The Botox Elephant in the Room

Botox, fillers and cosmetic enhancements are a modern day must have for a huge amount of people, not just your celebs and influencers but now across the whole of society, men and women alike, from young to old. There are however a large number of people offering these services that maybe aren’t qualified to be doing them or don’t really know what they are doing. If your car needs a paint job you don’t ask your cousin as he did a good on your fence last summer do you? So why would you entrust something as precious as your face in the hands of someone who isn’t an expert. Luckily for you we have the beautiful Dr Sarah Hosier of Visage Medical, a fully qualified dental surgeon and medical aesthetic practitioner on hand to answer the enhancement questions you want to know about. Who to trust, when to get things done, how much to get done, what to get done and when enough is enough…Dr Sarah answers all.

I was just doing an online consultation with a botox virgin. In fact, new to any kind of treatment. He (yes, you read that right HE) does not fit what most of you would think would be my average patient. He said to me, laughing, that he would have liked to have made it to his forties without any aesthetic intervention- but is fast realising that he’s not going to get away with that! I informed him with a knowing smile a- that getting away with it, is something that alludes most of us…myself included. That’s where medical aesthetics and someone like me comes in.

He isn’t one of my regulars, yet he represents what is increasingly known as the “typical patient”. Anyone. Everyone. You. Me! He simply has, what is becoming a very understandable, normal desire. He would like to look fresher, healthier, younger, more alert. He wants to look the best he can, while still looking normal!

He mentioned Botox before I had even started replying to his concerns. But he, like many of you, had fair few questions, questions that I get asked every day, so here are some bits you need to know.

What is botox and is it safe?

Botox has been used for years to successfully treat wrinkles and creases in the face. Botox, is simply a brand name of what is known as a neuromodulator. All brands work in the same way. They block the signal from a nerve to a muscle, so when injected the muscle cannot contract. This makes the wrinkles relax and soften. We can treat lines around the eyes, forehead and frown to name a few of the many areas we can treat.

Botox is a protein made from botulinum toxin type A. Before you gasp, yes, this is the same toxin that causes botulism! Neuromodulators are used in wider medicine to treat a number of disorders-eyelid spasms, bladder disorders, chronic migraine, and even in pediatric medicine. Cosmetic doses are very tiny, and as such deemed safe…in the right hands.

Who can inject botox?

Now this is the scary bit. In the UK, there is currently no legislation preventing non medical professionals from performing these treatments. Scary thought, right? This doesn’t mean that the government or the medical community finds it acceptable for non medical professionals to perform cosmetic injections. There have been stories in the media, that are not isolated cases, where people ranging from reality stars to personal trainers, beauty therapists to the girl that does spray tans from her garage at number 76 have trained and injected. I’m sure these people are great in their field but that is not what this is about, should they really be putting needles in people’s faces. Technically speaking, it’s not illegal and there are training providers who accept anybody who pays. The overwhelming consensus in the medical community, in the aesthetic medicine industry and the entire medical sector is that injectable treatments should only be performed by a trained medical professional the most obvious being doctors, nurses and dentists. Stricter regulation is urgently needed in this industry, so you really do need to be careful who you go to.

Can everyone have the treatment?

No. Patients must always be over 18. A full medical consultation must take place as this allows screening for appropriate patient selection and detection of absolute contraindications (a condition or factor that means treatment should not be administered). This reduces risk and increases safety. Absolute contraindications include: previous history of allergy (although rare), pregnancy, breastfeeding and certain medical conditions. Patients on certain types of antibiotics may have to delay treatment. It is vital that patients on blood thinning medications never stop taking these medications just for the purposes of a cosmetic procedure. This may only happen under the supervision of a Consultant, if at all!

Does it hurt, and how quickly do I see the results? IS the muscle then paralysed?

Anti-wrinkle injections are quick, and done with the finest of tiny needles, so most patients find them painless. The effects of NM treatment are only ever temporary. The muscles are NOT permanently paralysed. The maximum clinical effects are seen around 2 weeks after the initial injections. Movement (and so sadly the wrinkles) slowly start to come back at the 6-8 week mark, returning back to pre-treatment movement around the 3 month mark.

So is this the same as fillers?

This is a very different treatment to dermal fillers. Fillers are a type of gel, not a liquid, and fillers are used to replace lost volume and restore and improve facial contours. They can also be used to treat skin folds and creases, but they act by revolumising, they have no effect on muscles.

Can things go wrong?

Fortunately, complications are rare with anti-wrinkle injections. The most common undesirable effects are due to incorrect product placement or migration affecting neighbouring muscles. Precise placement is therefore necessary, so make sure the injector has an in-depth understanding of anatomy. Common minor issues that are common to any injection procedure, include redness, bruising, headache like symptoms and mild swelling. Almost all patients feel perfectly presentable afterwards. This is a procedure with little down time.
This is different to dermal fillers. Our faces are naturally a highway of vessels. Any of which can potentially become blocked or compressed by filler. If this occurs the consequences can be significant. Such events necessitate emergency dissolving. Fortunately, these occurrences are rare, but they can happen even in the most skilled, experienced hands, so patients must be made aware, be consented accordingly- and understand the signs and symptoms to look out for, and the process to reverse the filler.
Will people be able to tell that I have had work done

The vast majority of patients want to improve their appearance while still looking like themselves. A sound approach comes from understanding the subtleties in aesthetics, the differences between the male and the female face and understanding facial proportions.

Knowing where and when to stop is vital when maintaining someone’s overall look and avoiding looking DONE. Some patients cannot see when enough is enough, so as professionals, we have a duty to firmly draw the line, and only recommend treatments that will benefit our patients. Some people become addicted to certain treatments like lip fillers, and excess can lead to severe medical problems…bigger is not always better, so stay safe and know the limits.

The world of medical aesthetics is a wonderful thing to be part of. Within one consultation we can be talking about anything from light therapy, peels, injectable skin boosters, dermal fillers and anti-wrinkle injections. Treatments can be preventative in younger patients or more restorative in older patients.