Getting Started in Facial Aesthetics
Although frown lines and crow’s feet are natural signs of ageing, some patients may want to eradicate them. With this in mind, this piece will consider the role of wrinkle relaxing injections, describing their benefits and presenting an overview of their clinical use.
‘What do you think I need, Doctor?’ By far and away this is the most commonest question I get asked by my facial aesthetics patients. My standard response for the past few years has been, ‘No one needs wrinkle relaxing injections, its all about what you want’.
Wrinkle relaxing injections is a wants based treatment. No one needs it, no one is going to get ill from not having it and certainly no one will die if they don’t undertake it.
Wrinkle relaxing injections work on motion lines, these are lines that worsen or appear when the patient contracts the muscle. Generally speaking, we are dealing with the upper third of the face, but I do use wrinkle relaxing injections in the lower face area (smokers lines, chins, gummy smile, Massetter, corners of the mouth). If lines/folds are present at rest and do not worsen when the muscles are contracted, then fillers will need to be considered.
There is the Glogau Classification of Photoaging. This was developed to objectively measure the severity of photoaging and especially wrinkles. It helps practitioners pick the best procedures to treat photoaging. There are 4 groups that a patient will all under:
Group 1 – Mild, typical age – 28-35. No wrinkles. Early Photoaging present: mild pigment changes, no keratosis, minimal wrinkles. This group will not require any wrinkle relaxing injections as they have no wrinkles.
Group 2 – Moderate, typical age – 35-50. Wrinkles in motion. Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear. This is the best group to treat with wrinkle relaxing injections, since they have no wrinkles at rest and only in motion.
Group 3 – Advanced, typical age – 50-65. Wrinkles at rest
Advanced Photoaging: Obvious discolourations, visible capillaries (telangiectasias), visible keratosis. We can still treat this group with wrinkle relaxing injections, since the wrinkles worsen when they contract their muscles. However we cannot guarantee to either reduce or eliminate any wrinkles they have at rest.
Group 4 – Severe, typical age – 60-75. Only wrinkles. Severe Photoaging: Yellow-grey skin colour, prior skin malignancies, wrinkles throughout – no normal skin, cannot wear makeup because it cakes and cracks. This group cannot be treated with wrinkle relaxing injections as the muscles are not causing any wrinkles.
Once the patient has elected to undergo any form of wrinkle relaxing injection, they, unlike our cousins across the Pond, what to achieve a natural result and not the frozen ‘I’ve been botoxed’ look. What does this natural look entail. In my eyes and my patients eyes, this natural look with wrinkle relaxing injections is achieved by the patient still being able to express themselves using the facial musculature without the appearance of, or at least the reduction of wrinkles on the treated areas.
The main benefits of wrinkle relaxing injections are based on the temporary nature of its effects. The toxin used will work at the neuro muscular junction to inhibit the neuro muscular messenger acetylcholine (a neurotransmitter) sending a signal to the muscle to contract. However after a few months (anything between 3 and 6) new nerve terminals reestablish connection with the muscles, allowing it to contract again. This gives our patients the confidence to try the treatment and if for any reason they don’t want to continue, they are restored back to their original appearance.
Patients also love that fact that the duration of treatment is very short and associated with this, the downtime is very minimal. On average the treatment of the upper third of the face should take no longer than a couple of minutes. Immediately after the procedure, the patient will have areas of swelling, but this should last no longer than 20minutes. This is where the media have latched on the phrase ‘lunchtime miracle cure’.
As we can see the main benefit of wrinkle relaxing injections is to smooth out wrinkles, however it has numerous medical benefits such as stopping excessive sweat, reduce/eliminate migraines, use in arthritis pain, blepharospasm, cervical dystonia and bladder control.
Considering whether to start a patient on wrinkle relaxing injections depends on balancing the risks of treatment against the potential improvements. Potential risks associated with this procedure can include, but are not limited to: swelling, bruising, headaches, flu like symptoms, ptosis of eyebrow or eyelid, non responsiveness.
As with all clinical procedures correct assessment, a detailed examination, informed consent obtained with an explanation of the realistic results expected are all mandatory.
Wrinkle relaxing injections when used on the correct patient will leave the patient more confident, looking fresher and appreciative of your work.
Dr Harry Singh BChD MFGDP has been carrying out facial aesthetics since 2002 and has treated over 3,000 cases. In his last dental practice (focused on aesthetics) he ended up performing more facial aesthetic treatments than dental treatments. Due to the very high profit margins associated with facial aesthetics, he decided to concentrate on facial aesthetics and currently has over 700 facial aesthetic patients. He has published numerous articles on the clinical and non-clinical aspects of facial aesthetics, and spoken at dental and facial aesthetics conferences on these topics. Harry was shortlisted at the Private Dentistry Awards in 2012 and 2013 in the Best Facial Aesthetics Clinic category and was a finalist in 2012 at the MyFaceMyBody awards for the Best Aesthetics Clinic.
For further information on Harry’s courses and to download a video ‘Getting Started in Facial Aesthetics’ free of charge, please visit www.botoxtrainingclub.co.uk