Last updated July 2023
Anti-wrinkle injections are amongst the most popular cosmetic procedures performed in the world today. Treatment involves injections into muscles of facial expression to reduce or temper their activity. Producing natural and consistent results requires using appropriate products, good record-keeping, photographic documentation, and understanding the injection methods and underlying facial anatomy. Anti-wrinkle injections have been performed at the Victorian Cosmetic Institute’s Melbourne clinics since 2005. During this time, we have constantly refined our methods and systems to produce more consistent patient outcomes.
We aim to fully explain the procedure to you prior to treatment, including the potential risks and benefits of the procedure in your individual situation.
What are anti-wrinkle injections?
Anti-wrinkle injections aid in wrinkle reduction formed by the muscles of facial expression. Composed of a commercially prepared form of Clostridium botulinum, this causes a block in the nerve activity of the injected facial muscles, temporarily reducing muscle movement.
This patient presented for anti-wrinkle injections to her frown lines and forehead. She received 8 units anti-wrinkle to her forehead, 26 units to her frown lines and 6 units under each lateral eyebrow (to prevent eyebrow drop). An additional 10 units were administered to her frown at her 2-week review appointment to achieve her desired outcome. The photo below was taken with the patient making a frown expression. The after photos were taken three weeks after her initial treatment. Note: dosage requirements vary between patients.
The below photos were taken at the same time as the above photos. In the below example, the patient is raising her eyebrows.
The following are the markings of the injection points made prior to injection.
This patient presented to the Victorian Cosmetic Institute for jawline slimming. She had anti-wrinkle injections in each of her masseter muscles, which work as a muscle relaxant reducing the size and firmness of the masseter muscle. This treatment has both aesthetic and functional purposes. Aesthetically, the jawline appears slimmer and more defined. Functionally, relaxing this muscle can help reduce headaches, jaw pain, and dental issues such as teeth grinding and clenching.
This patient presented to Victorian Cosmetic Institute wanting her forehead lines treated. Anti-wrinkle injections were used in her forehead and frown. The static lines have been smoothed using dermal filler, to reduce her frown lines and forehead lines further.
For more before and after case studies, click here.
How do anti-wrinkle injections work?
Anti-wrinkle injections are injected into specific facial muscles to help reduce their activity. When the muscles of facial expression contract, they may crease the skin and cause wrinkles. Continual contraction unabated over time may result in expression lines. However, anti-wrinkle injections may help to prevent this. The frown, forehead, and around the eyes are commonly treated areas.
By adjusting the dynamics and interplay between facial muscles, it is also possible to alter the aesthetics of the face. For example, by reducing the downward pull of the depressor anguli oris muscle, the mouth corners can be elevated. Or, by reducing the downward pull of the orbicularis oculi muscle, the brows can be elevated.
The effect is temporary, lasting roughly 3-4 months on average.
- Anti-wrinkle injections help relax certain facial wrinkle-causing facial muscles and can help change the dynamics and interplay of facial muscles and expression.
- The injectables can be used to treat a variety of concerns other than facial wrinkles, including teeth grinding or bruxism and excessive sweating.
- Anti-wrinkle injections have been used for aesthetic purposes since the 1990s.
- Various brands of anti-wrinkle injections are available in Australia, with only one brand that does not cause the development of resistance to future treatments.
- Proper documentation, videos and photos are essential for optimal and consistent outcomes.
What else can be treated with anti-wrinkle injections?
Anti-wrinkle injections can also be used for a variety of medical conditions. These include;
- teeth grinding or clenching
- jawline slimming
- cervical dystonia
- facial spasms
- muscle spasticity
- migraine prevention.
- Hyperhidrosis or excessive sweating
When injected into the skin of the armpits, hands, or feet, anti-wrinkle injections can reduce excessive sweating in these areas. In a clinical trial, 98% of the patients said they would recommend anti-wrinkle injection treatment for hyperhidrosis to others.
What are the most common facial areas treated?
However, they can also be used to;
- alter brow height and shape – certain muscles around the eyes are relaxed to help create an overall lift in the eyebrows.
- stop the mouth corners from pulling down – helps reduce the pull of muscles on the mouth and lower face.
