Wrinkle Relaxing

Botulinum toxin is a protein produced by the bacterium Clostridium botulinum. This bacterium makes several different types of protein, from type A to type F.

There are currently two different types of botulinum toxin commercially available in the United Kingdom:

• Type A toxin (including the brands Botox®, Vistabel®, Dysport®, Azzalure®, Xeomin® and Bocouture®)
• Type B toxin (Neurobloc®)

Botulinum toxin type A is a powerful neuromodulator, and it relaxes the muscles, therefore it is commonly used in the aesthetic industry to reduce facial wrinkles. Botox® is made of botulinum toxin type A and is the first, and most popular, botulinum toxin used in both the aesthetic and medical fields.

Yes, it is. Provided you use only reputable brands that have stringent quality control and have a long track record of purity and safety. Only choose botulinum toxins that are FDA approved and CE marked.

Botulinum toxins have been used for medical purposes for many decades, and there are millions of people using them year on year for anti-ageing purposes.

There are several different botulinum toxin brands on the market at present, with Botox® being the most well-known and most expensive. We highly recommend staying with certified, established brands with a long history of safety, and not compromising your safety for lower cost.

Botox© is the first brand of type A botulinum toxins (also known as Onabotulinum A) to gain an aesthetic licence in the UK. It is FDA approved in the US since 2002. It is manufactured by an extremely successful pharmaceutical company called Allergan©.

Many people have mistaken the brand Botox© as a general term for the botulinum toxins treatment, which is simply not correct. For this very exact reason, always confirm with your doctors of the specific brand they use for the treatment. At Harley Street MD, we use only Botox©; we do not stock other brands of botulinum toxins.

Do not be tempted by injectors out there who are not registered with the British College of Aesthetic Medicine (BCAM) and choose to use cheaper unregulated products that are less effective and simply unsafe.

Botox© is a prescription-only medicine and is licensed to treat a variety of medical and cosmetic conditions. It is dispensed by HealthXchange pharmacy – the official distributor of Allergan© products in the UK.

Botox© works by inhibiting the release of acetylcholine in the neuromuscular junction and therefore is extremely effective in relaxing overactive muscle contraction and reducing the production of sweat. It is commonly used in softening facial wrinkles, reducing muscle bulk in targeted areas such as the masseters (chewing muscles), and treating excessive sweating in the underarms.

Its usage has expanded widely over the years and is no longer confined to the cosmetic field. Botox© is very safe and has since been embraced by other specialties such as ophthalmology, urology, dentistry, gynaecology, and orthopaedics.

Botulinum toxin is a neuromodulator. When injected into targeted areas, it relaxes the facial muscles; without excessive contraction, the skin becomes smoother and wrinkles are softened. It is commonly used in the upper face, such as frown lines, crow’s feet, and forehead wrinkles. It can also be used in the lower face by advanced injectors.

Dermal filler is a type of volumizer that has a gel-like consistency. It can be made of hyaluronic acid, calcium hydroxyapatite, polycaprolactone, or poly-L-lactic acid, with hyaluronic acid being the most popular and safest type of dermal filler. It is used to restore youthfulness in areas depleted of volume. Dermal fillers are useful for areas such as hollows under the eye, but can also be used to add volume to the lips, cheeks, and for nose reshaping. Fillers are more useful for correcting volume loss.

Both Botox© and dermal fillers can also be used in combination to achieve your desired look. You can have both treatments on the same day, provided they are not used in the same target area.

Botox© blocks neuromuscular transmission by binding to receptor sites on motor nerve terminals and inhibiting the release of acetylcholine. When injected into a specific muscle, it blocks the signal from the nerve to the muscle. When the muscles of facial expression are relaxed by the effect of Botox©, the skin around the area looks smoother and wrinkles appear softer.

Individual results may vary, and results usually last between 3–4 months. Unfortunately, botulinum toxin does not remove wrinkles permanently; therefore, it is advisable to have the treatment repeated every 3–4 months to maintain and improve upon the original results. Its long-term effects have been studied in many clinical trials since its discovery, and it is considered safe to have botulinum toxin injections at this frequency over a period of years.

