A Patient's Guide to Non-Surgical Treatments; Wrinkle Relaxers and Dermal Filler

A Patient’s Guide to

Wrinkle Relaxers and Dermal Fillers

Tracey Dennison RGN MSc

Copyright © 2016 by T Dennison

First published October 2016

All rights reserved. This book or any portion thereof
may not be reproduced or used in any manner whatsoever
without the express written permission of the publisher
except for the use of brief quotations in a book review.

[] Preface

Ever walked past a salon or clinic and seen those magical words ‘non-surgical facelift’ and thought ‘great … I wonder what it is!’ Or been tempted by someone advertising Botox® but aren’t exactly sure what it is and how it works? Well read on! This book is for all those of you who know that there’s something else out there but are not completely sure what ‘else’ is or if it might be an option for you; if you would want it, and if you did, how on earth would you know where to go to get the right treatment?



What are non-surgical treatments?

A bit about Dermal Fillers

So what about Botulinum Toxin?

Why would you want to?

So, I want a treatment – what happens next?

Side effects – what are they?

Post Treatment Advice

Practitioners Top Tips

Patient Stories

Frequently Asked Questions …. And Answers

Final thoughts ….

About the Author

[] What are non-surgical treatments?

Really the whole ‘non-surgical’ thing is a bit misleading. Essentially it means that an operation is not involved however, don’t be fooled, this is still a skilled medical procedure and predominantly relates to injectable treatments. These treatments take a variety of formats and can be used in different ways to either emphasise specific areas or balance the face as a whole. Equally the term ‘non-surgical treatments’ relate to a whole range of procedures from injectables to peels, fat-freezing, lasers and a whole host of others besides. This book focuses on wrinkle relaxing injections (eg Botox®) and dermal fillers.

[] A bit about Dermal Fillers

Generally speaking, a younger patient group looks to emphasise particular features (lips are a prime example) and a slightly older demographic will look for balancing/refreshing/rejuvenating treatments, for example to replace volume lost through time.

Now, I know what you might be thinking … the dreaded ‘trout pout’ right? It is usually the first thing which springs to the mind of the uninitiated and quite honestly, I can totally see why! It is scary letting someone mess with your face, and the fact that there are risks and sometimes not everything goes according to plan sets anxiety levels to maximum.

There is an answer though, so let me take you through it. Firstly the original ‘trout pout’ was not done with the calibre of fillers we use today. Today’s fillers are largely reversible. There are exceptions and if you’re thinking of having a procedure, it is always a good idea to check which fillers your practitioner prefers to use. The reversible ones are made from various formats of Hyaluronic Acid. This is a substance which occurs naturally in the body but degenerates over time (hence the creeping lines and sagginess which inflict their presence on us as we tiptoe past 30!) Should anything go amiss with these fillers, provided you know what to look for, (we’ll come to that later), your practitioner would have a good chance at reversing the filler and solving the problem before it becomes serious. Not so with the non-reversible ones, problems here are much harder to treat, so beware; know what your practitioner is injecting! The Hyaluronic Acid fillers are temporary, some will last an average of 6-9 months, the newest ones on the market last up to 18 months but be aware that, over time, they will be absorbed and to maintain your desired look you will need further treatments. There is a place for the more permanent fillers and some can give excellent results, just be sure that they are in the hands of an experienced professional with appropriate training and insurance (and yes, it’s absolutely okay to ask your practitioner to provide you with this information).

Bearing all the above in mind, it has to be said that today’s fillers are amazing products. In the hands of a skilled practitioner, they can work wonders and you know, if you look good, you feel good and you radiate confidence, now who wouldn’t want a bit of that?

So aside from making lips bigger (in a beautiful, not trout-ish way), what else can they do? Well do be honest, they’re pretty versatile really, and a good practitioner will not have a ‘standard’ treatment because every face is different. Different shapes, sizes, ages, skin type, the list goes on. Every treatment should be bespoke to the individual patient however, there are some basics you might like to know.

The areas of aging around the mouth (lips, philtrum, chin and nose to mouth lines) tend to creep up on us first. Often we’re so busy noticing the new fine lines around our eyes that we don’t spot what is changing just that bit lower down and yet, funnily enough, they’re all related. Those creeping eye lines, nose to mouth and mouth to chin groves generally have one thing to blame; it’s all in the cheeks! Well, there can be more to it than that but imagine your cheeks to be the ‘coat hangers’ of your face. You know how if the shirt isn’t hung on the hanger properly it just doesn’t look quite right? Well the same principal applies here. When we lose volume in our cheeks everything sags just a little bit. Crow’s feet start to appear and all those issues around the mouth start to happen too. Now I’m not saying that cheeks are the answer to everything, but they are often a good place to start. That is if we’re talking about fillers to achieve a freshened appearance.

