Are wrinkle treatments safe?
So you spend more time staring at your crow’s feet lines on Zoom than telling people they are still on mute. Perhaps you’re tired of people asking you why you’re angry. Or maybe you are finally coming to terms with the fact that you need to invest in more than a $3.99 sheet mask from the Priceline bargain bin to address those forehead lines. Your best friend won’t stop raving about her latest anti-wrinkle treatment. You’re curious… but still feeling apprehensive. Isn’t anti-wrinkle a ‘toxin’ after all?
When my patients finally take the plunge and book their first anti-wrinkle appointment, they come to their consultation with a clear idea of the aesthetic outcome they would like to achieve. However, they often have little understanding of how anti-wrinkle medication actually works and the associated risks. Although the idea of an improvement in facial appearance is exciting, it’s important to remember that these are a medical treatments that carry risks, as with all medical treatments.
Let’s take a closer look at the research behind anti-wrinkle medication and some of its uses outside of cosmetic medicine. I’ll also suggest some steps you can take before and after your appointment to reduce common side effects and ensure an optimal treatment outcome.
What is anti-wrinkle medication and how does it work?
Anti-wrinkle medication is a natural purified protein which when injected, temporarily relaxes muscles by blocking the release of chemicals involved in normal muscle contraction. This relaxation can improve the appearance of fine lines and wrinkles associated with muscle movement (e.g. frown or forehead lines). Anti-wrinkle injections can also soften and prevent the formation of resting lines. Other uses for anti-wrinkle injections involve softening the upwards or downwards ‘pull’ of a facial muscle if it is resulting in a distracting facial feature (e.g. gummy smile or downturned mouth corners).
The evolution of anti-wrinkle medication
Many patients are unaware that anti-wrinkle medication is also used to treat a diverse range of medical conditions including cerebral palsy, chronic migraine, blepharospasm, spasticity, bladder dysfunction and cervical dystonia to name a few.
The cosmetic use of anti-wrinkle medication was actually discovered by accident in the late 1980’s by Vancouver Ophthalmologist Dr Jean Carruthers and her husband, Dr Alastair Carruthers (a dermatologist). One of Dr Carruthers’ blepharospasm (involuntary eyelid blinking/twitching) patients requested further treatment in the surrounding areas so they could get that “beautiful untroubled expression again”. She went home that evening and said to her husband, “I think I have found something for your cosmetic frown line patients”.
Anti-wrinkle injections have since empowered patients to age with intention, meaning they now have an option to prevent and maintain the early signs of ageing with minimal downtime, rather than waiting for advanced ageing signs to appear and committing to permanent correction with cosmetic surgery.
So anti-wrinkle treatments are popular… but are they safe?
Anti-wrinkle medication is one of the most widely researched drugs in the world. There are four brands of anti-wrinkle medication approved for use in Australia. The anti-wrinkle medication I use at Butter has over 30 years of clinical use and its efficacy and safety has been proven in over 190 clinical trials and more than 5300 peer-reviewed clinical publications. The doses for cosmetic indications are actually quite small compared to the doses used for several of the medical conditions listed above (some of which involve use in children too).
The safe and effective use of anti-wrinkle medication depends upon proper storage of the product, selection of the correct dose and proper reconstitution and administration techniques.
Anti-wrinkle side effects
Despite anti-wrinkle medication having an excellent safety profile, there are some side effects to be aware. The most common side effects of anti-wrinkle injections are injection site redness, swelling, bleeding, pain, bruising and some tenderness or a headache post injection. If these side effects are experienced, they are often mild in severity and resolve quickly.
Asymmetry is another side effect that can occur due to injection placement or a patient's anatomical variations. This may present as a ‘spock’ brow, which is when the outer brow appears to be lifted too high when raising your eyebrows. Fortunatley, this issue is easily addressed by adding extra units to the affected areas.
When using antiwrinkle medication, there is always a small risk that some of the injected medicine may leak into a nearby muscle. This can result in temporary unwanted relaxation of these muscles. Depending on the treatment area, this can include a feeling of heaviness or drooping of the eyebrow, eyelid or an uneven smile.
Rare side effects include an allergic reaction, infection, rash, visual disturbance and non-response to treatment.
Anti-wrinkle safety at Butter
Each cosmetic treatment at Butter involves a medical consultation with myself and my prescribing doctor. You will have the opportunity to discuss all potential side effects and how to prevent and manage these following your anti-wrinkle treatment. The Butter prescribing doctor is also on call 24/7 in the unlikely event they are required to assist with a serious complication.
As a Registered Cosmetic Nurse and previous Senior Clinical Specialist Trainer, I have significant experience in assessing the facial muscles that cause lines and wrinkles. I am confident in adjusting my dosage and injecting technique to suit your anatomy and treatment goals. Every patient is unique and requires a different dose and injection pattern. Sometimes it is safer to start with a conservative dose for your first treatment, with the option to add further units at your follow up appointment if required. This can be particularly helpful if you are worried about looking/feeling heavy in the forehead, or being unable to express yourself naturally. Please be aware that using a lower dose can affect the longevity of your treatment. Longevity plays an important role in your satisfaction with the treatment outcome, however a natural outcome is also important. Throughout our consultation and your subsequent anti-wrinkle treatments, we can find the right balance for you.
