals you are trying to achieve? Do you want to completely eliminate your wrinkles or just soften them?
Also, don’t forget that anti-wrinkle injections are a medical procedure, and like any medical procedure may have unintended side effects (which I will discuss below). It’s important that your injector can have an honest discussion with you about the risks.
There may be certain reasons why it may be safer to postpone or even avoid anti-wrinkle injections entirely.
Certain medical conditions, especially some neurological conditions and bleeding disorders, may make injections riskier.
The same goes for certain medications which thin the blood. Women who are pregnant and breast-feeding should also avoid anti-wrinkle injections.
There’s no evidence about the effect of anti-wrinkle injections on a developing baby, or a breast-feeding baby: but why take the risk?
It’s much safer to postpone your treatment until after you have stopped breast-feeding.
It’s very important for your injector to take a full medical history from you, including any medications that you may be taking (don’t forget about puffers and The Pill), allergies, and any previous cosmetic injections or facial surgery or facial trauma.
Most medications and medical conditions won’t stop you from having injections, but it’s better to be safe than sorry.
What to do before anti-wrinkle injections? What not to do before anti-wrinkle injections?
Besides doing your research and finding a reputable injector who you feel comfortable with, there’s not a great deal that you need to do before having your injections.
Avoid medications like aspirin and ibuprofen for a few days beforehand as they can thin your blood and make bruising more likely.
If you feel like you may need some pain relief, you can try taking two paracetamol tablets about half an hour beforehand, but this generally isn’t necessary.
Try to be well hydrated by drinking a few glasses of water beforehand and try to have some food on board so your blood sugar doesn’t drop during the injections.
If you are someone who is prone to fainting, please let your injector know! And if you’d feel more comfortable bringing a support person, you’re more than welcome to do so.
How long do the injections take? How long does it take to see results?
The actual process of doing the injections is very quick.
The longest part of the whole procedure, in my experience, is drawing up the medication into the syringe to get it ready to inject.
When I see a new client, I like to have a very thorough chat about the procedure and their expectations and goals.
That’s probably the longest part of the whole thing!
That or my obsessive-compulsive need to clean the area a lot before I inject!
If you were having injections for the first time, maybe budget forty-five minutes to an hour for the whole thing.
For subsequent visits it should be much quicker as you’ll know what to expect.
Anti-wrinkle injections take somewhere forty-eight hours and fourteen days to start having an effect, and everyone is different.
In some people it kicks in all at once, and in others it’s more gradual.
Generally, by two weeks you’ll have the full effect, which is why I like to review at two weeks and not before.
That’s also the reason that I won’t add any extra until this time period is up.
When should I contact my injector if something isn’t normal?
Immediately! If you have any concerns whatsoever regarding your injections, please let your doctor know as soon as you can.
My patients are given my contact information to make sure I can be reached after hours. I’m one of these sad people who can’t stop looking at their phone and answering emails, so it doesn’t normally take long for me to reply.
In any event I like to call all of my clients briefly a few days after their injections just to touch base and see how you are travelling.
Plus, I’ll also make a review appointment to see you again in roughly two weeks. The injections will be working by then, and if any “touch-ups” are needed we can add some more.
How long do anti-wrinkle injections last? How often should you get anti-wrinkle injections?
The average length of action of anti-wrinkle injections is twelve weeks.
Some people are lucky, and their injections will last significantly longer, and in some unlucky people they will wear off quicker.
As far as I know there’s no “trick” to making the injections last longer, although some people think that exercise may speed up your metabolism and make the medication breakdown faster.
I’m not sure how true this is, and in any event, I wouldn’t ever suggest that people stop exercising.
When to get your next dose depends on you.
Some people think that getting your next dose before the last dose has fully worn off makes the next dose last slightly longer, but again I’m not sure of the truth of this.
I generally automatically make an appointment for my patients for three months’ time.
Do anti-wrinkle injections hurt?
Everyone has different experiences with their anti-wrinkle injections, and it can even vary between injection sites.
Some people find the forehead the least pleasant, and others find the frown the least fun. Some other people don’t even seem to notice the needle at all!