For the younger demographic, or those just wanting a specific change in their look all of the above may not be relevant however certain principals apply and the techniques for facial assessment go on and on, however there are a few top tips for you below:

p<>{color:#000;}. When assessing your face we generally use the ‘rule of thirds’ along with the ‘golden ratio’. The school of thought is that there is a rule in nature of 1: 1/14 roughly translated this means that specific measurements can be made across all of nature where the proportions are about 1/3 to 2/3. So for example the width of the base of your nose (if in-line with the golden ratio) would equate to 1/3, in comparison the width of the mouth from corner to corner would be 2/3 according to the ‘golden ratio’. This simple maths can work all over the face, (depth of forehead 1/3, eyebrows to chin equals 2/3,) however this is considered to be the golden ratio – that which the most beautiful people conform to. It is not how we are all built; however, there are things we can do with Dermal Fillers, to push our patients towards that golden ratio if that is what they desire. Again, a good practitioner will assess their clients look in relation to the golden ratio and make recommendations accordingly.

p<>{color:#000;}. If you want fillers round your mouth, your practitioner will take a good look at your teeth. Don’t be worried, this is standard, but do be aware that a significant over or under bite can make our job such a lot more difficult and your practitioner may not be able to achieve the look you desire.

p<>{color:#000;}. An obviously asymmetrical face is not something which can be fully corrected with fillers. If the jaw bends to one side for example (think Stephen Fry) fillers will not correct this. They can be used to balance proportions elsewhere in the face though which may disguise obvious asymmetry to a certain extent.

p<>{color:#000;}. Thin lips may always be thin lips. Many ladies and gents with very fine lips are looking for a little extra oomph. Sometimes it is possible to achieve this and with a steady programme of treatment spanning several months the desired effect may be achieved – possibly. It may well be worth the risk for you to try the treatment and see if your lips are responsive but be prepared, it might not work so well.

p<>{color:#000;}. Remember, we are not totally symmetrical! It’s stating the obvious I know but trust me, the moment you have a treatment, you analyse your face like never before and notice all sorts of little things you may only just be picking up on for the first time. This is why your practitioner will take before and after pictures of your treatment. If you are considering a treatment, it is helpful for you to do the same so you can see the results and not stress over ‘new’ anomalies (eye brows slightly different heights is a good example) which in actual fact were there before.

p<>{color:#000;}. I believe Newton’s 3rd law coined the phrase ‘for every action there is an equal and opposite reaction’. Well I can tell you that works with faces too! Particularly (but not exclusive to) more mature skin, adding filler in one area may well highlight weaknesses elsewhere and these can show up as unexpected lines. A good practitioner will either know your face well enough to anticipate what will happen and plan to manage it during your initial treatment or will be able to correct it for you if a weakness does appear more noticeable. If you are loyal (and happy) with your practitioner it’s wise not to chop and change. Letting someone get to know you and your face over time will lead to better and better treatments. Regularly changing your practitioner introduces a risk that is only really worth taking if you are very unhappy with your previous treatments. Either way, when you visit a new practitioner for the first time, you should be aware that they don’t know you and every face is different so you may need more than one appointment to get the result you desire.

In the right hands dermal fillers can give amazing, beautiful and natural looking results all over the face whether it is for temples, cheeks, nose, chin or jawline. There are risks and it can seem pricy but compare the cost of your treatment to how much you spend on ‘magic’ anti-aging creams a year (the average British woman spends £650 on the high street on skin care alone each year, men are not far behind at £600); all of a sudden it doesn’t seem quite so bad does it?

[] So what about Botulinum Toxin?

Botulinum Toxin is also popularly known as Botox®, Bocouture® and Azzalure® (amongst others). This injectable medication has been used for years to treat many different medical conditions such as; cervical dystonia, axillary hyperhidrosis, strabismus, blepharospasm, neurogenic detrusor over activity, chronic migraine and upper limb spasticity.

