Aesthetic Treatments
 
Wrinkle Injection

» Wrinkle Injections
1. WHAT ARE THE DIFFERENT TYPES OF WRINKLES?

There are two types of wrinkles – static wrinkles and dynamic wrinkles. Static wrinkles are the fine lines, creases and folds that you see on the skin at rest and they are due to loss of skin collagen, elastin and hyaloruonic acid that give support and volume to the skin. This loss of skin structure is compounded by age, environment and gravitational effects. Static wrinkles are commonly seen with age and sun damage.

Dynamic wrinkles are created by muscle movements and initially you see them when you animate or work those muscles as when you talk, laugh, smile, frown or cry. Later with time, the skin loses volume and elasticity and the dynamic wrinkles, through repetition, become etched in the skin to form static wrinkles. They remain even when there are no muscle movements.

2. WHAT CAN I DO FOR MY WRINKLES?

Static or skin wrinkles can be delayed by using a good skin care regime and a sunscreen. Once formed they can be erased by using skin resurfacing procedures like laser or light or chemical peel treatments or by tightening the skin using radiofrequency, Thermage treatmen , or infrared SkinTyte treatment. They can also be made less obvious by injecting dermal fillers under the wrinkles.

Dynamic wrinkles can be improved by relaxing those muscles that create the wrinkles. This is done by injecting precise amounts of botulinum neurotoxin into these muscles

» Botulinium Neurotoxin
1. WHAT IS BOTULINUM NEUROTOXIN?

Botulinum neurotoxin is essentially a sterile, natural, purified protein that when injected into muscles in small doses can relax these muscles. This neurotoxin blocks the release of acetylcholine, a chemical in the junction between the ends of the nerves and the muscles, and when acetylcholine is blocked the injected muscles relaxed. It is thus not acting as a poison/ toxin as the name suggested

2. IS BOTULINUM NEUROTOXIN INJECTION SAFE?

Yes! Doctors have used Botulinum neurotoxin to treat patients with medical problems for well over the past 20 years.

The first botulinum neurotoxin approved by the USA Food and Drug Administration (FDA) in December 1989 was to treat eye muscle disorders eg blepharospasm and strabismus(squints). In December 2000 the FDA approved the neurotoxin for treating cervical dystonia, a condition where there is severe contractions of the neck and shoulder muscles. It is later in April 2002 that botulinum neurotoxin was approved for cosmetic use - for the temporary improvement of the appearance of moderate to severe frown lines between the eyebrows, the glabellar lines. In July 2004, the FDA approved it for the treatment of severe hyperhidrosis, or severe underarm sweating

In 2009 and 2011 respectively, two other botulinum neurotoxin received FDA approval for cosmetic use.

3. WHAT ARE BOTULINUM NEUROTOXIN USED FOR?

The botulinum neurotoxin is used to treat dynamic wrinkles on the face and neck muscles, to reduce the appearance of wrinkles at the glabellar frown lines, the crows feet eye lines and forehead wrinkle. It can be used to delay the formation of these wrinkles

It is also used to treat prominent facial muscles from teeth clenching /grinding, to slim down the lower face and calf muscles. If done properly, botulinum neurotoxin can make the skin looks lifted and tighter and the pores appear finer

4. ARE ALL BOTULINUM NEUROTOXIN THE SAME?

There are many botulinum toxins in use by dermatologists. Botulinum neurotoxin may differ in the protein composition and manufacturing process. In Singapore only two have HSA approval and both are used by Dr Joyce Lim.

5. CAN BOTULINUM NEUROTOXIN IMPROVE ALL WRINKLES?

No! Botulinum neurotoxin is useful in treating wrinkles that are caused by muscle movements(dynamic wrinkles) They are not useful for static wrinkles – these are wrinkles on the skin caused by sun damage or the aging process and which occur without muscle movements.

They are also not useful for treating skin folds or the jowls – these are related to gravity and needs skin tightening procedures like the Thermage or the SkinTyte treatments or thread lifts. Dermal fillers can be injected to improve skin folds

6. CAN BOTULINUM NEUROTOXIN PREVENT WRINKLES FORMATION?

Dr Joyce Lim sometimes sees young patients in their late twenties or even early thirties, who have a very intense muscle activity between the brows, the glabellar area. These patients would be the ideal candidate for botulinum neurotoxin injections to try to prevent these very active muscles from forming a frown line. Botulinum neurotoxin not only relaxes muscles but it prevents the development of wrinkles

7. HOW IS BOTULINUM NEUROTOXIN INJECTION GIVEN?

Botulinum neurotoxin is injected into the treatment area which is usually a group of muscles or into the skin. The medicine is injected serially into the group of muscles or skin with a very fine needle attached to a small syringe.

When treating frown lines the medicine is injected to a group of muscles just above the eyebrows. The toxin is also injected into a muscle at the bridge of the nose.

When treating crow's feet the medicine is injected serially at several points into the muscles causing the wrinkles at the sides of the eye

When treating square jaw the medicine is injected into the masseter muscles, which are the muscles we use for chewing our food.

When treating sweaty underarms or sweaty palms the skin is usually anaesthetised before the medicine is injected into the underarms or palm in a grid pattern.

