Facial wrinkles and lines can be reduced with cosmetic injections into the skin. The two main types of injectable substances used are botulinum toxin type A and dermal fillers. To treat deep lines, the surgeon or cosmetic practitioner may decide to use both types of injectables to achieve the best result.
Botulinum toxin type A is given by intramuscular (IM) injection to weaken muscles in the face and lessen the lines associated with facial expression. The toxin relaxes the underlying muscle and allows the skin to flatten out.
Dermal fillers are piped by injection along wrinkles and lines to plump the skin. Examples of dermal fillers include bovine (cow) collagen and the person’s own body fat.
Botulinum toxin type A
Doctors use botulinum toxin type A to treat medical conditions, including facial tics, muscle spasms and excessive sweating. In Australia, the cosmetic use of botulinum toxin type A is restricted to the treatment of frown lines between the eyebrows. It is currently available in Australia under the brand names Botox®
Any other cosmetic use is not approved and becomes the responsibility of the treating doctor. It is not uncommon for medication to be used to treat conditions for which they have not been approved. However, the implications of this should be explained to the person at the time of prescription.
Uses for botulinum toxin type A
Botulinum toxin type A is injected into certain muscles of the face to soften facial lines, including:
- frown lines between the eyebrows
- lines across the bridge of the nose
- ‘crow’s feet’ wrinkles extending from the outside corners of the eyes
- forehead lines
- lines on the throat (‘turkey neck’).
A very fine needle is used to inject the botulinum toxin type A into selected facial muscles. Discomfort is minimal and brief. Most people describe it as an ant-bite sting for a few seconds. The wrinkle-smoothing effects of the injection may last for up to six months.
Things to consider with cosmetic injectables
Before you opt for any cosmetic treatment, there are some important issues to keep in mind, including:
- Choose an appropriately qualified surgeon. Ask them about their training and experience in performing the procedure.
- Inform yourself fully of the possible risks, side effects and complications of the procedure.
- Think carefully about your expectations. Cosmetic treatment may improve your appearance and self-confidence, but it won’t necessarily deliver your ‘ideal’ body image or change your life.
- Think about the impact on your financial situation, as cosmetic treatment does not usually qualify for rebates from Medicare or private health insurance companies.
- You should have a ‘cooling off’ period after attending your first consultation. This will give you time to think about your decisions.
Don’t be shy about asking questions and discussing your concerns with your plastic surgeon. Make sure you get a full explanation of the anticipated results and what you can expect after the procedure. If you are unsure, seek a second opinion before going ahead.
Medical issues for botulinum toxin type A
Botulinum toxin Type A injection must not be used if:
- you are allergic to any of the ingredients listed in the formulation
- you have an infection in the muscles where it would normally be injected
- you have any muscle disorders in other parts of your body, including myasthenia gravis, Eaton Lambert syndrome or amyotrophic lateral sclerosis.
Precautions for botulinum toxin type A
Tell your doctor if you are taking other medications, including prescription or over-the-counter medications and any complementary medicines or supplements.
You must also tell your doctor if you:
- are taking or are likely to take antibiotics, especially aminoglycoside antibiotics
- are scheduled to have surgery using a general anaesthetic
- have inflammation or severe weakness in the muscles where the product would be injected
- are pregnant or intend to become pregnant
- are breastfeeding or are planning to start breastfeeding
- have ever had facial surgery
- have angle closure glaucoma
- have problems with your heart or circulation
- are taking drugs that may interfere with muscle function.
In these circumstances, it may not be possible to use botulinum toxin type A injections.
Complications of botulinum toxin type A
Side effects, if they occur, are usually temporary and restricted to the area of injection and can include:
- drooping of the eyelids
- face pain
- swelling at the injection site
- skin tightness
- muscle weakness
- numbness or a feeling of pins and needles
Procedure for dermal fillers
A very fine needle is used to ‘fill’ the wrinkle, line or skin depression with the product. The wrinkle-smoothing effects of most dermal fillers are temporary and regular treatments are needed to maintain the effect.
Some of the different types of dermal fillers include:
- collagen – suitable for deep lines and some scars. The effects last for about four to six months
- hyaluronic acid – suitable for thin surface lines, such as those that occur around the mouth and across the forehead. The effects last for about one year
- hyaluronan (a form of hyaluronic acid) – suitable for deep lines and acne scars. This product can be used as an alternative for people who are allergic to collagen. The effects last for about six months
- polylactic acid – suitable for skin depressions and deep lines. The polylactic acid prompts the treated skin to produce collagen
- polyacrylamide – suitable for deep lines. Once injected, the product forms a soft and permanent implant
- fat injections – fat tissue is taken from other areas of the body using a thin needle. The fat is sterilised and injected into the facial line or wrinkle. Effects can be long lasting. Touch-up injections may be needed in some cases. This treatment is also known as ‘microlipoinjection’.
Medical issues to consider for dermal fillers
Dermal fillers may not be suitable if you have:
- certain medical conditions, such as an autoimmune disease
- a history of keloid scarring
- inflamed or infected skin
- severe allergies such as asthma
- food allergies
- ever had a life-threatening allergic reaction (anaphylaxis).
General precautions for dermal fillers
Tell your doctor if you are taking medications, including prescription and over-the-counter medications. Some medications, such as blood-thinning drugs, may increase the risk of complications after the procedure.
Some people are allergic to bovine (cow) collagen. Small test injections should be given prior to treatment to check for an allergic reaction. People with an allergy to chicken should not use hyaluronan-based dermal fillers, because these products are made from rooster combs.
Complications of dermal fillers
Depending on the dermal filler used, possible side effects and complications may include:
- swelling and redness at the injection site
- skin discolouration
- bacterial infection
- viral infection
- ulceration of the skin around the injection site
- lumps (nodules) forming under the skin
- allergic reaction.
Be guided by your doctor. General self-care suggestions for the first few days following cosmetic injections include:
- Avoid exposing the treated skin to extremes of temperature (such as saunas).
- Keep the treated skin areas clean.
- Avoid touching or rubbing the treated areas.
- Use paracetamol if you need pain relief.
- See your doctor if you experience unusual symptoms or if you have any concerns.
Where to get help
- Your doctor
- Plastic surgeon
- Australian Society of Plastic Surgeons Tel. 1300 367 446
Things to remember
- Facial wrinkles and lines can be reduced with cosmetic injections into the skin.
- The two main types of injectable substances used are botulinum toxin type A (which relaxes the facial muscles that cause the lines) and dermal fillers (which plump out the wrinkles).
- The wrinkle-smoothing effects of most cosmetic injectables are temporary and regular treatments are needed to maintain the effect.
This page has been produced in consultation with and approved by:
Australian Society of Plastic Surgeons
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.