What causes wrinkles and how can we get rid of them? The Victorian Cosmetic Institute answers frequently asked questions about anti-wrinkle injections.

1. Anti-Wrinkle Injections:
Frequently Asked Questions

2. Let's have a little chat about wrinkles. My five year old
nephew frowns a lot. He's normally a happy little boy but he's
got a bit of temper on him and he does a lot of frowning. I
love watching him. But when he stops frowning, his frown
lines go away. So why then when we frown do ours become
engrained and embedded? Part of this is because of the
aging process. So at the moment my little nephew's wrinkles
are going away but that process is going to stop unfortunately
for him. Except maybe not as he's got a good connection in
the industry.

3. What causes wrinkles? There are a number of factors that
cause wrinkles. We know repetitive muscle action creates
wrinkles. We know that as we age our collagen and elastin
breaks down so our skin doesn't repair itself as well which is
why those lines stay in place. We know that our bones even
remodel and that the shapes of our face change as we age.
One of the most important things that occur is that the fat that
sits underneath our skin actually shrinks as we get older and
doesn't hold the skin up as well. So, because of less support
there are more creases in place. Then of course, in terms of
the aging of the top layer of skin, sun, smoking, stress,

4. weight loss, bad skin care, bad makeup and obviously
genetics all contribute to how fast you're going to age.
I think some people frown so much that they don't even know
they're frowning. They frown in their sleep, they frown when
they're thinking. I haven't had any product for quite a while so
you will see I'll be doing a whole array of facial expressions
tonight during my talk because I’m a very expressive person.
I remember thinking when I couldn't stop frowning, what can I
do to get these wrinkles to go away before I first started in the
industry. I tried facial exercises, I tried massage, I tried skin

5. care, I probably would have tried everything out there. I never
thought I'd be dabbling in cosmetic medicine but I think I got
to the point when one day I looked in the mirror after a
particularly stressful period. I said, I didn't recognise the face
looking back at me. My father kept telling me how tired I
looked and that’s what really prompted me to explore this
industry.
I was having eight hours of sleep, I was eating organic, I was
doing hot yoga. I was doing everything that I could and so I
just remember thinking if I could just stop doing that face all
the time. It's very hard, very hard to take over full control of

6. your facial expressions and it's because we've been doing
these faces for such a long time.
So fortunately there is something we can do to stop pulling
those facial expressions. This is our little friend here. I'm
going to talk a little bit about the science of how anti-wrinkle
injections work. You may notice I said I wasn't going to
mention brand names and that's because we're not actually
meant to mention brand names of medications and that is
part of the Therapeutic Goods Administration guideline. But I
can still talk about the science behind the products we are
using.

7. Anti-wrinkle injections are a purified protein and this protein
actually gets made by this little guy here who is a little
bacteria called clostridium and he's everywhere. He's in our
gut, he's in food, he's in the soil but he's not really doing
much. If the environment is right for him to have a party and
get together with all of his mates then they can produce toxin
in a very large quantity. If ingested by humans orally in the
right amount it can make you incredibly unwell.
But they realised that one of the main side effects from this
toxic effect was you actually get muscle paralysis. So some
smart scientists thought what if we inject just a little, little, tiny

8. quantities that it is safe, we don't actually see any of these
toxic effects. In fact this was used initially as a medical
treatment in a number of different situations. It is used on
children with cerebral palsy who have muscle contractions to
relax their muscles. It's used in excessive sweating so people
who have excessive sweating under the armpits, people with
muscle spasms of the eyes. So it was used medically before
it was used cosmetically. Then when they realised that
people who were having it done for their eye spasms had all
of their wrinkles going away, they thought well that's a great
money spinner. So then we were able to use it elsewhere in
the face.

9. Any questions so far? No? All good. I'll just keep rattling on.
So how it works is when we inject it into your skin it gets
taken up by the nerve cell. The signal that gets sent from the
nerve to the muscle that tells the muscle to move, can't get
through. So as long as the product is present there the
muscles are forced to relax. We stop these wrinkles from
forming by relaxing the muscles.
Most people can have this product, there are a few people
that can't have it. So pregnant women, this is a category
C medication so you can't have it if you're pregnant and the

10. company do recommend that you do at least a three months
wash out before you do have treatment. Having said that,
anecdotally, in a recent dermatology journal I was reading
there have been a few case studies of pregnant women who
didn't know they were pregnant when they had their
treatment and it all turned out to be fine. But I wouldn't hang
my hat on a few case studies which is why I did my big detox.
You are not supposed to have it if you're breastfeeding. You
are not supposed to have it if you have a few different
muscular conditions such as Guillain-Barre syndrome and a
few others where you are not allowed to have it. You can't

11. have it if you have a known allergy to the product. Also there
are certain religions that don't want to accept human products
at all because there is a little bit of human element that goes
into the product in the manufacturing process.
I'll just run through some commonly asked questions that our
girls in the call center always get asked about these products.
The number one question is how do you inject it and does it
hurt? We inject it using really, really tiny needles, insulin
syringe needles. The number of injection sites you need
varies depending on which muscle groups we're treating.