- reduce gummy smiles – by injecting the muscles that raise the upper lip
- evert the upper lip (also known as the lip flip) – relaxes the muscles to reduce the amount of pursing and inversion of the upper lip.
- reduce vertical neckbands – minimises the drag of the platysma muscle on the face, and reduces the prominence of neckbands.
- reduce bunny lines on the nose – lessens the appearance of bunny lines on the nose by relaxing the muscles.
- reduce dimpling of the chin – anti-wrinkle injections can be injected to help relax the chin to prevent the appearance of orange peel-like dimpling.
- reduce the bulk of the masseter (chewing) muscles – injections are used in the main muscle that causes the bulk and reduces bruxism and squareness of the jaw. This can help slim the jawline and relieve associated headaches or pain.
In addition to this, anti-wrinkle injections can also be used to treat armpit, hand, feet and facial sweating.
More in-depth information about anti-wrinkle injections can be found here.
What does treatment involve?
At VCI, photos and videos of the face (of facial expressions) are required at each treatment, and at follow-up appointments for before and after treatment comparison. Standardised photography (camera equipment, lighting, camera settings) is used, which helps ensure that the only changes are the changes in the subject.
Careful face cleaning with antiseptic to remove makeup and skin pathogens is the first step of treatment.
We then use the Accuvein vein finder to establish the locations of any veins in the treatment areas. Visualising and avoiding veins helps to reduce bruising post-treatment.
The muscle movements of the area(s) to be treated are then assessed, and injection points are marked to ensure the accurate placement of injections. These markings may also be photographed and recorded for the purposes of documentation for future treatments.
The anti-wrinkle injections are injected with a fine needle and syringe into the pre-marked areas using an injecting gun. The injecting gun allows for a more precise injection than by hand. Depth and dosage are highly accurate using this method. Furthermore, discomfort is significantly reduced as the movement of the needle through the skin is significantly faster and straighter than what can be performed by hand. Ice cubes or a vibration device can also be used in the treatment area prior to injection. This also significantly reduces discomfort.
After treatment, the skin is cleansed again with anti-septic, removing any blood or markings.
The importance of proper record keeping, including photo and video documentation, when performing anti-wrinkle injections
Anti-wrinkle injections are temporary and require repeated treatment. Achieving consistent results requires proper documentation of the baseline state (photos and videos) and the details of the treatment performed. Results do not also appear for several days, and appropriate follow-up and documentation of results are also required.
Each individual may respond differently to treatment based on their muscle strength, immune response, and dosage used. Often it may require several treatment sessions to achieve the desired outcome, as some trial and error may be required, for example, with dosage or injection positioning. Once the desired outcome has been achieved, the documented ‘formula’ can be used again to achieve this result again for future treatments.
For this reason, we take photos and videos of the face and facial expressions before every anti-wrinkle injection treatment. Furthermore, your practitioner will carefully document your treatment, including the dosing and positioning of injections. Treatment follow-ups, particularly any ‘top-ups’ performed, are carefully documented and considered for future treatments.
With proper documentation, the treatment can be adjusted and improved upon each session, and more consistent treatment-to-treatment results can be achieved.
What are the potential side effects or risks of anti-wrinkle injections?
Given the temporary nature of anti-wrinkle injections, most risks or side effects are also temporary.
These may include injection-related side effects or risks including;
- Bruising may appear after any injection that breaches a blood vessel and is more common around the eyes, where the skin is finer. The Accuvein Vein Finder helps to find the location of veins under the skin and help prevent the injector from injecting into these veins that may not otherwise have been seen.
- Transient redness and swelling of the treated area (similar to a mosquito bite) usually last less than one hour.
Or side effects or adverse outcomes related to the dosage or positioning of injections may include;
- Asymmetrical results – this may sometimes be corrected with additional treatment on the inadequately treated side.
- Inadequate dosage in one or more areas – leading to a lack of perceived effect. This may require further treatment.
- A change in the appearance of one’s smile – usually due to over-treatment of the crow’s feet or improper positioning of the crows feet injections
- A change in the shape of the mouth – usually an asymmetry due to mistargeting the muscle
- A droopy or heavy brow – due to excessive dosage in the forehead or frontalis muscle
- A droopy eyelid – usually on one side only and caused by frown treatment with anti-wrinkle injections. Approximately one per cent of people experience movement of the product into one eyelid, and this causes a partial eyelid droop that can last for one month. Any side effect of treatment is temporary and will resolve naturally. A particular eyedrop can be given to reduce the effect of this side effect, if necessary, temporarily.