Botox© is very versatile and can be used in many different areas for optimal results. The upper face — such as the forehead, frown lines, and crow’s feet around the eyes — is where it is most commonly administered.

Experienced clinicians can also use botulinum toxin to reduce fine lines underneath the eyes, lift the eyebrows, soften bunny lines, relax a dimpled chin, reduce necklace lines, and relax the platysmal bands in the neck.

There are many uses for botulinum toxins beyond wrinkle reduction. They can be injected into the chewing muscles (masseters) to help stop teeth grinding and to slim the jawline.

Botulinum toxins block the release of acetylcholine, the neurotransmitter that stimulates sweat production. For this reason, Botox© can also be administered into the underarm area to treat excessive sweating.

Botox© has been licensed for the treatment of chronic migraine since July 2010 by the Medicines and Healthcare products Regulatory Agency (MHRA). By relaxing the muscles, studies have shown that it is effective at reducing muscular tension, which contributes to headaches and migraine symptoms.

Yes, it can. By strategically placing micro-boluses of Botox© at the corners of the eyebrows and avoiding the lateral segments of the frontalis muscle when injecting the forehead, Botox© can in fact help lift the eyelids.

Yes, it can. Botox© exerts its effect by inhibiting the release of acetylcholine, a neurotransmitter that also stimulates sweat production. Botox© can therefore reduce sweating in any injected area. If injected into the forehead, the forehead will become less sweaty.

At Harley Street MD, we also specialise in injecting Botox© into the underarm areas. It works extremely well and is a highly effective solution for patients who suffer from hyperhidrosis (excessive sweating). Botox© is particularly popular during the hot summer months to help prevent sweat patches in the underarms.

The areas to be injected will be disinfected with a chlorhexidine alcohol solution or a non-alcoholic disinfectant. Botulinum toxins are injected using disposable syringes with micro-needles.

The whole procedure itself takes typically 15-30 minutes. You will be able to return to your daily routine right after.

Wrinkle relaxing injections are not painful, and most people compare the feeling to a brief, tiny insect bite. You do not need any anaesthetic or sedation for the procedure. We will, however, always offer a topical numbing cream to ensure your comfort. We also apply cold compression prior to injection to both minimise pain and reduce the risk of bruising. Each injection only takes a few seconds to complete, so any discomfort is minimal.

Contrary to popular belief and what is frequently portrayed in movies or drama series, you will not see the effect immediately after the injection. Most people take 3 to 5 days to begin noticing the effects. It can take 10 to 14 days for the treatment to work fully.

Contrary to popular belief, and what is frequently portrayed in movies or drama series, you will not see the effect immediately after the injection. Most people take 3 to 5 days to begin noticing the effect. It can take 10 to 14 days for the treatment to work fully.

Botox© is contraindicated in patients who:

• Are pregnant or breastfeeding
• Have a known hypersensitivity to botulinum toxin A or human albumin
• Have infection or severe inflammation at the injection site
• Have a disorder of the neuromuscular junction (Myasthenia Gravis, Lambert-Eaton syndrome, Multiple Sclerosis, motor neuron disease, or any myopathy)

You should tell your doctor prior to receiving Botox© treatment if you:

• Have multiple severe allergies or a history of anaphylaxis of any kind
• Have or have had a breathing problem, such as severe asthma
• Have or have had swallowing problems
• Have or have had bleeding problems or are taking blood-thinning medication
• Have plans to have surgery or have had surgery on your face
• Have weakness of your forehead muscles, such as trouble raising your eyebrows
• Have drooping eyelids
• Have recurrent swelling around your eyes

Botulinum toxin is not licensed for use in women who are pregnant or breastfeeding. This does not automatically suggest that it is unsafe; it simply means that manufacturers have not performed clinical trials in this group. It is unlikely that the licensing status will change any time soon, as there is minimal financial incentive for manufacturers to run trials involving pregnant women. Even with approved licensing, market research suggests that most women would still choose not to undergo treatment during pregnancy. If you are currently trying for a baby, it is therefore advisable to delay any cosmetic procedure.

