Botox Questions and Answers

There is no difference between anti-wrinkle injectables and Botox. Botox is a brand name. Just like Kleenex, the term Botox is used to define an injection procedure that actually has several different competing products on the market. The most popular botulinum toxins used for cosmetic treatments are Botox, Dysport, Azzalure, Vistabel, Boucouture, Botox Cosmetic and Xeomin. Anti- wrinkle injections relax your facial muscles and prevents your skin from creasing and causing wrinkles. When injected correctly, the effect should last 4- 6 months depending your lifestyle and metabolism

Botox injections are safe and effective treatments only when administered by a trained and experienced medical practitioner. As with any procedure, they also have possible side effects which patients should be made aware of.

When Botox is injected into muscles, it blocks nerve impulses to those tissues. Where the Botox is injected, neuromodulators temporarily restrict the nerves that stimulate these injected muscles to contract. These muscles are temporarily weakened and can’t make the movements that cause wrinkles and frown lines. You can still make facial expressions, but they will not be as exaggerated. After a few months, the muscle weakness wears off and your muscles regain activity, the line-smoothing effects begin to diminish and the treatment needs to be repeated.

Botulinum Toxin is an approved treatment for injection into the skin to correct wrinkles and lines of the face. Due to the use of a needle, there may be bleeding at the injection site. As is expected for any injection procedure, pain / redness /stinging and /or bruising may be observed in association with the injection. This reaction may last for several days. Headache, facial pain, bruising and local muscle weakness have been reported.  If any of these symptoms should occur and persist for more than one week or if  you develop any other side effects  listed below please report them to your injector.

  • muscle weakness near where the medicine was injected;
  • trouble swallowing for several months after treatment;
  • muscle stiffness, neck pain, pain in your arms or legs;
  • blurred vision, puffy eyelids, dry eyes, droopingeyebrows;
  • dry mouth;
  • headache, tiredness;
Botox Side Effects,
  1. Choose an experienced doctor – Good Botox depends on the skill and technique of the Botox injector. Find a doctor who specializes in facial anatomy and has been successfully administering Botox for several years. Never be afraid to ask how treatments they have performed.
  2. Be honest with your doctor – Give your doctor your full medical history so he/she can decide if you are a good candidate to receive cosmetic Botox. Tell your doctor:
    • What medication & supplements you are taking
    • What allergies you have
    • Any medical conditions, illnesses, or diseases
    • Any medical procedures (i.e. recent Botox, surgery, other treatments, etc.)
    • If you are pregnant, breast-feeding, or trying to conceive
  3. Make sure Botox is the correct treatment for you -You may be better off getting Dermal HA Fillers or Profhilo instead of Botox for certain wrinkles on your face.
  4. Avoid taking supplements that can thin the blood–  Do NOT cease any prescribed medications. To minimize any potential bruising, stop taking the following for one week before you get Botox injections:
    • Aspirin
    • Ibuprofen- Paracetamol is okay
    • John’s Wart
    • Vitamin E
    • Fish oil or Omega-3s
    • Ginko Bilboa
    • Ginseng
    • Avoid alcohol
  5. Have realistic expectations about what Botox can do for you– Botox results are usually very good but your result may not be as perfect as you expect. If it is your first time getting Botox, tell your doctor. Most doctors are more conservative with first time Botox patients. It is better to under-inject and review after 2 weeks in order to judge how you will react to the Botox and give you a better long-term result. Having realistic expectations about your results will save you from possible disappointment.

  1. Go Au Naturel- Your skin will be cleaned with rubbing alcohol before you get Botox. Feel free to show up to your appointment without makeup
  2. Stay still – Don’t worry if you are afraid of needles- Botox injections do not hurt- there is a slight “pinch” that you will feel at the injection site. Some patients say they feel a mild stinging with each injection but little or no pain. Pay attention and follow your doctor’s instructions. He/she will tell you to smile, relax and frown during treatment.
  3. Do not apply makeup- Best to wait several hours or until the next day before applying makeup. You skin will feel very dry after being have been cleansed with Witch Hazel and Alcohol swabs. Until a gentle moisturiser on your face before going to sleep and before applying your foundation. Never directly apply make up onto alcohol cleansed skin.

What you do after your injections and how you take care of your skin is very important.