12. Because the needles are so small it doesn't hurt but it also
doesn't tickle. I will not lie, it's still a little needle. But we can
keep you comfortable in a few ways and that's by using ice.
Here at VCI we also use nitrous or laughing gas to relax you
if you're a bit anxious. If you're very worried, you can even
pop some numbing cream on for a half hour before the
procedure. I describe it's almost like a little mozzie bite and
certain parts of the face do sting a little bit more than others.
Some certain areas of the face, my patients will say have you
done it already? So it really depends where you're having it.
When does it start working? It starts working in about two

13. days. So the day you have your injections you don't notice
anything. A couple of days later you realise that you can't
really move that muscle anymore and then its maximum
effect is at the two to three-week mark. It lasts for around
three to four months. Some people do metabolise the product
faster than others. I've seen in some cases it last up to six
months in certain areas and then other people might run out
at about two and a half. Everyone is different. As a general
guide, we normally tell you three to four months.
Can I go back to work afterwards? Absolutely you can. This is
a lunchtime procedure. In terms of potential side effects we

14. always warn there's a risk of bruising, although it's usually
quite low if you've got a good injector. There is a risk of
swelling and that's normally just a temporary little swelling in
the skin like a mozzie bite from the fluid being injected under
the skin. That usually gets absorbed really quickly, usually
about thirty minutes or so.
When should I start having it? That depends on when your
wrinkles first show up. So I have a lot of people I’m in
conversation with and they'll say “I'm too young to start I'm
only thirty-five. I'll worry about it when I'm fifty.” But the reality
is if you've got lines when you're thirty-five, letting them get

15. really, really deep makes it harder for us to treat. So the
earlier you come in and recognise these changes the better
because we can completely eliminate them if you come in
earlier enough.
Can I have Botox in my lips? The answer is no because you
will be talking with difficulty because it's a muscle relaxant. So
when we come to lips that will be part of using derma fillers.
How much do I need? That's going to vary. We do find that
sometimes men do need higher dosages than women and
how much you need really depends on how strong your

16. muscles are in that location.
So you’ve all got a little face there now. Let's have a look. I
will break your face up into three and I will run through the
areas that we can treat with these products. So, upper face,
from your eyes up. We have our forehead and because this
muscle here lifts the eyebrows up we see the emergence of
horizontal forehead lines. Now we can actually inject through
that muscle there. So if you can see lines when you stop
raising your eyebrows, then that would be a good area for
you to start treating.

17. Not everyone likes to have that area done because people
use their eyebrows to animate. So it's certainly not an area
that everyone would need to have treated. Some people will
complain that they feel too frozen if they can't raise their
eyebrows. Or they just want a little bit in there to soften the
lines. That's also fine but they don't want no movement in that
area.
The other thing is that if you have very hooded eyes, if we
treat your forehead, we can make that hooding worse. So,
some people will come in and want me to treat their forehead
but I have a look at them and they're talking to me like this.

18. That's because they've got so much skin there that they're
using their forehead to hold their eyes open. In that case I'd
normally refer them to have a blepharoplasty or an eye
surgery done first before we would even think about putting
a product in the forehead muscle. So that's something to be
aware of.
The worst thing that can happen when you're having your
forehead done is one of two things. Either your eyes,
eyebrows drop, flatten and your eyes feel very heavy
from using a too high dosage or you can end up looking like
Mr. Spock. There are a number of celebrities running around

19. looking like Mr. Spock which is when the lateral portion of the
eyebrow shoots straight up. When they animate, this doesn't
move and this comes really, really high. Now a very mild Mr.
Spock can look good in some women. It can give them a nice
lateral eyebrow elevation. You certainly don't want to do it to
men. There are a few male celebrities that I've seen that
really need a correction of their forehead. The good news is if
we do give you a Mr. Spock look we can actually correct that
in a couple of weeks. But if we do get a flattening of the
eyebrows, we need to let the product wear off in order to
correct that usually.

20. The other main area in the upper face that we treat is the
frown line. Now I probably would say I treat frown lines the
most. Out of any area of the face people want their wrinkles
gone, most people want their frown line gone. That's because
of two things. One is it can make people look angrier than
they are. I have a lot of women who professionally prefer not
to able to frown because if they are in a position of authority
at work, they look cool, calm and collected. They look really
chilled out under pressure and that actually helps them
professionally.
But the other thing it does is it actually relieves tension head -

21. aches and migraine. So it's got a few medical applications as
well. It’s a nice little two in one. So when you do a frown line
some people think you can just put one there. It's actually
three muscles that we use to create our frown, so it normally
takes anywhere between three and seven injections to knock
the frown out properly.
In terms of risks with treating a frown, it's probably one of the
safest areas to treat but then again a bad injector could give
you a droopy eyelid on one side or not necessarily a bad
injector. It could happen to the best of us. But if someone
for whatever reason is not being particularly careful, that's