Botulinum Toxin is a neurotoxin (which sounds a little scary I know) but used safely and prescribed only when appropriate this is a very safe medication. It works by, simply speaking, disrupting the communication between the nerve and associated muscle in a specific area and therefore the nerve temporarily stops telling the muscle to contract. It has been used to improve the look of lines and wrinkles since the late 1980’s (in the UK). Botulinum Toxin is a very popular option for treating forehead lines, frown lines, crow’s feet, bunny lines, a downturned mouth, platysmal bands (neck treatment) and the décolletage.

Whilst the names (particularly Botox®) are very well known, this is not a brand name or drug you should see advertised. Most aesthetic practices talk about ‘anti-wrinkle treatment’, ‘wrinkle therapy’ or something similar. This is because Botulinum Toxin is a medication available only on prescription. In the UK it is illegal to advertise prescription drugs. Equally, there is no ‘patient right’ to have this treatment. Patients or clients need a full medical assessment and only when the prescribing practitioner is satisfied that Botulinum Toxin is the right treatment option for the patient, can it be prescribed. UK laws are also very clear that in most cases, the patient consultation and treatment appointments need to occur on different days. This is for two reasons. Firstly, unless your practitioner is a medical doctor, then they will not be able to keep a stock of Botulinum Toxin (the rules differ between Dr’s, Dentists and Nurses), and also because new guidance from the General Medical Council, recommends that patients are given ‘thinking time’ between appointments to make sure they want to go ahead and do not feel pressurised into a treatment that, with some thought, they may decide not to have.

So what can you expect from these ‘wrinkle relaxing injections’? Generally patients are looking for a smoother forehead, reduced crow’s feet or less obvious frown lines, all of this is potentially possible, but there are a few things it depends on. Skin condition is a massive predictor of how well these treatments will work. As always, younger skin will get the best results due to increased tone and elasticity. More mature skin requires more skill from your practitioner and a good knowledge of how relaxing muscles in one area may affect the look in another. For example, ladies and gents with more mature skin generally have a little more loose flesh and weaker muscles. There is an increased risk of complications due to these factors. Equally, relaxing certain muscles within the face may cause other movements to be more noticeable. Accepting that this is a very general sweeping statement which may not apply to everyone, it is worth being mindful of what can happen and remembering to ask the questions during your initial consultation.

By far the biggest challenge within the aesthetics field is balancing patients expectations with what can be achieved. The best focus is a natural refreshed look. Aiming to look 30 years younger is probably not something which can be achieved without more radical procedures, but aiming to look good for your age is usually very achievable, and anyway, who would want the face of Barbie and the body of a much older person, it just wouldn’t look right! Aim for balanced and refreshed and with the right practitioner you should look and feel confident and wonderful.

[] Why would you want to?

It’s a fair question, these treatments will not be like a ‘spa experience’, they can be uncomfortable, there will be needles, there could be bruising, oh yes, and they are expensive, but they do provide an option. These treatments are simply that, an alternative to the potions and lotions we hope will smooth, plump and volumise. If done well and when there are no complications, these treatments are a much more reliable way of achieving the look you desire. If you achieve this you feel good, you look good and your radiate confidence as a result. These treatments are as much about the psychological as the physical. With that in mind it is worth your while knowing that a psychological assessment is part of the medical assessment all patients undergo. This is purely to ensure that there are no psychological reasons why this medication should not be prescribed for you. It is worth knowing that prescribing laws are strict and every prescriber has to be able to justify their clinical rationale.

There are reasons where your practitioner may refuse treatment and some of these might be related to mental health issues. Patients who project a body image which does not reflect the patients actual physique may be refused treatment, also patients who have expectations which cannot possibly be met with the treatments the practitioner can offer are also unlikely to find a practitioner happy to take their case, however, a good practitioner will refer these patients onto someone more able to meet their needs (eg for surgery rather than a non-surgical solution). There are also lots of other reasons relating to physical health which may make a patient unsuitable for treatment, examples include pregnant or breast feeding women, patients with an active autoimmune disorder (eg Lupus or Rheumatoid Arthritis) patients undergoing Chemotherapy and others, be guided by your Doctor or Nurse they are there to support and help you and will advise you accordingly.