  1. Don’t touch your skin where the Botox was injected.
  2. Do NOT apply makeup
  3. Avoid strenuous physical activity for 24 hours.
  4. Avoid consuming large amounts of alcohol.
  5. Avoid getting facials, chemical peels, microdermabrasion, etc. for 48 hours.
  6. Avoid taking the blood thinning medications mentioned above.
  7. If you get a Botox bruise, arnica cream will help. Concealers can also help cover bruises.
  8. Call your doctor or seek medical attention if you experience any side effects or complications from the Botox treatment.   

Routinely there is no down time for anti-wrinkle injections. Our patients normally return to their normal activities immediately after their treatment. Dr. Hamilton recommends avoiding strenuous exercise or massaging the area for the first 4 hours after treatment. Also avoid aspirin and similar blood-thinning medications to reduce bruising.

 

Botox injections are safe and effective treatments when administered by a trained and experienced medical practitioner. As with any procedure, there are possible side effects which patients should be made aware of. One of which is Droopy Eyelid. Whilst the occurrence is very rare- it can happen even in the hands of the most skilled injector. When patients get a droopy eyelid from Botox, it usually begins about 1-3 weeks after the injection and lasts about 3-4 weeks on average. Droopy eyelids will typically go away and are not permanent.

Dr. Hamilton’s injection technique into the forehead will raise your natural eyebrow arch a few millimetres higher leaving your eyes looking wider and more youthful. He takes great care to inject the correct areas of your forehead to avoid drooping of the brow itself and preventing heaviness of the eyelids. With first time patients it is better to under inject and review after two weeks. Additional units of Botox can be injected at that stage if needed.

Droopy Eyelid After Botox

Many of our patients ask “Which is best:  Micro needling or Botox? “ There is no definite Yes or No answer to that question. The most suitable treatment for any patient really depends on their personal aesthetic goals. Depending on our patient needs, we often recommend both. Botox smooths the appearance of lines and wrinkles but does not directly treat the surface of the skin. Using Micro needling to improve the surface and condition of the skin along with Botox injections can help to improve the results longer term.

Up until a few years ago Botox and Dermal HA Fillers were the only injection treatments which gave good results for smoothing wrinkles and filling fine lines. Micro needling is an alternative for those who are not keen on using Botox injections. You might not immediately see the dramatic changes you’d expect and definitely not as much as with a medical aesthetic non -surgical procedure. You may need approximately 4-6 sessions to get a dramatic difference.

Botox injections for Laugh Lines around the eyes typically last 3 months while Botox for the frown lines between your eyebrows and forehead lines can last between 4-5 months.

For some patients their Botox effect goes away more quickly than that, while for others it lasts much longer. This is because some patients break down the Botox more rapidly than others. How long the results last really can depend on the patient’s genetic makeup.

Factors which can also effect the longevity of your results can be, the amount of toxin which was injected, your metabolism and lifestyle. Patients who spend long periods in front of computer screens, play outdoor sports, long distance drivers and golfers etc often experience less longevity for their Crows Feet Botox.  While there are no papers written to prove the subject, we have observed over the past few years in our clinics that athletic exercise definitely does have the possibility of decreasing the duration of Botox. This actually makes sense, as excessive exercise produces free radicals which have the ability to break down tissue in the body, as well as products that are injected.

Dr. Mark recommends to his patients who experience this, they can do one of two things

  • Ideally wait an extra month until you get more movement in your forehead +frown lines and have all 3 areas injected
  • Have the only eye areas injected after 3 months
  • Attend 2 weeks after your Botox treatment to review the results and Dr. Hamilton top it up if needed.
  • Most of Dr. Hamilton’s patients maintain their Botox effect by having injections every 4-5 months whilst other patients he may see only once per year. There is no hard and fast rule.
Botox and exercise

Cheap Botox is NOT good and good Botox is not cheap. A quality aesthetic procedure from a highly experienced injector is going to cost more. Inexperienced providers, unlicensed individuals and those offering ‘fake’ Botox will offer very cheap treatments. While these appear to be easier on your pocket- try not to not fall for it.

The cheaper the Botox, the more you need to ask about the dilution of the product. Botox must be diluted with a sterile saline solution before it can be injected.Some people get Botox injections which do not seem to last long. This might be because the Botox was too diluted and not enough actual Botox was injected.

The dosage of Botox can vary depending on which areas of your face you want to treat, as well as on your physician’s technique. Ask your doctor how many units of Botox you will need to get your desired results. Make sure you are paying for and getting that many units. A diluted product is not a bad product just as long as you get enough of what you need!

