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 responsible medical 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
Medical practitioners use botulinum toxin type A to treat medical conditions including facial tics, muscle spasms and excessive sweating. It is currently available in Australia under the brand names Botox® and Dysport®. In Australia, botulinum toxin type A is registered for cosmetic use to treat facial lines and wrinkles.
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
- forehead lines
- ‘crow’s feet’ wrinkles extending from the outside corners of the eyes
- 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 lasting a few seconds. The wrinkle-smoothing effects of the injection may last for up to six months.
Things to consider with cosmetic injectables
Important things to think about before deciding on any cosmetic treatment:
- Most anti-wrinkle injections and dermal fillers are ‘prescription-only’ medicines which must be administered by a registered health practitioner.
- Choose and consult a registered medical practitioner in person and ask them about their training and experience in performing the procedure.
- Check the Australian Health Practitioner Regulation Agency (AHPRA) website to make sure the medical practitioner is registered in Australia. If a nurse is administering the injection on the authorisation of a medical practitioner, check the AHPRA website to ensure they are registered to practice in Australia.
- Inform yourself fully of the possible risks, side effects and complications of the procedure.
- Be honest 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 your financial situation, as cosmetic treatment does not usually qualify for rebates from Medicare or private health insurance companies.
- Make sure that the clinic you go to has a ‘cooling off’ period after attending your first consultation to give you time to take in the information.
- Think about taking a family member or friend as a support person.
- Serious, life-threatening complications can occur as a result of cosmetic injections. Be aware of the signs and symptoms of possible complications. If you experience serious complications, call triple zero (000) for an ambulance, or go immediately to your nearest emergency department.
- Talk to your medical practitioner about whether you will need to have a support person with you for a period of time after your cosmetic procedure to help in case of an emergency.
Be aware that:
- Only registered medical practitioners (and in limited cases nurse practitioners and dentists) can lawfully prescribe ‘prescription-only’ medicines.
- Nurses may only administer ‘prescription-only’ medicines when authorised to by a registered medical practitioner (or an endorsed nurse practitioner in the category of perioperative care) who has taken responsibility for the care and treatment of the patient.
- Most nurses are not nurse practitioners so cannot lawfully authorise the administration of injectable ‘prescription-only’ drugs.
- The fact that a nurse is experienced in administering cosmetic injections or claims to be a ‘cosmetic nurse’, ‘nurse injector’ or similar, does not mean they are a nurse practitioner.
- You can use the AHPRA website to verify that a nurse or associated or supervising doctor is registered in Australia.
- If a nurse proposes to administer a prescription-only injection and you have not consulted a medical practitioner, check the AHPRA website to ensure they are an endorsed nurse practitioner in the category of perioperative care.
Don’t be shy about asking questions and discussing your concerns with your medical practitioner. 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.
Medical issues for botulinum toxin type A
Do not use botulinum toxin type A injections 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 medical practitioner if you are taking other medications, including prescription or over-the-counter medications and any complementary medicines or supplements.
It is also important to tell your medical practitioner 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 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 around the injection area. They can include:
- drooping of the eyelids
- face pain
- swelling where you were injected
- skin tightness
- muscle weakness
- numbness or a feeling of pins and needles
- blurred vision.
Procedure for dermal fillers
A very fine needle is used to ‘fill’ the wrinkle, line or skin depression with a 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 (sold in Australia as Collagen, Zyderm®, Zyplast®, CosmoPlast® and Cosmoderm®)
- 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 (sold in Australia as Restylane®, Perlane®, Dermalive®, Juvéderm®, Emervel®, Sub Q®, Esthelis® and Belotero®)
- 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 (sold in Australia as Hylaform®)
- polylactic acid – suitable for skin depressions and deep lines. The polylactic acid prompts the treated skin to produce collagen (sold in Australia as Newfill®, Nufill® and Sculptra®)
- polyacrylamide – suitable for deep lines. Once injected, the product forms a soft and permanent implant (sold in Australia as Aquamid®)
- 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 (thick, raised scars)
- 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 medical practitioner 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. Have a small test injection before treatment to check for an allergic reaction.
If you are allergic to chicken, do not use hyaluronan-based dermal fillers, because these products are made from rooster combs (the red part on top of a rooster’s head).
Complications of dermal fillers
Serious, commonly reported complications of dermal fillers include:
- vascular occlusion – this occurs when filler is injected into or around an artery, causing blood flow to be reduced or stop. Skin may look pale (blanched) and start to turn blue over a period of 24 hours. This is usually painful and, if untreated, the skin may start to ‘die’ and turn black
Any of these can occur shortly after an injection has been administered; all require urgent ‘reversal’ treatment by a medical practitioner to reduce the risk of death or long-term complications.
Additional possible side effects and complications may include:
- swelling and redness where you were injected
- skin discolouration
- bacterial infection
- viral infection
- ulceration of the skin where you were injected
- lumps (nodules) forming under the skin
- allergic reaction
- permanent disfigurement and scarring
- haematoma (a collection of blood under the skin or in the deeper tissues)
- weakness of the muscles of the face, head and neck, which can have undesirable effects on swallowing, vocal cord function and eye movements (double vision)
- inflammatory reactions – especially associated with unregistered dermal filler products which may require surgery to remove.
Self-care suggestions after cosmetic injectable treatments
Be guided by your medical practitioner. General self-care suggestions for the first few days following cosmetic injections include:
- not exposing the treated skin to extremes of temperature (such as saunas)
- keeping the treated skin areas clean
- not touching or rubbing the treated areas
- using paracetamol for pain relief
- seeing your medical practitioner if you experience unusual symptoms or if you have any concerns.
Complaints about cosmetic injectable treatments
Concerns about cosmetic procedures may be dealt with by different organisations or government departments, depending on the nature of the complaint. The table below will help guide you to the appropriate organisation or government department. If you are not sure which one to contact, any one of them can help you or advise you on whom to speak to about a complaint.
Where to get help
- Call triple zero (000) in case of an emergency, or go to your nearest hospital emergency department
- Your medical practitioner
- Plastic surgeon
- Australian Society of Plastic Surgeons Tel. 1300 367 446
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.