Consultation for the treatment of crow’s feet wrinkles & frown lines – by Leading Oculoplastic Surgeon, Dr Sabrina Shah-Desai & her team

No, neuromodulator injections are usually painless.

The effects will begin to work after a few days, reaching maximum effect by 2 weeks.

For most people the effect lasts for 3 to 4 months – you’ll know when it wears off as you’ll start to be able to frown more deeply again. After a course of 3 injections over the first 2 years, most patients feel the effects last 6 months or longer, thus requiring less frequent injections or smaller doses.

The dermal fillers we use are made from hyaluronic acid – a substance that occurs naturally in the body. These types of fillers are biodegradable, which means that they will gradually be absorbed as the gel breaks down and water takes its place. When totally absorbed, the filler gel disappears unnoticed from the body.

This treatment is not suitable if you are taking the following medications: antibiotics like gentamicin, tobramycin, clindamycin and lincomycin or quinidine for heart rhythm problems. You should not have muscle-relaxing injections if you have a muscle-weakening disorder (myasthenia gravis, Lambert-Eaton syndrome, ALS (Lou Gehrig’s) or motor neuropathy, are pregnant, breastfeeding or allergic to human albumin (not egg allergy). Avoid having alcohol in your system, as it can increase the likelihood of bruising and make the injections spread to muscles you don’t want to treat.

Hyaluronic acid-based dermal filler can support the muscles on resorbing bone and help reduce line and wrinkles due to muscle over-activity. Plexr Skin Tightening is a plasma-based solution that will vaporise excess skin by up to 30 % with each treatment, leaving it appearing tighter and more contoured.

• Horizontal “Worry” lines (frontalis over-activity) – lines that appear across the forehead and can sometimes remain visible.
• “11’s” or Vertical “Frown” lines (corrugator over-activity) – small lines that deepen overtime between the brows from concentrating or frowning.
• Laugh or Smile lines (orbicularis over-activity) – crow’s feet that appear around the eyes when smiling or laughing
• Jelly Rolls of lower eyelid (orbicularis hypertrophy)– horizontal under-eye lines caused by blinking, squinting and unavoidable reflexes.
• Bunny lines (procerus over-activity) – tiny lines that appear when wrinkling the nose.
• Bobbly / Golf-ball chin (mentalis over-activity) – a dimpling effect on the chin due to excessive flexing.
• Marionette Lines or labio-mental creases (DAO over-activity) – lines on either side of the mouth that deepen over the years due to loss of facial volume.
• Square jaw / Bruxism (masseter hypertrophy) – masseter muscles that are over-pronounced in the jaw.
• Turkey Neck (platysmal bands) – when the thick muscle that runs from the ear to the collarbone pulls the lower face downwards over time, causing a sagging effect.
• Brow ptosis or Asymmetric Brows – when the brows start to drop or there is asymmetry.
• Blepharospasm / Hemi-facial spasm – muscular spasms around the eyes or involuntary contractions on one side of the face.

Most women like to have a more rested appearance with high brows and no lines. They tend to require additional fillers to maintain their preferred brow position and microdroplet injections for their necks around the time they reach their mid-50s.
Meanwhile, men usually prefer to retain a few horizontal forehead lines, instead focussing on treatment for their “11” vertical frown lines. They tend to require microdroplets for their brow and forehead by their mid-40s.

As with any drug, there are some possible side effects. However, the product only stays in the body for a maximum of 6 months, so any side effects associated with the injection will diminish after that time. Possible side effects can include:

• Bruising and or erythema: redness of the skin at the site of injection.
• Feeling unwell: headache, respiratory infections, nausea and flu-like symptoms.
• Temporary Ptosis or droopy eyelid: this typically reverses in 4-6 weeks as the toxin begins to wear off. It can be managed with Apraclonidine and Phenylephrine drops three times a day for a few weeks.
• The “Spock look”: lateral brow peaking can be addressed with a small amount of further treatment at the apex of the peak.
• Droopy, flat brow or a lower resting eyebrow position: this can occur when the forehead is treated to eliminate horizontal forehead lines. The risk increases with age and can be minimized by microdroplets.
• Temporary lower facial paralysis: this is an effect of the chemical neuromodulator diffusing further than the treatment dose and can be minimized by microdroplet.