I like to use ice to numb the area, after having given the region a good clean.
You can also have a go using the “squeezy ball”, which helps take your mind off it. No one likes injections, but we’ll get through it.
We can take as long between injections as you like, and if you need to do some deep breathing, or be distracted, we can try that too.
The needle is tiny, it doesn’t take long, and ice really helps.
Will anti-wrinkle injections give me a natural look?
It all depends on the dose and where the injections go.
In my opinion, the best injections are the ones that no one notices. I think that the lines on your face can tell a story, and especially when it comes to your “smile-lines” around the eyes, they add a lot of personality and character.
So, I like to inject less rather than more, and soften rather than freeze.
Of course, if your goal is complete elimination of the lines, this can also be achieved by adding more. But let’s think about starting with a small dose first!
Are anti-wrinkle injections safe?
Although anti-wrinkle injections are a cosmetic procedure, it’s important to remember that they are still a medical procedure, and like all medical procedures do have a small degree of risk involved.
Allergic reactions to anti-wrinkle injections are possible in theory, but very rare.
The possible side-effects underscore the importance of doing your research and finding an injector with experience and knowledge.
Probably the worst side effect of anti-wrinkle injections is when the medication weakens or paralyses the wrong muscle, the worst example of this is a droopy eyelid, or “ptosis”.
This occurs when the anti-wrinkle injections move from the muscles around the eye to the eyelid muscle.
The eyelid will be droopy until the injections wear off, an average of twelve weeks. There are eye drops which may help a little, but it’s really just a matter of waiting for the injections to wear off.
The way to avoid this is for injections to be at least one fingers breadth away from the bony part of the eye socket, and for you not to vigorously massage the area for a few days.
You can put on your make-up and wash your face like normal, but don’t rub too hard.
Avoid touching the injected area too much as dirty fingers can increase the risk of infection, which is always present when the skin is broken for any reason.
The area should be cleaned thoroughly with anti-septic before any injections are performed.
The most common problem is usually bruising.
Statistically speaking if you inject enough people, eventually one of them will get a bruise.
If it happens it will be recognised at the time pressure applied to the area to minimise the bruising. It’s very embarrassing for the injector!
The most common place for this to happen is around the eyes as there is a vein which runs down along the injecting site.
It can usually be seen and avoided, but sometimes it gets hit, causes a bruise, and you’ll have to wear make-up over it for a few days.
I’ve already mentioned dropped or heavy brows, as well as “Spocking”, so I won’t repeat myself.
Some people may develop a mild headache, or even mild “flu-like” symptoms.
It’s as if the body senses the anti-wrinkle medication as being an infection, and the immune system starts up to fight it.
Paracetamol can help with this, as can keeping up your fluid intake. It usually only happens the first time you have anti-wrinkle injections.
What should I do after anti-wrinkle injections? What should I do that evening? Or the next day? How do I reduce swelling and bruising after anti-wrinkle injections?
Some of the literature and pamphlets that you may read about anti-wrinkle suggestions suggest that you completely abstain from exercise for 24-48 hours, as well as avoiding any activities like saunas which make you sweat.
This is potentially overkill, but caution is a good thing.
I usually tell people to take it easy for the rest of the day. It’s all about listening to your body and being sensible.
If you feel like, you can probably go to your Pilates class, but don’t run a marathon. You can have a glass of wine with your dinner, but don’t drink the whole bottle. Definitely don’t massage the area firmly, as discussed above.
Try to stay hydrated, and if you feel slightly unwell or have a mild headache, try an icepack or simple painkillers like paracetamol.
Avoid aspirin and ibuprofen as these painkillers can thin the blood and worsen bruising. Sleeping upright on a few pillows, with the head above the level of the heart can also help to minimise swelling.
Are anti-wrinkle injections for men?
Yes, they are, and many men get them. The injections work in exactly the same way, and everything written above holds true for men as well.
I have more questions that weren’t answered here. How do I ask them?
We always love to answer your questions, so if there’s anything that we’ve missed here that you think might be important, please leave a comment here or reach out to us.
If you’re in the Melbourne area, stop in for a free skin care consultation with us.