What are anti-wrinkle injections?

Anti-wrinkle injections have become increasingly popular treatments for both men and women at all stages of life.

As skin ages, fine lines develop around areas of movement, resulting in lines around the eyes (crow’s feet), lines between the eyebrows (frown lines) and lines on the forehead (horizontal forehead lines). These form because of the habitual pulling of the skin by the muscles of facial expression (mimetic muscles of the face).

Treatment targets and weakens the muscles causing these lines. The medication* consists of proteins that block the transmission of nerve impulses from the nerve ending to the muscle fibre. This creates a temporary block of the muscle fibre action that lasts several months. Over time, the muscle fibre gradually regains its full function.

Who is a suitable candidate?

Many of our patients come to us because their friends and family tell them that they look cranky and they want their frown lines treated. Others are concerned about their crow’s feet or forehead lines. Whilst these account for the majority of our anti-wrinkle injection patients, there are other indications, such as enlargement (hypertrophy) of the masseter muscle causing a square jaw in women and excessive sweating in the armpits (hyperhidrosis).

What to expect

Anti-wrinkle injections are given by very small needles into the muscle involved. The injection points are determined by the orientation and depth of the target muscles. We use our thorough knowledge of anatomy and the ability to analyse how your face moves to determine the most appropriate placement points and the dose for you.

You will start to notice an effect after 2 days and full effect after 10 to 14 days. Many patients have found that the effect of their anti-wrinkle injections can be maintained with treatments 3 to 4 times a year. However, this can vary quite considerably from person to person and with time.

Facial muscles are arranged into groups that oppose the action of each other (agonist and antagonist). It is the balance between the agonist and antagonist that determines where certain facial features sit, e.g. the height and shape of the eyebrows. Interfering with this balance in a negative way can cause the eyebrows to sag or become too peaked (‘spocked’). It is therefore crucial to maintain or improve the balance in order to achieve an aesthetically pleasing outcome.

It is also important to be mindful that facial ageing affects all four layers of the face, namely skin, muscle, subcutaneous fat and bone. It stands to reason that other treatment modalities, such as dermal fillers will play a more prominent role in delivering a refreshed appearance as we age.

An additional point to consider is that the underlying structural ageing changes cause the face to sag. A number of the facial mimetic muscles, particularly those involved in smiling, elevate and lift the face. These elevator muscles of the face work overtime to compensate for the sagging, causing lines to form. Appreciating and recognising this phenomenon means that we treat these muscles judiciously to avoid causing further sagging.



We all have the same facial muscles. The pattern in which these muscles are used varies from person to person. Sometimes this is hereditary, for example, some of us make the same facial expressions as our parents. In other instances, the pattern may be due to anatomical reasons, for example, people with sagging eyelids tend to subconsciously raised their eyebrows to compensate, causing horizontal wrinkles to form on their foreheads.

As doctors and artists, we assess the face in a wholistic manner rather than just treat the wrinkles to ensure a natural looking and aesthetically pleasing outcome. Our end goal is not complete removal of all lines with no facial movement. Instead we are aiming for a reduction in over-expression.


Most people have seen or known someone who has had a suboptimal outcome from anti-wrinkle injections. It is therefore natural that many patients have the fear that they will be made to look ‘frozen’. We can assure you that in our hands, this is not going to be the case.

We aim to ‘modulate’ the muscles sufficiently to weaken them without paralysing them. We aim for the clinical outcome of softening rather than eradicating wrinkles. When treatment is given optimally, the hyperactive muscle movement during normal social animation is calmed to an acceptable level, while still allowing normal and appropriate facial expressions to be made. Being able to achieve these results consistently takes knowledge, experience and wisdom. We as doctors, personally perform all cosmetic injectable treatments. These treatments are never delegated.

*As medical doctors and the fact that this is a prescription medication, means we are not allowed to mention the ingredient by name.


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