Hyperhidrosis; really only a condition which those who suffer from it can truly understand, but for those plagued with the problem of excessive underarm sweating the possibility of a solution is truly life changing prospect. This awful problem can be treated with Botulinum Toxin (eg Botox®) injections. This treatment uses a different technique to the muscle relaxing injections, however, the end result is that the sweat glands are temporarily disabled massively reducing the amount of perspiration released under the arms. This treatment is effective for around 6 months and can have the most dramatic impact on a patient’s life, comments like ‘amazing, life changing and confidence building’ come back time after time after a patient has had hyperhidrosis treatment. Patients requesting this treatment require proper assessment and treatment is at the discretion of the practitioner as, again, this treatment requires a prescription to be completed.

[] So, I want a treatment – what happens next?

Well, first of all, do your homework! Make sure you have a good practitioner with excellent reviews. A personal recommendation from a friend is very often how things happen in Aesthetics; knowing someone who has had an amazing treatment with a fabulous result is an excellent way forwards.

Contact a few practitioners and have a chat, ask lots of questions, make sure you feel happy and confident with whoever you choose and above all, do not be persuaded by a ‘special offer’! Do you really want a bargain job done on your face?

Be suspicious of very cheap prices and be aware that advertising Botox® or similar medication is illegal, be wary, be careful and if you don’t feel happy at your consultation don’t book a treatment, do not gamble on your face. There are plenty of great practitioners out there, check medical registrations (GMC, NMC, GDC etc) ask about experience and discuss complications and how your practitioner would manage an adverse incident; do they carry an emergency kit (they should) do they have other practitioners to call on if needed (this is always a good thing). Above all do you feel happy with your practitioner; are you confident they will follow you up and if anything untoward were to happen, are you reassured that they will see you quickly and be able to assess, diagnose and manage the situation?

[] Side effects – what are they?

With any injectable treatment you run the risk of pain, bruising and swelling however other side effects are a bit more treatment specific;

Botulinum toxin: it is not uncommon for patients to experience a headache or mild ‘flu-like’ symptoms for a few days after treatment. There is always a risk that the toxin may spread beyond the intended muscle group and can cause a droop to the forehead/eye/cheek. Around the mouth, it may also difficulty forming a ‘whistle’ shape or using a straw. These are just some of the possible complications however, areas adjacent to wherever the toxin is injected can be presumed to be at risk.

Occasionally toxin can increase the occurrence/severity of eye bags – if a patient is prone to puffy eyes in a morning it is wise for your practitioner to be cautious injecting around the eyes and never to inject under the eye as this may increase the risk of post-treatment swelling significantly. The good news is that the effect of botulinum toxin is temporary and the symptoms of misplaced toxin can sometimes be managed whilst waiting for these unfortunate (but also uncommon) side effects to wear off.

Dermal Fillers: It is possible to experience lumps and bumps (which often settle over the first couple of weeks,) however the serious complications here can be somewhat more complex. Firstly you need to know if the filler your practitioner will use has the potential to be reversed or not.

Fillers which cannot be dissolved have their place but also have a much higher risk of complications. The most serious concern is the possibility of injecting filler into a vein or artery. With reversible fillers, and provided this problem is spotted early (indicators include pain, discolouration, small blisters, sometimes a greyish tinge to the nose) the situation can be resolved. With non-reversible fillers the management of this complication is trickier and may require the services of a plastic surgeon. Either way you should be advised by your practitioner what to look for and what to do should you experience any difficulties.

[] Post Treatment Advice

Wrinkle Relaxant eg Botox®/Bocouture®

Try to exercise your facial muscles for an hour or so after your treatment. This will work the medication into your muscles. This may improve the treatment outcome but will not negatively impact on your treatment should you forget to do this. Try to refrain from touching the treated area and from wearing make-up for 24 hours after your treatment.

Do not have a facial, or electrical facial for 2 weeks after your treatment – it is believed that having these kinds of treatments within the 2 week timeframe may cause your treatment to be less effective. Certainly with electric facials there is a current passed through the muscle looking to create tone, given that the botulinum toxin looks to do the opposite then it does seem nonsense to have both.

Avoid lying down or bending for 3 hours after treatment. Avoid strenuous exercise and heat therapies such as a sauna, steam room or hot tub for the next 24 hours and please don’t drink alcohol for 24 hours after treatment. All of these activities increase circulation in the upper layers of the skin, by causing the vessels to dilate and therefore potentially, there is an increase of blood flow in the area which could effectively wash the medication to other areas – areas which you may not want to have treated.

Some patients experience a mild headache after the wrinkle relaxant treatment, if this happens over the counter pain relief should help although please avoid Aspirin, Ibuprofen, Nurofen or other anti-inflammatories as this may increase bruising.