22. possible. Then a droopy eyelid would take a few weeks to
settle down.
So that's the upper face areas. In terms of dosages for a
typical forehead, people would have anywhere between five
and fifteen units, depending on which brand you're using go
in to the forehead. For the frown it’s anywhere from ten to
thirty units. The average dose would be about twenty units
that I use in most of my patients.
So coming to the mid face, we have crow's feet, we have
wrinkles in the corner of our eyes, and we also have our

23. bunny lines. They're the ones that you would get from
scrunching your nose. So again crow's feet are a really nice
thing to do. But in terms of the risks and the benefits, they
can alter your smile and not everybody wants that. But some
people want to look smooth and fresher like they did a few
years ago.
The main risk with treating crow's feet is that you can flatten
out the top part of someone's cheek if you inject too low. You
will see some celebrities who when they smile they end up
with a little flat shelf just on that corner. It looks a little bit
unnatural, they look a bit frozen and that's usually because

24. they've had too much injected here. They wanted to obliterate
all their wrinkles rather than just keeping a couple of little
ones on the outer edge that looks natural and smiley. But
everyone wants to go for different look. You can probably tell
I’m a little bit biased in that I like to achieve really natural
looking results. But it’s horses for causes, everyone has their
own opinion.
Treating these little bunny lines in the middle there is
something that your injector really needs to pay careful
attention to because a lot of women if they can't frown, will
actually start scrunch up their nose when they're angry. So

25. what we don't want to do is treat you in one area and create
wrinkles in a new area. So it might be when you have your
frown you need a little bit injected around that central portions
as well if you're starting to recruit other muscle groups.
Then, we have our lower face. So from here down. Now we
can treat lip wrinkles, vertical lip wrinkles and we can treat the
sad lines that start to form down here, the corners of the
mouth. We can also stop the chin from curling up which
happens for some people as they get older. Other women will
get a flattening of the chin but many women will get a curling
up here and a drooping down of the nose. So we can actually

26. use anti-wrinkle injections at the base of the nose to lift it
back up, to lower the chin, to stop the sad lines from forming
and to stop the vertical lip lines from forming.
Pros and cons with treating these areas again are with the lip
wrinkle, I've had one person say that they got breathalysed a
few weeks later and they couldn't blow into the machine
because it reduces the strength of your pout. I think I've had
another lady said she had trouble spitting out her toothpaste
for a few weeks and another say she couldn't pronounce her
P's properly because someone had put an exceptionally large
those in the top lip. So I would always suggest starting small

27. in that area. The other thing is if you over dose the area you
can end up with a bit of a celebrity pout which not everybody
wants, so again it depends on what look you are looking for.
Treating the lower face area is a brilliant area to treat and it's
probably under treated in many cases. But it will help lift the
outer corner of your mouth that you will find will start to turn
down as you age. If done well it looks completely natural. It's
an area that I know that I need done because often at the
end of my sentence I’ll say ‘mm’ and draw in and down in that
area. If I don’t watch this as I’m getting older, that's going to
creep up and I’ll have those wrinkles to deal with.

28. In terms of the risks and the benefits, the main thing is if it
leaks into the next muscle you can end up with a wonky
smile. So one side of side of the lip will go up more than the
other when you smile. That's correctable at the two week
mark. So I certainly wouldn't let it discourage you from
treating that area because it's really a brilliant treatment. Only
small dosages are required to treat the lower face. So upper
face is where the big guns come out, lower face we're talking
usually two to four units for the top of your lip. Usually two
and a half for each side here, for the sad muscle and usually
between two and five to treat a chin.

29. The other area we can use anti-wrinkle injections is actually
in your jaw muscle. A lot of people jaw grind particularly
when they're sleeping. That causes really bad tension
headaches and they flatten their teeth out and they go to the
dentist and they get plates and all manner of things. A little
bit of Botox in the jaw actually will stop that from happening
because you can't clench down as hard.
The other thing we use it for is actually facial slimming. So a
lot of patients who might either workout a lot in the gym,
mainly women, men usually want that nice wide jaw, but
women either workout in the gym. A lot or typically a lot of

30. Korean or Asian patients don’t like to have that broad jaw
either. I don't think it's unattractive on them, but they want a
slimmer face. By injecting units into the jaw we can actually
just take the edge off and help create that sort of attractive
oval looking face. It can enhance your beauty in many
cases depending on how wide your jaw is.
The last area I'll talk about is we can use anti-wrinkle
injections in the neck to treat the horizontal neck bands. Not
a lot of people know about that use, but treating through
there means you can't go like this all the time. So the neck
looks a lot softer and the horizontal neck bands look a lot

31. of softer. Again you don't want a bad injector doing that
because you won't be able to get your head off the pillow. So
again probably it’s better to always start with less and put
more in later if it’s not doing what you want it to.

32. Go to our website to find more
information about anti-wrinkle
injections.