No clinical trials have been conducted to prove the safety of Botox to the unborn child. This is why Dr. Hamilton would recommend waiting until after pregnancy and breastfeeding to have aesthetic Botox injections. The safety of your baby is much more important than any wrinkles.

There are no studies indicating possible harmful effects of BOTOX® (onabotulinumtoxinA) during pregnancy. Therefore, it is best to try to wait for 3-4 months after having BOTOX® injections to allow the effects to wear off  before trying to get pregnant.

Dr. Hamilton will not treat you if there is a possibility of you could be pregnant. He never injects patients who are pregnant or breast feeding. Other physicians might choose to treat their patients in this circumstance but he feels it not worth taking the risk.

Try not worry if you had Botox and found out you were pregnant. If you have Botox injections just before you conceived the risk of it harming your baby is low. The Botox is injected in very small doses and works at the neuro-muscular junction receptors in your face. It is not going to move from there. Best of luck and have fun with the Baby Making !

The short answer to the question is : YES

However, there are a few considerations you need to be aware of.  Previously, there were some concerns that changes in cabin pressure during a flight taken soon after Botox® treatment could lead to unwanted side effects. Theoretically different cabin pressures could cause the Botox® to migrate from the original injection site, potentially resulting in an asymmetrical appearance and also could cause bruising. These concerns are not scientifically proven. Current literature advises that as long as patients wait 24 hours post-treatment to fly short haul and 48 hours before flying long haul, the risk of these adverse events occurring is negligible.

Cabin pressures are generally the same as the air pressure on the ground. It is the air pressure outside the cabin that is different. Dr. Hamilton treats many patients who work as flight attendants and lots of patients from overseas. If they are flying long haul, he advises them to wait one day

Can I fly after Botox
Can I fly after Botox

Is It Safe to Fly After Dermal Filler® Injections?

It is always best to plan your treatments in advance and wait at least one week before flying short haul and two weeks before a long haul flight after having dermal filler injections. It takes about 5-7 days for dermal fillers to settle and to see optimum results. Some patients experience swelling and bruising immediately after treatment. You need to allow for any swelling or bruising to go down and reduce the chances of you experiencing complications that cannot be easily remedied abroad.

Dr. Hamilton would recommend that his patients wait at least one week post-treatment (especially in the case of lip Fillers) before taking a flight. Changes in cabin pressure can worsen any swelling or bruising. If you are prone to water retention after flying or have experienced swelling after previous treatment, it would be best advised to wait for 7-14 days after dermal filler injections, especially if you are travelling long haul.

Post-Treatment Complications and Flying

As with any aesthetic procedure, there is the possible risk of late-onset side effects and complications which might require assessment and treatment. Although serious complications rarely occur, Dr. Hamilton would recommend staying within the local vicinity for up to 2 weeks after treatment so that any problems should they arise could can be addressed safely and efficiently by him.

High Blood Pressure / Fluid Retention History

If you are prone to high blood pressure or have ever suffered from swelling and /or fluid retention during or after flights – we strongly advise not to have dermal fillers within 4 weeks of a long haul flight. Your health is more important than your wrinkles.

 

Can I fly after Dermal Fillers
Can I fly after Dermal Fillers

The best injectors can give a patient a bruise, red spot or temporary bumps with any of the cosmetic injectables.  Your pre-treatment and post-treatment actions can have a big effect on this. Here are a few pre and post treatment tips that can help you avoid any unnecessary bruising.

It is best to avoid planning any important work/ social events for 3-7 days after treatments.  If you bruise easily, you will need to allow for 2 weeks to fully heal.  Most bruises can be covered fairly well with make-up, but not all.

Before Treatment

Stop drinking alcohol 2 days prior to injections.

No garlic 2 days before injections.

Take Arnica tablets 2-4 days prior to morning of injections.  Don’t take if you have high blood pressure or heart problems.

Medications to discontinue 7 days before treatment.  Some of these may be needed for medical reasons so check with your doctor first.  The reason to stop these is that they make your blood less likely to clot which can cause bruising.  If you are on prescribed medication eg; Warfarin please stay on it. If you need pain medication, paracetamol is fine to use.