The wrinkle relaxing treatment can take between 3-7 days to start to have an effect and will have reached a full effect by 2 weeks which will gradually wear off over the course of the next 4 months (approx.) although this can vary greatly from patient to patient.

Dermal Fillers – post treatment advice:

Aftercare is fairly straightforward and should not cause disruption to your everyday activities however, for the first 24 hours patients should avoid over exposure to heat and sunlight. As with Botox®/Bocouture® this is because hot baths, saunas, strenuous exercise and alcohol intake can increase the blood flow and can make it difficult for the filler to settle in the position it was placed. This again has the potential to allow the filler to move away from where it was originally placed and cause an un-aesthetic look.

It is also important to please avoid the application of make-up for 24-48 hours after treatment; in having an injectable treatment your practitioner will have created an entry point for infection (potentially right down to the bone). Whilst every clinical precaution should be taken to avoid the introduction of infection, the patient also has a responsibility to keep this risk low. Applying make-up (and let’s face it, sometimes our make-up can be really quite old!) over an injection point not long after treatment increases the risk of infection significantly and could create all sorts of problems which are easily avoided by simply keeping the area clean, dry and make-up free.

Also, chemical peels, laser skin resurfacing, laser skin tightening, other laser enhancements and facials (traditional and electrical) should be avoided for 2 weeks after the filler treatment. This again is due to the possibility of moving the filler away from where it is intended to be.

Post-treatment pain should be minimal however if you experience increasing pain, discolouration in the skin, itching or excessive swelling you need to contact your practitioner straight away. It is possible (not definite) that these signs may be indicating that there is filler in a vessel which would need careful management and therefore treatment without delay is very important.

It is common to experience mild to moderate swelling; this is very often worst the day after treatment and then settles over the next few days. You may also experience bruising (which can sometimes be quite significant) and possibly mild pain all which can be relieved with over the counter pain medications if necessary.

[] Practitioners Top Tips

Ice is fantastic for reducing pain, swelling and bruising – apply before and after treatment for best effect (your practitioner may provide ice for you).

Attend for your appointment with a make-up free, clean face.

Ask as many questions as you want, as many times as you need, don’t be worried or shy about questioning your practitioner, they should expect you to and will welcome your interest in your treatment.

Be completely honest with your treating professional. It is so important to give a full and clear medical history including any herbal medications you may be taking.

[] Patient Stories

Lucy’s story

Having suffered with terrible underarm sweating for years I finally decided to take the plunge to see if Botox® could help and well …. just wow! I experienced a life changing treatment for what’s technically called hyperhidrosis. This had hindered me in social situations and caused much embarrassment. I chose my treating nurse based on my personal knowledge of her practice, knowledge of her experience and her professionalism.

This treatment has made such a difference to my life and I can now chose outfits based on what I’d love to wear, rather than what I know will hide the wet patches under my arms! If you suffer with the same condition, I really recommend you consider this.

The treatment was professionally delivered, I had a full medical review and was given lots of reassurance, being terrified of needles this was a very big deal for me. As it turns out, the whole thing was only mildly uncomfortable. I’ve already had a second treatment (the effects of the initial treatment lasted an impressive 6 months!)”

Catherine’s story

Oh gosh, my frown lines truly were amazing. They had been bothering me for years, and I spent a couple of years plucking up the courage to go ahead with a treatment. What made a huge difference was being confident in the clinic where I choose to have my treatment and the doctor and nurse who assessed me. They really put me at ease and I was left feeling assured and confident with the treatment I was receiving. The injections really did improve my frown lines. There are many people offering this service but I would always recommend finding a clinic which gives you the assurance of medical professionals who really know what they are doing.

Sarah’s story

My priority was to find a professional, knowledgeable practitioner who really listened and could design a treatment plan completely around my concerns. It was important to me not to be pressured into having a treatment but to understand how the impact a treatment on one area would have on other areas and how best to address this.

I finally went ahead with my treatment and it was really brilliant! I felt listened to and understood. The treatment didn’t take long (dermal fillers) and was all done in about 30 minutes, there was hardly any pain, just a little discomfort and I couldn’t see any bruising.

[] Frequently Asked Questions …. And Answers

How much do wrinkle relaxing injections cost?

This depends on how much is needed but be assured, there is no such thing as ‘cheap Botox®’.

