Facial lines are caused by the repeated use of the underlying facial muscles which over time results in a permanent crease or wrinkle. As an alternative to surgery or to maintain the effects of surgery it is possible to reduce these lines by relaxing the action of the underlying muscle using botulinum (Botox). Where Botox is injected, it relaxes the facial movements which result in wrinkling. This gives a smoother, more rested appearance to the face. Botox also has a preventative effect when used repeatedly to reduce the onset of wrinkles forming in the long term. To achieve the best results Botox is injected to a level which does not cause complete freezing of the muscles but relaxes them so that some movement is still possible.

Dr Grover has a particular interest in Botox injections and performs all non-surgical treatments himself and does not delegate any of these to a nurse. He enjoys looking after his patients individually. He was the lead clinician in the UK coordinating the international multicentre trial on safe dosage of Botulinum toxin which lead to it being awarded its license for cosmetic use in Europe and the United Kingdom. Rajiv has also carried out original research that shows that the preventative use of Botox reduces long term ageing in the forehead and brow, therefore reducing the need for a surgical browlift later.

Botox is most commonly used in the upper face. Areas frequently requested are the horizontal forehead lines, vertical frown lines between the eyebrows, and crow’s feet (or laughter lines) radiating away from the eyes. It can also benefit around the mouth and chin, as well as in the neck to soften the vertical bands which arise from the Platysma (neck) muscle.

Botox injection is currently the most popular cosmetic procedure with over 10 million Botox injections being performed worldwide annually. The treatment is now 40 years old and therefore has a well established safety record. In the USA the Food and Drug Administration (FDA) now licenses Botox for cosmetic use as does The British Government and European Union. For many people, Botox treatment represents their first experience with cosmetic surgery. As a quick and effective treatment, with excellent results and virtually no downtime, it is perfect for those patients who have minimal signs of facial aging such as forehead furrows and crow’s feet. Whilst Botox can often delay the need for more extensive surgery, it is important to stress that it does not achieve the same results as surgical procedures.

Botox is a remarkably safe treatment for wrinkles with little down time associated with the treatment. Occasionally slight bruising may occur where Botox is injected and a mild headache may follow. Bruising may be greater in patients who are taking aspirin, or any blood thinning medicines. These products should be avoided if possible prior to the injection. Muscle relaxation is first noted at between the 4th and 10th day after injection; it is not immediate and usually takes 14 days to mature.

Successful therapy is signalled by muscle relaxation that begins 4 and 10 days after injection with the main effect visible at about 14 days. The effect after the initial injection lasts between 3 and 5 months for most patients.

Repeat treatment is suggested every 4-5 months to keep the muscles sufficiently relaxed to allow the skin furrows to smooth out. In practice this means coming three times per year.

Fillers including Restylane (Hyaluronic Acid) may help to eliminate the finer expression lines. Depending on the severity of the skin changes it may be more appropriate to recommend lifting operations of the forehead, temporal region or face which would also have the longest lasting effect.

Tension headaches and migraine may be reduced in number and severity for some patients. This tends to help in patients who recruit forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded. It has been found to help with headache in about 30% of migraine sufferers.

Dr Grover uses the finest calibre Italian needles, so most patients compare Botox to the sensation of having an eyebrow hair plucked. It is advised not to use aspirin before treatment as this can increase the risk of bruising because of its blood thinning effect.

• Pregnant women: although there have been no reports of birth defects with this medicine, no pregnant patients should be treated.
• Breastfeeding: similarly, there is no evidence that Botox is expressed in breast milk, but it is best avoided if breastfeeding.
• Patients with a history of neuromuscular disease (multiple sclerosis and myasthenia gravis) or other types of diseases involving neurotransmission should avoid this medicine.
• Known allergy to human albumin (egg white) or Botox; currently there are very few documented cases of allergy to Botox in the scientific literature.

As with any sort of injection there can be some bruising and minor swelling although this is rarely severe and usually settles within a few days. Very rarely if the Botox reaches the upper eyelid muscle there may be transient drooping. This is the most significant risk and occurs in about 1 in 1000 injections. It occurs from local spread of the Botox from the injection site and can be minimised by accurate dosage, proper placement, and avoiding local pressure to the area for 48 hours after treatment. If drooping eyelids occur, it usually resolves over a few weeks. Special eye drops may temporarily reduce eyelid droop if it occurs.

Do not massage the area of the injection. Do not take any aspirin for two or three days either side of the injections as this may help to reduce the chance of bruising. It is also advised not to perform any vigorous exercise for 24-48 hours after the treatment. Anything that could move the Botox from where it has been injected in the first couple of days should be avoided. In practice this means avoiding having any facials or massages for 48 hours where you might lie face down on a circular pillow.