Can you become immune or resistant to anti-wrinkle treatments?
Unlike other treatments or medications, we often do not ask ourselves if it is possible to become resistant to anti-wrinkle injections, despite the possibility that this could be an ongoing lifelong treatment. Often both patients and practitioners are not aware of or do not believe in this possibility, as cases of complete resistance rendering the treatment completely ineffective are rare.
However, resistance to treatment may also present as;
- reduced effectiveness of the treatment
- reduced duration of effect
This may occur over the period of time when one is being treated with anti-wrinkle injections.
Resistance to anti-wrinkle injections may occur due to an immune response to the adjuvants that occur together with the anti-wrinkle injections. These adjuvants, including complexing proteins, do not contribute to the effect of anti-wrinkle injection. The immune system recognises these adjuvants and may form neutralising antibodies in response, rendering future treatments less effective.
Although several anti-wrinkle injections are available, only one brand in Australia is ‘purified’, free of complexing proteins. At Victorian Cosmetic Institute, we exclusively use this brand to minimise the chance of becoming resistant to future treatment – either partially or completely. By doing so, it is more likely to be able to deliver consistent outcomes from treatment to treatment without concerns that resistance may be a factor.
Can I resume normal activities after treatment?
We advise not to massage the treatment areas after or perform vigorous exercise that may shift the positioning of the anti-wrinkle injections. Otherwise, normal daily activities can be continued immediately post-treatment.
When will I see the results?
Anti-wrinkle injections generally have an onset action of 4 to 7 days to fully develop, with an average longevity of roughly 3 to 4 months.
How long do anti-wrinkle injections last?
The effectiveness duration depends on the dose administered, the strength of the muscle injected and the area that has been injected. For example, anti-wrinkle injections last 3-4 months but may vary according to individual response and dosing.
Is it possible to become resistant to anti-wrinkle treatments?
It is possible to become immune to some brands of anti-wrinkle injections.
The active component of the treatment is a bacterial toxin that does not cause an immune response. However, the associated components manufactured with the bacterial toxin, including complexing proteins and inactive toxins, may cause an immune response. In these situations, neutralising antibodies are formed that cause future treatments to be wholly or partially ineffective. Note that the associated components have no clinical effect.
To prevent patients from becoming resistant to anti-wrinkle injections, we only administer botulinum toxin that does not contain the complexing proteins that may cause an immune response.
Why do anti-wrinkle injections stop working?
The greater the dose, and the more frequent the treatment, the more likely the immunity will occur. It is possible that neutralising antibodies have been produced by the body’s immune system and may act as a vaccine onto itself.
To prevent this, we utilise a ‘purified’ version or brand of tanti-wrinkle injections at the Victorian Cosmetic Institute, which has the least risk of causing an immune response and subsequent non-responsiveness to treatment.
However, once immunity has been conferred, it is essential to note that none of the brands will work – even the purified version. In the case of immunity, waiting, often for years before the exemption is reversed, is necessary.
Anti-wrinkle before and after case studies
The following are examples of anti-wrinkle injections injected into smile lines or crows feet, forehead lines, frown lines, neck or platysmal bands and a gummy smile.
How much do anti-wrinkle injections cost?
This depends on the muscle strength, desired outcome, and whether the goal is to reduce or stop movement altogether. Each area and person requires a different number of units which determines the cost.
Your practitioner will assess you and provide a quote in your initial consultation, or see our pricing page for an approximate cost.
Why should I choose Victorian Cosmetic Institute as my provider?
Our dedicated team of cosmetic doctors and nurses have years of extensive experience in performing anti-wrinkle injections.
We allow you ample time to communicate your goals to us and use our expertise to help you achieve your desired outcome. It is paramount that our patients have a good relationship with their practitioner and the experience you have with us is also important. We offer various ways to help alleviate any discomfort or anxiety from the procedure.
Simply contact us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment.
It’s as easy as booking online or you can phone us directly on 1300 863 824.