Medical Aesthetics (Anti-Wrinkle Injections and Fillers)

Botulinum toxin injections (often called anti-wrinkle injections) and hyaluronic acid fillers address different problems. Botulinum toxin temporarily softens muscle contraction and reduces expression lines on the forehead, between the eyebrows and around the eyes. Fillers restore lost volume in areas such as the cheeks, temples, under-eye area or lips and fill deep lines. Many people need both, and where appropriate they can be given in the same session.

The effect of botulinum toxin usually begins within 2–5 days and settles at about 2 weeks. In most people it lasts 3–4 months, after which muscle movement gradually returns. How long it lasts depends on the area treated, muscle strength and the individual. When the effect wears off, the face returns to how it was before treatment, with no lasting change. The result is assessed at a review about 2 weeks after treatment, and a small additional treatment is given if needed.

Hyaluronic acid filler is gradually absorbed by the body, usually over 6–18 months depending on the area and the density of the product. It tends to last a shorter time in mobile areas such as the lips and longer in areas such as the cheeks and chin. Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase; this matters both for correcting an unwanted shape and in emergencies such as vascular occlusion. Permanent fillers that cannot be reversed are not recommended.

Most filler treatments result only in short-lived swelling and bruising. A rare but important risk is that the filler enters a blood vessel or compresses it. This causes blanching or bluish discolouration of the skin and severe pain; if not treated quickly, it can lead to tissue loss and, very rarely, loss of vision. Fillers should therefore be given by a doctor who knows the course of the facial blood vessels, with the dissolving enzyme kept ready for emergencies. If you experience unusual or severe pain, marked blanching or grey or blue discolouration around the injection site, or any change in vision during or after filler treatment, seek medical help immediately. For any change in vision, go to an emergency department immediately. Do not wait for a message or callback from the clinic; also inform the treating doctor without delaying emergency assessment.

Botulinum toxin is injected with very fine needles and usually causes only a brief pinprick sensation. An anaesthetic cream is used before filler treatment, and many filler products also contain a local anaesthetic. Most people return to work and social life immediately after treatment. Redness at the injection points fades within a few hours, while bruising and swelling can last a few days. For this reason, schedule treatment at least 2 weeks before an important event.

Facial fat grafting (lipofilling) suits people with more extensive volume loss in the cheeks, temples or around the eyes who prefer their own tissue; it can also be combined with a facelift. Fat is taken from the abdomen or thighs with fine cannulas and placed in the face in small amounts. Fat that takes stays for a long time, but as some is absorbed, a second session may be needed. Unlike fillers, it requires sedation, swelling lasts 1–2 weeks and entry scars a few millimetres long remain.

Cosmetic botulinum toxin and filler treatments are given to people aged 18 and over. There is no set starting age; the decision is based on the need seen at the examination, not on age. Treatment is not given during pregnancy or breastfeeding, when there is an infection or cold sore in the treatment area, in neuromuscular disorders such as myasthenia gravis, or with an allergy to the product. Any previous fillers, especially permanent ones, must be mentioned at the consultation.

Injections help with volume loss and problems related to muscle movement, but they do not lift sagging skin or remove excess skin. If there is marked sagging of the cheeks and neck, excess upper eyelid skin, prominent under-eye bags or a low brow, a facelift, eyelid surgery or a brow lift may be more suitable. In these situations, using filler alone can make the face look heavy and unnatural. Both options are discussed openly at the consultation.

The fee for medical aesthetic treatments depends on the type of treatment, the number of areas treated, the amount of product needed and the characteristics of the product. Facial fat grafting is assessed separately because it requires an operating theatre and anaesthesia. Once the need and the approximate amount of product have been determined at the consultation, you receive a written, itemised quote. As cosmetic treatments, these are generally not covered by health insurance.

Aspirin, blood thinners, fish oil and some herbal supplements can increase the risk of bruising. Prescription medications should not be stopped on your own; if needed, the decision is made together with the prescribing doctor. Smoking can reduce how well fat takes, especially with fat grafting, and slows healing. Avoiding intense exercise, saunas and alcohol on the first day after treatment is advised. All medications you take and any allergies should be mentioned at the consultation.