In the UK we cost treatments per ‘area’, an area typically being the forehead, crow’s feet or frown lines (although a number of other areas can be treated). Expect a minimum starting price to be at least £150, frequently much more; these products are expensive and therefore so are the treatments. Be suspicious of any practice offering ‘deals’ (this is illegal according to UK law) and any offer of ‘sharing’ treatments is also illegal.

How long before the results from wrinkle relaxers can be seen?

This largely depends upon the product used; some are quicker acting than others. All should be producing noticeable results by day 7 and will have settled by day 14 at which point any unevenness can be adjusted for, ‘top-ups’ are not to be expected (this is a prescribable drug and therefore your medical practitioner can only reasonably administer more if you actually need it to correct asymmetry or if a stronger dose is required to sufficiently treat the targeted muscle group).

How long after receiving Botulinum Toxin do you see the full benefit?

By 14 days after your original treatment.

How long do wrinkle relaxing injections last?

You can expect 4-6 months’ worth of effect from your treatment. Be aware though that the effectiveness will wear off gradually over this time, it is therefore not uncommon for movement to start to return to the treated area within 8 weeks.

What determines how long it will work for each person?

Following the post-treatment instructions gives the best chance of the treatment lasting as long as possible. Lifestyle issues may play a part eg those who exercise heavily may find the treatment doesn’t last as long as it might for less active patients. Certain skin types may find the treatment more or less effective than others but this isn’t always very easy to predict and may require a patient to try the treatment and see how it works for them on an individual basis.

What areas of the face can wrinkle relaxers be injected?

Common areas include the forehead, frown lines, crow’s feet, bunny lines (around the nose), lips (for smoker’s lines), neck (to treat a ‘ropy’ look) and others according to your practitioner’s discretion and competence.

Can Botox® be injected under the eye?

Yes, in some cases in can create a ‘wide eyed’ look, however there are many circumstances where it is not recommended especially if you suffer from noticeable eye bags or puffy eyes in a morning. Having botulinum injections there may make the situation considerably worse.

How can side effects from wrinkle relaxers be avoided?

This is a tricky one, good injection technique is important as is following all the post treatment advise but essentially all of these kind of treatments carry an element of risk and even in the safest hands about 1 in 10,000 patients will at some point experience a side effect of treatment. It may be possible to manage some side effects (not reverse them) until the treatment itself begins to wear off. The good news is that, if you are unlucky enough to experience a side effect of treatment, then it will, in all probability, wear off over a period of a few weeks.

Is Botulinum Toxin safe?

In the doses used for cosmetic purposes the amount of medication injected is very, very tiny and should not cause any very serious side effects. Botulinum Toxin has a very historical pedigree and is commonly used in many areas of medicine including: migraine prevention, torticollis, writer’s cramp, hemi facial spasm, hyperhidrosis, and is also used to assist the management of spasticity and contractures. Newer studies have also identified a link between treatments with Botulinum Toxin being used as one of the strategies to relieve depression. So, yes, in the right hands, using the right doses for the right indications this is a very safe drug.

Who is qualified to administer these treatments?

Under current UK law there is poor regulation regarding who can inject however it is recommended that you seek these treatments only from registered, qualified and insured medical professionals (eg Dr, Nurse or Dentist). It is important to consider your practitioners knowledge of anatomy and ability to manage complications, be confident that you have chosen a competent practitioner and don’t be swayed on price!

Can you exercise after treatment or will it reduce the results?

It is recommended that you don’t undertake strenuous exercise for at least 24 hours after your treatment. Strenuous exercise causes the increase of blood flow to the surface of the skin which can reduce the effectiveness of your treatment or even move the product to elsewhere on your face which may give an unaesthetic result.

What is a Botox® Lift or Brow Lift?

Depending upon the placement of botulinum toxin, it is possible to achieve an eyebrow lift; this can be subtle or exaggerated. Discuss with your practitioner the ‘look’ you are aiming for and clarify if your expectations can be met before you have your treatment.

I always look cross or tired, can wrinkle relaxers help with this?

Yes, it is one of the most popular reasons patients request treatment. Most often it is the frown lines (11’s between the eyebrows) which form noticeable furrows as we age. Botulinum Toxin can remove or soften this problem, if lines remain (often this is the case in more mature skin) then they can be removed or softened with a soft dermal filler.

I have a headache after my injections, how long will it last?

It is not uncommon to experience headache or mild flu-like symptoms after treatment. It can be managed with over the counter analgesia such as paracetamol and should subside within a few days.