8. WHAT CAN I EXPECT DURING THE BOTULINUM NEUROTOXIN INJECTION?

The treatment is simple and quick and takes only a few minutes. No anaesthesia is needed. Ice is often used prior to giving the injection. Discomfort is minimal and brief and you will experience a sensation of tiny pin pricks. The treatment is simple and most people have it done during their lunch hour

9. WHAT CAN I SEE IMMEDIATELY AFTER THE TREATMENT?

Usually the injected area appears normal. Sometimes there may be a small bruise. You may start to see that the dynamic wrinkles become less obvious over the next few days

10. WHAT MUST I DO AFTER THE BOTULINUM NEUROTOXIN INJECTION?

You need not do anything and most people resume normal activities immediately after the treatment.

For the first hour you can try to move the muscles that have been injected as much as possible to activate the effect of the toxin on the muscle. Do not rub the skin or muscles on or around the injected sites.

11. WHEN WILL I SEE RESULTS?

You will feel a reduction in muscle movement within the next few days. It takes 3-7 days to see a reduction in muscle movements and even longer for the appearance of the overlying skin to change and soften, with reduction in visible lines. Generally the maximum effects are seen within 10-14 days.

12. HOW LONG WILL THE RESULT LAST?

It depends on the activity of the muscles treated and the dose of neurotoxin used. Generally, the effect lasts from 4-6 months. You are encouraged to have regular injections every 4-6 months as with regular injections, the effects tend to last longer. Try not to wait for the muscles to return to the pre-injection status but rather you should come in when you start to see movements of the treated muscles or the appearance of muscle lines

13. WHAT HAPPENS IF I STOP THE BOTULINUM NEUROTOXIN INJECTIONS?

The neurotoxin relaxes the muscles that cause the expression lines. When you decide not to continue with the injections, the relaxed muscles will return to their normal activity, and the wrinkles will revert to their pre-treatment levels. You will not get more wrinkles.

14. WILL MY FACIAL EXPRESSION BE AFFECTED AFTER BOTULINUM NEUROTOXIN INJECTIONS?

The neurotoxin works specifically on the muscles that are treated. The other facial muscles are not affected and you can still smile and have facial expressions. It will not “freeze” your face or give you a fake look

Some patients are looking for total paralysis of the area injected – the frozen look. If they see any movements they think that the injection is not working. The aim of Botulinum Neurotoxin injection is to relax muscles and to soften the look. Total paralysis or a mask-like face is not the goal and is not normal.

15. WHAT ARE THE SIDE-EFFECTS OF BOTULINUM NEUROTOXIN INJECTION?

Botulinum toxin injection is a relatively safe procedure. Side-effects are uncommon.

They are usually related to the injection procedure itself. There may be slight discomfort or soreness from the needle prick and a small chance of a bruise developing around the injection sites. These can be reduced by stopping the intake of ginger, gingko, garlic, fish oil, vitamin E and blood thinners a few days prior to the injection. The bruise can be easily covered with makeup

Slight drooping of the eyelids may occur but this is uncommon and transient and is usually not noticeable. Transient headaches may occur although neurotoxin injections are used to treat migraine.

All side-effects are temporary and self-limiting. No permanent side-effects have been reported so far. There is no evidence that the injected Botulinum neurotoxin travels to a distant site. Investigators have discovered Botulinum neurotoxin like proteins in a distant site but these are not active proteins

16. WHO ARE NOT SUITABLE FOR BOTULINUM NEUROTOXIN INJECTIONS?

Let Dr Joyce Lim know if you have any underlying immunologic or neurologic or muscular and skeletal diseases. If you have a neurological problem called myasthenia gravis, you are not suitable for the Botulinum neurotoxin injections.

Patients with a bleeding disorder, or those who are on anticoagulation therapy would not be given multiple injections.

Dr Joyce Lim prefers not to give neurotoxin injections if you are pregnant or if you are breastfeeding. Remember to let Dr Lim know if you think you may be pregnant

17. WHAT ARE THE OTHER AESTHETIC TREATMENTS WITH BOTULINUM NEUROTOXIN?

In addition to treating wrinkles, botulinum neurotoxin can be used for facial enhancement like shaping the eyebrow or face, elevate droopy eyelids, soften prominent eye muscles and soften smoker’s lines around the mouth. Combined with dermal filers Botulinum neurotoxin can be used to slim down the jaw line or create a heart shaped face.

18. HOW DOES BOTULINUM NEUROTOXIN HELP EXCESSIVE SWEATING?

After injecting into the skin, the neurotoxin enters the glands in the skin responsible for the excessive sweating. It blocks the release of a chemical that signals sweating.

The area to be treated is first anaesthetised using an anaesthetic cream to reduce your discomfort. Lots of small injections are used to cover the area. During the procedure Dr Joyce Lim may apply ice before each injection is given.

Usually the effect of reduced sweating begins in a few days and increases for a couple of weeks. Depending on the amount of medication used and individual variation, the effect usually lasts between some months and a year with the average being 7-8 months. Sweating gradually returns after this time. The degree of sweating reduction will also vary with the dose and individual variation.

The commonest side-effects are pain at the injection sites and bruising. If the hand is injected there may be transient mild weakness especially in hand grip or in picking up fine objects
 
...................................................
290 Orchard Road
#11-16/20, Paragon Medical Suites
Singapore 238859
T : 6834 9159
Email: drjoyce@joycelim.com
 
...................................................
290 Orchard Road
#11-16/20, Paragon Medical Suites
Singapore 238859
T : 6834 9159
Email: drjoyce@joycelim.com