Common complaints I hear of when meeting patients for the first time, whether new to medical aesthetics or new to me, is issues with their anti wrinkle dose and "wearing off too quickly".

So it bears repeating - anti wrinkle treatments work by paralysing the nerves that send signals to the muscles in your face to move, causing lines - eg frown lines, forehead and crows feet being the most common areas to treat. This effect may begin as early as 3-5 days and is complete by 2 weeks or 14 days when I normally like to review you to check the dose is right, you're happy with results and there is no unevenness or other fixes.

After this, these nerves begin to regenerate as early as 6-8 weeks after treatment, when they begin to send signals to the muscles again, until at 3 months, movement is around 80% or more of movement before any treatment. Over time and regular treatment, or with a higher dose, this may stretch out to 4 months, but this is in effect how anti wrinkle treatments work.

There is no -"on-off" switch, but a more gradual return to movement that will soften over time and repeated treatments.

This is most common after the first 1-2 times you have anti wrinkle treatments, even if you had a standard dose, depending on how strong your muscle movement is before treatment and especially if you have lines visible at rest, usually indicating a stronger muscle.

Occasionally, people believe this is dependent on the brand used, when it may have worn off quicker the first time with Brand D but worked longer with Brand X for eg. All else being equal, my experience has been that it is usually the fact that it is your first or second time having treatment rather than the brand (but it is good to keep it in mind).

So some tips to keep in mind when seeking anti wrinkle treatments, especially if you are new to this.

• after your first treatment, it is common for some unevenness when it begins to kick in, until review at 2 weeks, and in 99% of cases this will settle by the time of review.
• we assess correct dose at 2 weeks, when the treatment is at peak effect if you are happy with the result.
• some movement the first few times, especially if you opt for a lower dose to "soften" lines rather than "freeze" lines, may return as 6-8 weeks and increase over time till re-treatment around 3 months
• lines present at rest, called static lines, are harder to fade and need regular treatment every 3 months with appropriate doses of the area to be treated until they fade, usually around a year; thereafter, they need ongoing maintenance to keep them from becoming worse again.
• unless we aim to freeze your face, it is usually not possible to completely prevent lines and wrinkles and it is important not to become hyper focused on chasing lines and wrinkles as opposed to an overall look of appearing refreshed, or rested, if that is your goal.
• as the result is dependent on the dose used, a goal of "no lines" usually will mean a higher dose is needed, and usually areas of the face next to the area to be treated will also need anti wrinkle injections as otherwise they will compensate for the frozen areas by becoming extra mobile (hyperdynamic)

So as always, our advice at Skin Essentials, is to choose a provider whose face you like, including in animation, and to have a clear idea of what your goal is so you avoid disappointment. Realistic expectations and trust in your provider is the key on which longterm therapeutic relationships are built.