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Common Myths about Anti Wrinkle Injections You did not know

Despite all the chatter about anti wrinkle injections and treatments on social media, I regularly meet patients of all ages who come to see me asking for anti wrinkle treatments who do not necessarily understand how it works, or how it differs from dermal fillers.

As a medical professional, patient centered care is a central and key tenet of what I was trained to do- first, do no harm.

Given that all aesthetic treatments are essentially elective and medical unnecessary, it is important to me that patients are as well informed as possible to make their choice and decision to proceed or mull some more.

So what are some common myths I have heard patients believe about anti wrinkle injections? (PS in Australia by law, we are not allowed to use drug names, hence terminology like “anti wrinkle” and “muscle relaxant” to get around health regulations that could land us in trouble with AHPRA!)

Myth #1 They work immediately

Occasionally a patient will reach out wanting to know if we can squeeze her in “today or tomorrow” due to an important event coming up in 3-4 days for which she wants to look fresh and though anti wrinkle treatments might do the trick. 

While there are some promising new versions of anti wrinkle treatments available around the world that apparently kick in as early as within 24 hours, we do not have that authorised yet in Australia; the apparent downside of these? They also wear off faster, in 2-4 weeks.

Duration of onset aside, I am not a fan of impulsive decision making when it comes to entirely elective treatments for the simple reason that they are still medical procedures and side effects, while rare with an experienced doctor, are still possible, the least of which is bruising, which may be apparent for a few days after treatment, potentially ruining an important occasion.

Most anti wrinkle injections on the market at present take anywhere from 3-5 days to begin to take effect and peak at approximately two weeks, when I tend to offer new patients a review, so we can determine if the effect is what they desired, and to determine correct dose for future treatments.

Myth #2 Anti Wrinkle Treatments will age you when you stop having them

Many people are worried that having these injections will permanently affect their face, or the way they use their muscles or even prematurely age them if they eventually decide to stop having treatment.

In reality, the botulinum toxin works by paralysing/ weakening the muscles that cause movement. Over time (usually weeks rather than months) new nerves are regenerated to supply these muscles, resulting (from as early as 6 weeks post injection) in return of gradual movement to these muscles; by 3 months, and often earlier depending on the dose used as well as desired movement by the patient, the dose will have worn off and the patient is ready for re-treatment.

Over time and with continued use, these muscles will remain slightly weaker compared to untreated muscles, resulting in the same dose lasting longer/ working better, resulting in smoother skin, fewer/ fainter lines especially in the forehead, frown and crows feet, giving a more youthful and refreshed appearance.

Therefore, in theory if one was to have regular anti wrinkle injections 4 times a year for 2-3 years and then decided to stop doing so, it would likely take some months for full movement and strength to return to those muscles, and to then lead to reformation of the lines that led the patient to begin treatment in the first place.

Myth #3 Anti Wrinkle Treatments can make you look frozen

Not unless you want to!

The way we used to use the toxin in its early days is likely quite different to the way we use it now.

While I certainly have a small number of patients who ask to be frozen, by and large patients these days are more concerned with looking frozen and looking fake and simply wanting to look refreshed and well rested.

Many of my patients also rely on the full range of facial expressions at work and in their personal lives (I have had several mums say to me “I want my kids to STILL know when I’m angry!”) and want anti wrinkle injections to help soften the appearance of etched-in lines, rather than risk loss of movement in an area of their face, such as the frown lines, or forehead lines.

Ultimately, aspiring to a frozen look means that your treating clinician has to use an excessive dose at least initially, to stop you moving your muscles at all. Over some weeks as nerves begin to regenerate, movement will return, as early as 6-8 weeks, so it is almost impossible to completely freeze areas of the face for months at a time without regular treatment in between the 3 months, which I do not recommend.

Myth #4 Anti Wrinkle Injections are only for Women

While women remain the biggest demographic to seek elective aesthetic treatments, some 10-15% of patients tend to be men, many of whom also want to age well, and discreetly, and many of whom want to keep up with their young looking partners.

Men tend to need slightly larger doses than women for the same effect as testosterone in men tends to confer greater muscle strength.

Conversely, societal expectations of men tend to be such that men who age well, are “rugged”, still have some wrinkles, so that men usually look to soften lines rather than erase them.

Myth #5 Anti Wrinkle Injections are addictive

The only thing that is addictive about injectables is the real risk of patients coming to rely on it to feel good about themselves to the extent that a small number will begin to hyper focus on this.

When this occurs, I tend to try and discuss this with my patients and to point out the hyper focus on them, as becomes the duty of any ethical practiotioner and to say no, or to ask that we hold off for a bit.

For this reason, I tend to generally not offer more anti wrinkle injections if lines initially come back earlier than 3 months in a patient new to toxin, or to keep adding more filler if a patient believes it will solve their problems. Obviously in these cases, discussion is important, but the ability to say no is just as important to keep the patient and practitioner safe.

Nothing about the botulinum toxin is addictive, and before it was recognised as an agent that could safely be used in aesthetics, it was used for decades to help in medical conditions outlined below.

Myth #6 Anti Wrinkle Injections are just for wrinkles

As noted above, the discovery of botulinum toxin in aesthetics came about by accident while using it for a medical condition called strabismus, in which scientists noticed the animals injected with it also had smoother frown lines!

This drug originally had mainly medical uses for neck spasms (cervical dystonia), muscle spasms in people with Cerebral Palsy and strabismus and to this day, botulinum toxin continues to have many therapeutic uses, including for the ones above, as well as for uses in certain types of chronic migraines, for bruxism (teeth grinding) as well as hyperhidrosis or excessive sweating and urinary incontinence.

So there you have it!

Some of the regular and common myths I encounter in clinic when discussing strategies to age well with patients, which may include judicious use of injectables if they are open to the idea.

Are there any side effects to anti wrinkle injections? 

There are very few in reality, but your clinician should check these with you prior to treatment anyway. 

Reasons you may not be suitable for anti wrinkle treatments: 
- best to wait if you are pregnant
- certain types of medical conditions may prevent you from having anti wrinkle injections, notably some neurological conditions

Common side effects with anti wrinkle injections: 

- bruising (anytime you have a needle in your face/ break skin) 

- slight headache initially 

- asymmetry of the muscle movement until full effect kicks in around two weeks 

- if the toxin migrates to an unwanted area, it may affect muscle movement in that area, leading to temporary unwanted side effects such as a dropped eyelid, or asymmetrical smile depending on the site of the injection. (This is rare but not impossible) 

When is it best to have treatment?

Generally speaking, I tend to avoid treating anyone two weeks or less prior to a big event eg wedding, celebration, because of the small but unpredictable risk of bruising at injections sites.

Also given botulinum toxin can take a few days to kick in and peak at two weeks post injection, some people may experience some temporary asymmetry when animated that may make them self conscious at an important event, especially if photos will commemorate the occasion.

As always, the best way to have any aesthetic procedure is to plan it carefully, with collaboration and to proceed with full information and consent, being prepared for followup if anything unexpected occurs with your trusted clinician. Doing so for most patients ends up being a very positive experience.

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