Dermal Fillers – what are they?

Dermal fillers are classed as a medical device which contains both natural and synthetic substances which have been developed to add volume and hydration to skin to restore its youthful appearance or enhance particular facial features. The most popular fillers contain non-animal hyaluronic acid which has been stabilised with synthetic ingredients to allow them to be maintained in the skin for a period of between 6 months up to 2 years (dependent on the product used.) Dermal fillers are a very popular treatment. Worldwide, over 30 million people have had this treatment.

So, lets explain; what is hyaluronic acid?

Hyaluronic acid is a naturally occurring substance in the skin; it holds moisture and therefore helps to hydrate and volumise the face. Natural hyaluronic acid is constantly being broken down and replaced as a recurring cycle within the body, this cycle completes every couple of days. The ageing process slows down this cycle and the effects of the hyaluronic acid are diminished. Hyaluronic acid in its injectable form is not restricted to cosmetic use but is also used to treat arthritic joints and can also be used in ocular surgery.

Why would I have dermal fillers?

Dermal fillers are commonly used to replace facial volume or structure which has been lost as the aging process takes its toll. In younger patients there is often a specific feature eg, the lips, which the patient feels conscious about and wishes to address either for definition or a touch of volume.

How long does the treatment take?

The injection process can be quite short, as little as 15 minutes for a small procedure. Bigger procedures can take significantly longer, however, it is generally the consultation and assessment which takes the time. Whatever the procedure being undertaken the practitioner should take a full medical history to make sure that dermal fillers are not contraindicated. After that it usually takes some time to assess the facial dimensions and the best placement of the product. The practitioner may well use cosmetic pencils to mark your face and calculate where the product should go and equally mark the areas which must be avoided.

Where can I have dermal fillers?

Dermal fillers can be used to improve skin condition, reduce the appearance of lines and wrinkles; create additional volume (eg lips) define shape (eg cheeks) and create a fresher rejuvenated look. Common areas for treatment are:

p<>{color:#000;}. Nose to mouth lines

p<>{color:#000;}. Cheeks

p<>{color:#000;}. Lips (definition and volume enhancing)

p<>{color:#000;}. Frown lines

p<>{color:#000;}. Lines around the mouth

Will having dermal fillers hurt?

Most often a local anaesthetic cream is applied to particularly sensitive areas such as the lips, some areas don’t generally require the cream but if you are particularly anxious it’s absolutely okay to ask for it. Ice is also an excellent pain reliever and great for minimising bruising. Many types of filler contain lignocaine which provides ongoing pain relief for an hour or so after the procedure is finished.

When will I see results from the treatment?

The results are immediate although there may be some swelling which can take around two weeks to settle. In certain cases, particularly with lip treatments, you can expect the swelling to be worse on day two rather than straight after treatment. It’s wise to schedule your appointment when you don’t have any special occasions to attend for at least a couple of weeks to ensure there is good time for any swelling or bruising to subside.

Will I need any time off work?

No, there is no reason that you would need to take time away from your everyday activities. You are good to go straight after your treatment. You should be careful to follow the advice your practitioner gives you which should include avoiding alcohol for 24 hours after treatment, avoiding strenuous exercise and excessive heat (sauna, hot baths etc) for 24 hours after treatment and avoiding makeup for ideally 48 hours after your injections.

What side-effects or risks are there to having dermal fillers?

Of course, as with any injection, there is a risk of redness, pain, swelling and bruising. It is unlikely that an allergic reaction will occur as hyaluronic acid is a substance which occurs naturally in the body. Itching is possible and should it occur alongside the development of small blisters, skin discolouration and/or increasing pain then you should contact your practitioner straight away; one of the rare complications of dermal filler is a vascular occlusion. If identified and managed quickly this problem can be quickly resolved however leaving this situation unmanaged could result in a much more serious problem which may even require the services of a plastic surgeon.

How long does a dermal filler treatment last?

The length of time you can expect to see a result from your filler will vary greatly dependent upon where the filler is placed. A treatment in an area of significant movement (oral) will not last as long as an area with little movement eg an ear lobe. Equally, the different fillers used will yield different length of effectiveness typically between 6 months up to two years. You should discuss the different fillers with your treating practitioner who can explain in detail which fillers can be used where, why and their length of effectiveness. Factors influencing how long fillers will last include: patients age, treatment area, type of filler used, skin condition of the patient, patients lifestyle and the patients’ health at the time.