If you find out that you are pregnant after the procedure, do not panic. Botox© is not thought to be dangerous to developing babies. Observational studies that followed women who discovered they were pregnant after treatment did not identify any harm to their babies. Both statistically and at a molecular level, it is highly unlikely that Botox® used in cosmetic settings would cause harm during pregnancy. Nonetheless, Botox® is not licensed for use during pregnancy.

You may fly shortly after a botulinum toxin injection in an emergency. If immediate flying is not essential, we advise waiting. Changes in cabin pressure may cause unwanted dispersion of the botulinum toxin, potentially resulting in an undesirable or asymmetrical outcome. Current consensus recommends waiting 1–2 days before travelling by air, if possible.

Botulinum toxin often takes up to two weeks to fully relax the injected area and show its final result. At Harley Street MD, we offer a complimentary follow-up appointment for assessment and a potential top-up if deemed necessary. For this reason, we prefer our clients to remain available for up to two weeks after the procedure, in case you would like a top-up, correction, or need any concerns addressed. If possible, plan your treatment at least two weeks before travelling abroad.

Serious side effects of Botox© is very uncommon. Non-surgical aesthetic procedures are not without any risks or potential complications. You may notice the following:

• discomfort or pain at the site of injection
• swelling
• temporary bleeding
• bruising (extensive bruising is very rare, but this can usually be covered up by makeup and is only temporary)
• headache
• drooping eyelid or double vision (this happens less than 1% of patients and will disappear over a period of 2 to 10 weeks. We will prescribe an eye drop called apraclonidine to help to speed up the recovery if this complication occurs).
• altered eyebrow position (this can often easily be corrected during the follow up appointment with tiny amount of Botox© injected above the raised area of the eyebrow)
• asymmetry of movement (this can also be addressed during the follow up for complimentary top up)
• allergic reaction: itching, welts, wheezing, dizziness
• vasovagal syncope or faintness due to injection especially in needle phobic population (please make sure you have something to eat and drink before the treatment and do not hold your breath during injection, always tell your doctor if you are needle phobic)

Botox© used near the eye has not been known to cause blindness. Potential side effects around the eye area include droopy eyelids, double vision, blurred vision, dry eyes, or eyelid swelling. The effect of Botox© is temporary and often last between 3 to 4 months.

Botox© is not known to cause cancer, there are no evidence to suggest so either.

No. Only relatively small amounts of Botox© are needed for all wrinkle-relaxing procedures. These quantities are insufficient to cause botulism or related symptoms. For comparison purposes, Botox© required for typical treatment of three facial areas usually ranges between 50 to 75 units on average, whereas Botox© treatment for an overactive bladder uses around 200 units. Neither of these groups of patients develop botulism. Therefore, in the realm of non-surgical aesthetic medicine, you can rest assured that Botox© does not cause botulism. This is also why it is essential to choose a brand that has a long track record of safety.

We will recommend you avoid taking vitamin E, Omega 3 supplements, and Ginkgo Biloba for 2 days, as they can increase your bruising risk. Please do not take any aspirin for at least 7 days before the treatment. If you take aspirin for medical reasons, please consult your doctor.

• Avoid alcohol beverages for 1 day.
• Avoid exercise on the day of the procedure.
• We recommend you have something to eat and drink before the procedure. Make sure you are not low in blood sugar or dehydrated before any non-surgical procedure.
• We advise avoiding makeup, or removing makeup when you arrive at the clinic. This allows for a good pre-procedure assessment and minimises the risk of infection during the procedure.

Yes, you can. British College of Aesthetic Medicine (BCAM) consensus confirms that non-surgical aesthetic procedures like botulinum toxin injections can be offered immediately after the consultation. As this is a non-permanent procedure, a long cooling-off period (as required for plastic surgery) is not necessary.

We often allocate a one-hour appointment for new patients who have never had the treatment before. This allows sufficient time to talk you through the procedure, explain potential side effects, and assess your suitability for treatment. The consultation is complimentary and carries no obligation.

If you are happy to proceed, you will be guided through the consent process and may have the treatment performed on the same day. If you are unsure and would prefer a cooling-off period, we are more than happy to provide all the information you need and allow you time to make your decision.

