What are muscle relaxing injections?
Doctors have been using botulinum toxin injections in medical practice for decades to treat muscle spasticity and facial spasms in adults and children. They are also successfully used by medical aesthetic doctors to treat facial lines and wrinkles.
What are the treatments available?
In the UK, there are three main types of botulinum toxin available to use, which are Botox®, Azzalure® and Bocouture®. The three main areas of the face that are treated include the frown lines (glabella complex of muscles), forehead wrinkles (frontalis muscles) and the crows feet (orbicularis oculi muscles) wrinkles around the corners of the eyes.
Muscle relaxing injections can also be used to treat jaw clenching and teeth grinding, excessive sweating, hyperactive muscles in the lower face and to smooth the neck (platysma muscle).
How does it work?
Acetylcholine is a chemical messenger produced in our nerves to stimulate the muscles to contract. Precise injection of botulinum toxin weakens the hyperactive muscle. The communication between the nerve and the muscle is stopped by blocking the release of acetylcholine. The action on the muscle is never permanent as the nerve ‘sprouts’ new nerve endings, which in turn lead to the muscle stimulation over time, allowing the muscle to regain its movement.
How does it work to reduce facial lines?
Facial lines are caused by repeated use of the facial muscles of expression e.g. raising the eyebrows, frowning and smiling. By reducing the amount of facial muscle movement, the lines can be softened. Botulinum toxin is injected into the muscles, temporarily reducing their strength for a period of three to six months on average. The effect on the muscle is always temporary.
The aim of the treatment is to break the habit of certain facial movements as described above, thus reducing the appearance of the lines and also reducing the development of further facial lines. Prevention is often better than cure.
After your treatment, it will take 7-12 days on average for the effects to start to be seen, reaching its maximum effect at 28 days. The results may last from to 3-6 months. With ongoing treatments, the effects may last longer as the muscle will become weaker and smaller, a process known as atrophy.
Occasionally you may require an adjustment treatment at two weeks if the muscle is not adequately relaxed. It is always better to inject a conservative amount of the botulinum toxin and add more if required. The botulinum toxin will make it difficult to frown and squint and therefore reduce facial lines, however if you try very hard you will be able to move the muscles a little. This does not mean the treatment has not worked. It is most important to retain normal facial expression.
Where can wrinkle relaxing injections be given?
- Eyes – to reduce crow’s feet
- Forehead and brow – to reduce frown lines
- Mouth – to reduce the fine vertical lines on the upper lip or to treat down turned mouths
- Gummy smile reduction – to reduce the amount of upper gum shown when smiling
- Smokers/lipstick wrinkles – to reduce the vertical wrinkles of the upper lip
- Down turned smile reduction – to relax the muscle that pulls the corner of the mouth, therefore reducing a sad appearance
- Chin dimpling – To relax the mentalis muscle and in turn reduce the dimpling of the chin and horizontal line between the chin and the lower lip
- Jaw – to treat bruxism and provide a narrower jawline
- Neck – to treat lines and lift the jowl line.
- Armpits and palms – to treat excess sweating
Are there any side effects?
The side effects are minimal, and all are temporary. The injections may sting very slightly but they are not painful. Other side effects are minimal redness and swelling at the injection sites that usually disappears after an hour or so. There is also a very small risk of bleeding, bruising or infection at the injection sites. You may experience transient headaches.
There is a very small risk of eyelid drooping (ptosis) and slight puffiness following treatment. In the unlikely event that this occurs, it is always temporary and usually settles after 2-3 weeks. The incidence of ptosis is about 2% but always ask your practitioner what problems they have had with treatments as this will differ between doctors. After several treatments, very rarely, some patients become resistant to the drug and it no longer works effectively.
Who cannot have muscle relaxing injections?
It is not recommended in anyone who is pregnant or breast feeding, or who suffers from a neuromuscular disorder. You should make your doctor aware of any medication you are taking including Gingko Biloba, aspirin and other blood thinners like ibuprofen, fish oils (omega3) and St John’s Wort.
Here is a list of questions you should ask your doctor prior to any muscle reducing treatment.
- What are your qualifications? (BCAM would always recommend an experienced doctor for your treatment).
- How long have you been carrying out muscle relaxing injections?
- How many patients have you treated?
- What form of botulinum toxin do you use?
- Are there any alternatives that I should consider?
- How often have your patients had ‘droopy eye’?
- Are muscle relaxing injections dangerous?
- Do you audit your results and patient satisfaction?
- What do I do if there is a problem with my treatment?
- Do you routinely follow up after appointments?
- Do you have any patients who you have previously treated whom I could speak to?
- How much does it cost? (This is the least important question)