Of course to maintain your look repeat treatments will be necessary.

How should I prepare to have my treatment?

Attend with make-up free cleansed skin if possible (your skin should be cleaned with a medial-grade solution at your appointment anyway). If possible, avoid taking aspirin/ibuprofen or any other non-steroidal anti-inflammatory medication for a couple of days before your treatment; this is to reduce the risk of bruising and bleeding at the injection site.

So, how do I go about organising my treatment?

Start with making an appointment with your chosen practitioner. Expect to have your face analysed, to discuss your expectations and for the practitioner to explain what they think can be achieved for you. Do not feel pushed into making a decision about having a treatment. It is absolutely fine for you to take time to think about your discussion, especially if your treating practitioner is clear that they cannot meet your expectations.

You will also need a full medical assessment, should you have any autoimmune conditions such as Rheumatoid Arthritis, dermal fillers may not be right for you (or you may need an allergy test to ensure you can tolerate the filler).

Can anyone have dermal fillers?

Whilst the majority of people are suitable for this treatment, there are some exceptions which include: anyone with inflammatory skin problems (particularly if the proposed treatment falls within this area of skin), pregnant or breast feeding women (there is no evidence to confirm that this would be safe for baby at this stage), anyone with autoimmune disease undergoing therapy.

No decent practitioner will treat a minor. These treatments are not suitable for young people and even those in their late teens/early twenties will be managed very cautiously by a reputable practitioner.

What if I have had a laser treatment/electric facial/chemical peel – can I still have dermal fillers?

If you have recently had a chemical peel or laser treatment, you should wait until the area has completely healed and the skin is no longer sensitive. It is not recommended that you have any of these treatments for a good two weeks after your dermal filler treatment.

How soon will I need another treatment?

Most practitioners will follow you up in one form or another couple of weeks after your initial treatment; this is so they can correct any problems which may occur such as asymmetry, which can be more noticeable once any swelling has settled down. Otherwise it will be several months before you need any further treatment in that area.

[] Final thoughts ….

Without a doubt, non-surgical treatments have their place. If you want an effect which goes beyond general good hydration then wrinkle relaxers or dermal fillers could well be an option for you. However, there are many other options out there besides just these 2 treatments and you need to be fully aware of the benefits and risks of any treatment you are considering and always have a full medical assessment to ensure you are safe to receive this kind of treatment.

Most importantly of all do your homework about your practitioner, check their qualifications, reviews and ask questions until you are happy that you have full confidence in them. Be clear on how they will follow you up and how you will be looked after if you have any complications or need any adjustments.

Ask questions; go for classy enhancements in preference to a ‘fashion’ look; the huge lips and massive cheeks may be okay this week, but you’re stuck with the look for as long as it takes for the filler to degrade and the photographs will last forever (if you can find a practitioner who is prepared to do this look for you!) Equally over inflated skin requires high maintenance to prevent it from sagging whereas subtly done is much easier to manage over time and gives an overall much more polished look which is far more aesthetically pleasing.

[] About the Author

After qualifying as a Registered General Nurse in 1996, Tracey has continued her education achieving a BSc (hons) and an MSc as well as a host of other qualifications including teaching, management and specialist Aesthetics training. She has pioneered the Face Rebalance® programme which is exclusive to East Riding Aesthetics. Tracey is passionate about helping people feel more confident about their looks using subtle techniques for natural looking results. Always happy to hear from you: [email protected]

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A Patient's Guide to Non-Surgical Treatments; Wrinkle Relaxers and Dermal Filler

Ever walked past a salon or clinic and seen those magical words ‘non-surgical face lift’ and thought ‘great … I wonder what it is!’ Or been tempted by someone advertising Botox® but aren’t exactly sure what it is and how it works? This book is for all those of you who know that there’s something else out there but are not completely sure what ‘else’ is or if it might be an option for you; if you would want it, and if you did, how on earth would you know where to go to get the right treatment? Focusing only on wrinkle relaxers and dermal fillers, this book provides honest, straightforward information including the benefits and risks of this kind of treatment alongside a whole host of questions and answers and patient stories. A quick but informative read for the curious and interested.

  • Author: traceynalec
  • Published: 2016-10-25 09:35:11
  • Words: 7250
A Patient's Guide to Non-Surgical Treatments; Wrinkle Relaxers and Dermal Filler A Patient's Guide to Non-Surgical Treatments; Wrinkle Relaxers and Dermal Filler