For optimal result and to avoid complications:

• Do not rub or massage the treated area for a few hours after injections.
• Avoid any form of facial treatment or chemical peel to reduce the risk of the botulinum toxin spreading to adjacent unwanted areas.
• Avoid putting on makeup for at least 4 hours after treatment to minimise the risk of infection.
• Avoid lying down or sleeping for at least 4 hours after treatment.
• Avoid strenuous exercise for 2 days, as it may increase the risk of unwanted dispersion of the product.
• Avoid alcohol for 2 days.
• Avoid extreme heat exposure such as sun tanning, sunbathing, or sauna use for 2 weeks.
• Contact the clinic if you experience any complications or side effects.

Botox© treatment can take up to 2 weeks to show results. Please be patient. If you require a small tweak or a top up, please do not hesitate to contact the clinic for a complimentary follow-up. A top up for wrinkle-softening injections using Botox© within 2 weeks of treatment is complimentary if deemed required after assessment by the doctor. We want all our patients to be happy with their treatments.

As new nerve endings develop over time, you will notice the effect of Botox© wearing off. This may take 3 to 4 months and varies between individuals. When the muscles start to regain their contractility, wrinkles will reappear.

It is recommended to repeat the treatment before the effects wear off, to maintain and improve upon the original results. Prevention is better than cure, and you should regard botulinum toxin injections as an ongoing anti-ageing intervention for optimal outcomes.

We recommend repeating treatment every 3 to 4 months. Why not take advantage of booking your next Botox© session right after your treatment? We will send you a reminder when it is closer to your appointment.

Botox© is the first brand of botulinum toxin available in the world and is manufactured by a successful pharmaceutical company called Allergan©. Botox© has been FDA approved in the United States since 2002 and is one of the most researched and well-tested botulinum toxin products, with the longest safety track record. As demand for non-surgical aesthetic treatments has grown, other companies have entered the market to compete. However, botulinum toxin type A products are not all made the same, and each brand contains a different formulation of the toxin.

Botox©, Bocouture©, and Azzalure© are all trade-name brands of botulinum toxin type A. The main differences between them lie in the composition of their complexing proteins.

Botox©
Botox© contains a 900 kD complex composed of the 150 kD neurotoxin plus complexing proteins. Similar complexing proteins are found naturally around the botulinum toxin. Botox© has the highest amount of clostridial protein among the three products described here, at approximately 5 ng per 100-unit vial. It also contains human albumin and sodium chloride as excipients, which help stabilise the active ingredient over the long term.

Bocouture©
Bocouture© entered the UK market in 2008 and is manufactured by Merz©. This product contains only the 150 kD neurotoxin without additional complexing proteins, and approximately 0.6 ng of clostridial protein per 100-unit vial. Bocouture© contains human albumin and sucrose as excipients.

Azzalure©
Azzalure© is produced by Galderma© and received regulatory approval in 2009. It contains a mixture of 600 kD and 300 kD complexes. There is reported to be approximately 4.35 ng of clostridial protein per 500-unit vial, which is less than in Botox©. The complex contains human albumin and lactose monohydrate as excipients, which may cause reactions in lactose-sensitive patients. Importantly, the unit conversion between Botox© and Azzalure© is not 1:1. One unit of Botox© is equivalent to approximately 2.5 Speywood units used by Azzalure©. In other words, one unit of Botox© is around 250% stronger than one Speywood unit of Azzalure©.

What does this mean in practice? Botox© contains more complexing proteins and therefore has a composition that more closely resembles natural botulinum toxin. Other brands contain fewer proteins, with Bocouture© containing the least. As a result, Bocouture© and Azzalure© may not offer all the properties associated with Botox©. Botox© is also the most expensive of the three products, reflecting its formulation and extensive safety data. It has the lowest dispersion rate, meaning it is more precise and less likely to cause unwanted muscle paralysis in non-targeted areas.

Large-scale surveys conducted by Allergan© have reported patient satisfaction rates with Botox© of up to 98%, which is a remarkable achievement. The number of people choosing Botox© continues to grow worldwide. At Harley Street MD, we believe patients deserve the best available treatment. For this reason, we are proud to use only the original Botox© brand manufactured by Allergan©, and we do not stock or use other botulinum toxin type A products.