Lines and Wrinkle

We all develop lines and wrinkle on the face and neck with increasing age. The reason being progressive loss of collagen in the ageing skin and decreasing ability to retain water in the skin. This leads to less support to the skin structure with fines lines appearing on the face and also deterioration in the texture of the skin. In addition we constantly use our facial muscles which is the how the contraction of the skin is achieved for producing facial expressions. This constant contraction of muscles leads to deepening of the fine lines and formation of deeper wrinkle. They are initially only seen when we contract our facial muscles but become more permanent as we age and our skin loses its elasticity. There are several modalities which can help with the prevention and treatment of these line and wrinkle from our face and hence improving the ageing appearance and producing a fresher look. The main modalities for treating wrinkle being

Botox treatment for lines and wrinkles

What are chemical peels

Chemical peeling is the name given to the procedure of applying non toxic chemicals to the skin. This leads to exfoliation of the superficial layers of skin cells. The fresh layer of skin cells give a smoother and fresher look and improvement is usually noticed in any uneven pigmentation on the skin.

Type of peeling

Superficial depth

Medium depth

Deep peels

Superficial and medium depth peeling is safer, provided it is carried out appropriately. These are the commonest types of peeling used. Deeper peels, as the name suggest, affect deeper layers of the skin and hence if not carried out appropriately can produce significant side effects. Any further reference to peeling here will be to superficial and medium depth peeling only.

What does it involve

Usually a solution is applied to the face by a trained professional as an office based procedure. The peel can sting and cause redness and crusting. Superficial peel can take up to seven days to heal completely and medium depth can take longer. There is initial redness which improves with peeling of skin. Emollients creams are used to help the healing skin. Skin becomes more sensitive after chemical peeling hence rigorous sun protection is advised.

Side effects

Common and established side effects

Redness, swelling, mild crusting

Uncommon side effects

Recurrence of cold sores, post inflammatory pigmentation, comedones, acne

Rare side effects

Infection, scarring

To avoid side effects it is important to follow your doctor’s instructions carefully.

Please contact us for further information.

Botulinum toxin

A toxin produced by the bacterium Clostridium botulinum. The word botulinum is derived from botulinus which means from a sausage (Latin: Botulus) as it was thought to be the cause of sausage poisoning which was quite common in 18th – 19th century Germany. Botulinum toxin is a neuro toxin causing blockage of nerve impulses and paralysis of the injected muscle. The effect is temporary as the muscle eventually regains its strength as the nerves regenerate.

Medical use

Initially used for treating conditions produced due to uncontrolled spasm of muscles of areas such as the neck, eyelids, eye muscles producing a squint.

Botulinum toxin also reduces sweating by blocking the nerves that control sweat glands hence also used for treating excessive sweating in the underarms which has not responded to other conventional treatments such as antiperspirant roll on and/or oral tablets used to control primary symmetrical hyperhidrosis which is not due to an underlying medical condition.

Aesthetic use

Hugely popular treatment to treat facial lines and wrinkles. It is widely known as Botox® in aesthetics. There are other known brands such as Bocouture®, Azzalure®, Vistabel® and Dysport®. They are all types of Botulinum toxin. The treatment can be effectively combined with other treatments such as chemical peeling, temporary fillers, microneedling and others for treating facial lines and wrinkles.

Is it painful?

There is mild discomfort and in some patients slight swelling and redness is seen after treatment. This usually settles within a few hours.

What happens during treatment?

A tiny amount of toxin is injected into the treatment area which is felt as a small prick. No local anaesthesia is needed and it is possible to continue with normal activities immediately following the procedure.

The effect is usually noticed in 3 to 7 days after treatment but best to wait for 2 weeks for full assessment of the treatment.

The effects are temporary and the effects wear off anywhere from 2 to 6 months. On an average the effects last about 4 months.


Side effects and risks

Established and common side effects

Immediately mild redness, swelling and soreness which resolves within the next 12 hours.

Bruising, if it appears persist for longer and up to a week.

Uncommon side effects

Headaches, for which taking a paracetamol is safe.

Rare side effects

Muscle weakness of the upper eyelid leading to droopy eyelid known as ptosis.

Paralysis of the forehead muscles can lead to drooping of the eyebrows.

Very rarely toxin can cause weakness of the eye muscles leading to double vision.

All the side effects are rare if they are carried by experienced injectors who are adequately trained and understand the anatomy and physiology of the area. These side effects are temporary and start to improve over the next few weeks. Also there are prescription medications available as eye drops to improve the droopy eyelid.

An allergic reaction is very rare but if you notice any hives, swelling of face, difficulty breathing or feeling faint, immediately seek medical help.



Chloroquine and hydroxychloroquine may reduce the effect of the toxin and aminoglycosides can increase the effect. Patients who are on blood thinners such as warfarin or aspirin may have more bruising.


Safety of botulinum toxin injections has not been established in pregnancy or when breast feeding, hence not be used in pregnant ladies and breast feeding mums.

As it is a neuromuscular blocking agent, it is not advisable to use it for conditions such as myasthenia gravis and motor neurone disease.




Do not touch the treated area after the treatment and do not have a facial massage. Manipulation of the treated area can lead to the toxin travelling to unintended areas leading to complications such as drooping of eyebrows or eyelids and sometimes even double vision.

Avoid any make up or creams for few hours, as the puncture wounds from the injections heal.

Within the first few hours and preferably for up to 48 hours, patients should avoid strenuous activity or exercise and avoid extensive sun or heat exposure, alcoholic beverages, UV light and use of steam and saunas

The treatment sites can produce more redness, swelling and/or itching if there is exposure to any of the above as described above.

The redness, swelling and any soreness subsides very quickly. Bruising may take a week.

After 12 hours, any bruising can be covered up with makeup.

Any symptoms of redness, swelling or tenderness beyond 3 to 5 days should be reported.

Using the muscles that have been injected for a few hours may benefit. For example, raising eyebrows, frowning or squinting.

We value your feedback which also helps us to reflect and learn. At times we may call you after your treatment to check the results and to discuss any adjustments if needed.


The Abington Clinic

01604 451200