Patients unsuitable for anti-wrinkle injections
Some patients are not suitable for anti-wrinkle treatments. This includes patients who:
Are pregnant, breastfeeding or trying to become pregnant
Have an active infection e.g. urinary, sinus, respiratory, gastrointestinal, dental, skin, or are on antibiotics
Have neuromuscular conditions such as myasthenia gravis or lambert eaton syndrome
Have had an allergic reaction to any of the ingredients within anti-wrinkle medication before
Are unwell at the time of the treatment with cold/flu/COVID symptoms or any other illness being investigated by a GP (please contact me ahead of your appointment if you are unsure if you are suitable for treatment)
Avoiding anti-wrinkle complications: before your treatment
To reduce your chance of experiencing anti-wrinkle complications, I recommend that you:
Don’t seek any cosmetic injectable treatments in the same treatment area in the 4 weeks prior to your appointment
Avoid medications or vitamins that cause thinning of the blood (such as aspirin, fish oil, vitamin E) for 1 week prior to your appointment, unless medically indicated
Avoid drinking alcohol for at least 24-48 hours prior to your appointment
Complete your medical questionnaire form prior to arriving to the clinic (this will be sent to you via SMS)
Come to your appointment with your tied hair back, wearing no makeup. All makeup will be removed before your treatment
Practice hand hygiene upon arrival to the clinic and avoid touching your face
Come to your appointment prepared to discuss your medical history, a list of your current medications (including dosage/frequency taken), your allergies, any skin conditions and information about previous cosmetic treatments/planned cosmetic treatments
Please consider rescheduling your appointment if you have any important events coming up in the 2-4 weeks following your anti-wrinkle treatment. For weddings, I recommend planning treatment at least 6 weeks in advance.
It is also important to check that you are visiting a health practitioner who is registered with the Australia Health Practitioner Regulation Agency (Ahpra). In Australia, only doctors, nurses and dentists are allowed to practice cosmetic injectable treatments. You can conduct an Ahpra health practitioner search here.
For your convenience, my Ahpra registration number is NMW0001779560.
Avoiding anti-wrinkle complications: following your treatment
To reduce your chance of experiencing any complications following your anti-wrinkle treatment, I recommend that you:
[Don’t]
Touch, rub or apply strong pressure to the treatment area. This will help to keep the anti-wrinkle medication within the targeted muscle and avoid unwanted side effects such as eyebrow/eyelid droop or uneven smile.
Apply makeup for at least 6 hours, but ideally for the rest of the day. This will reduce the risk of the treatment area developing an infection
Drink alcohol or do strenuous exercise for at least 24-48 hours
Visit spas, saunas or book any face down massages for at least 48 hours
Use active skincare products (retinoids/vitamins A, B, C/AHAs/BHAs) for at least 24 hours
Book any other facial or aesthetic treatments close to the treatment area for at least 2-4 weeks (ask me if there is a specific treatment you aren’t sure about)
There is no need to move, or avoid moving the muscles in the treatment areas injected
[Do]
Practice hand hygiene following your treatment and avoid touching your face
Stay upright and avoid lying down on the treatment area for the next few hours. It is best if you sleep on your back for the first night following treatment
For any pain, paracetamol is preferred. Anti-inflammatory medications like aspirin or ibuprofen are not recommended for at least 48 hours, unless prescribed by your doctor for a medical reason (ask me if you are unsure about when to take your medications)
For any small bruises, topical hirudoid or arnica cream can help with the resolution
Avoid direct sunlight on the day of your treatment and always wear SPF 50+
Book a 2 week follow up appointment
What to expect following your anti-wrinkle treatment
Anti-wrinkle treatments take up to 14 days to see the full effect, although you may see signs of the treatment beginning to work as early as 2-3 days following your treatment. The ideal time to book a follow up appointment is 2 weeks following treatment. At the follow up appointment, extra units can be added to the treatment area if necessary. For best results, anti-wrinkle appointments should be booked every 3-4 months.
Ready to book your anti-wrinkle treatment at Butter?
Still have a question about the safety of anti-wrinkle treatments?
References
Allergan Australia onabotulinumtoxinA Product Information, NSW 2023.
Cavallini, M., Cirillo, P., Fundarò, S.P., Quartucci, S., Sciuto, C., Sito, G., Tonini, D., Trocchi, G. and Signorini, M., 2014. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatologic Surgery, 40(5), pp.525-536.
Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol. 2020 Aug;61(3):217-225. doi: 10.1111/ajd.13273. Epub 2020 Mar 22. PMID: 32201935; PMCID: PMC7497045.
Goodman GJ, Liew S, Callan P, Hart S, Somia N, Sullivan J, Heydenrych I. Re Facial aesthetic injections in clinical practice: Pretreatment and post-treatment consensus recommendations to minimise adverse outcome Region-specific changes in line with the Covid-19 pandemic. Australas J Dermatol. 2020 Nov;61(4):362-366. doi: 10.1111/ajd.13374. Epub 2020 Aug 10. PMID: 32779184.
Kroumpouzos, G., Kassir, M., Gupta, M., Patil, A. and Goldust, M. (2021), Complications of Botulinum toxin A: An update review. J Cosmet Dermatol, 20: 1585-1590.
Swift A, Green JB, Hernandez CA, Aguilera SB, Fagien S, Gold MH, Casabona G, Frank K, Nikolis A, Cotofana S. Tips and Tricks for Facial Toxin Injections with Illustrated Anatomy. Plast Reconstr Surg. 2022 Feb 1;149(2):303e-312e. doi: 10.1097/PRS.0000000000008708. PMID: 35077430.
Elysia Hodge
Cosmetic Nurse + Founder
Butter Cosmetic + Skin Clinic