AVOID:

  • Aspirin and Ibuprofen for 2 days after treatment. (Paracetamol is fine.)
  • Vitamin A, Vitamin C, Vitamins B-6 and B-12 and Vitamin E
  • Folic acid
  • St. John’s Wart
  • Omega 3 fatty acids
  • Green tea
  • Ginseng

 

If you have ever had a cold sore around the mouth or near the injection site be sure to talk to Dr. Hamilton before your treatment.

 

After Treatment :   Apply Arnica cream regularly for 3-4 days post injection. Some common injection-related reactions may occur, such as swelling, bruising, redness, tenderness and itching. The intensity and duration of these effects will depend on your individual healing characteristics, but can last for 1-2 weeks. If you have any swelling, apply a cold pack to the treatment area for 5-10 minutes every hour. Avoid alcohol for 24 hours after treatment. Sleep on slightly inclined or raised pillows for the first night. If having cheeks or your nose fillers, avoid placing heavy/ large lens glasses on the injection site to prevent endentation of the filler.

No excessive exercise except for walking for 24 hours after treatment. No inversions in yoga or hot yoga for 48 hours.  No excessive sun or heat until any initial swelling and redness have resolved.

Dermal fillers injections – You will appear swollen on the morning following treatment which can last up to 5 days. This is normal and can reduced by the application of ice (NOT directly onto the skin) for 10 minutes at 60 minute intervals.

Anti-wrinkle injections-Routinely there is no down-time.

 

Wrinkles give us character. But if you’re bothered by them, it’s nice to know you’ve got options. Botox is one. When injected correctly, the results look naturally smooth and fresh. It is very important to have real expectations about these type of injections.  “Botox will not get rid of all the wrinkles on your face— however it will soften and erase wrinkles which are made from your facial expressions”

Dr. Hamilton advises his patients is to start Botox ONLY when their wrinkles begin to stick around. Using a good eye serum and Retinol based creams help prevent wrinkles forming. It is NORMAL and NATURALLY BEAUTIFUL to have fine lines when you smile or frown. These lines usually vanish when your face is relaxed. When these wrinkles are still visible while your face is at rest…that’s the time to THINK about having Anti- Wrinkle injections as a preventative treatment.

Some patients especially those with very fair and fine skin types, often want to start Botox in their mid-twenties. Patients with darker skin tones usually don’t need treatments until their mid to late 30’s. It is most unusual for someone to ask for Botox under the age of 25. Most aesthetics doctors are reluctant to start a patient on this type of cosmetic procedure at such a young age and will always ensure that they really understand the implications involved.

“According to the American Society of Plastic Surgeons, women in their 20s make up 30 % of Botox users. They start as a preventive measure which some doctors recommend stating that the earlier you start Botox, the better since it is best used as a preventative measure to avoid getting fine lines and wrinkles. It works by relaxing the muscle; once relaxed, it relaxes the overlying skin, so you don’t get wrinkles.”

Late 20s- You want to slow down wrinkles occurring in your early 30s. Prevention is always better than cure. Following a good skin care routine, along with a healthy lifestyle and diet, in addition to using strong sun protection will help slow down the aging process. Taking action with anti- aging injectables will prevent lines, wrinkles and loose skin from forming too soon and will help treatment results to last longer. It’s possible to benefit from Baby Botox treatments as early as 25. Before that age it is unlikely you will have developed enough lines that need treating.

30s- Looking in the mirror – You’ve started to notice a few wrinkles—especially crow’s feet and brow lines—and you want to stop them from becoming deeper. Here is a good Self- Test to check if you might need to start Botox – If you find yourself constantly smoothing makeup that collects along a crease or line, you’re a suitable candidate for Botox. Until a few years ago, most patients in this clinic typically started using Botox at age 40. That trend is changing. Now we see increasing numbers of patients in their early thirties starting Botox injections as a preventative measure rather than a cure for their wrinkles

40s- You start to notice deeper lines around your eyes, particularly crow’s feet, forehead and frown lines. Anti wrinkle injections will certainly improve these lines. A lot of our patients at this age ask Dr. Hamilton for help with tightening of their lower face and jawline  One of his popular treatments for sagging jawline and neck lines is the ‘Nefertiti lift‘. This technique relaxes the muscles of the lower face which in turn provides a lift to the jawline and mouth. You may also experience some loss of fullness in your face. Dermal Filler injections will fill in the lines and add volume with immediate effect.

50s- Lines between your eyes and around your mouth become more pronounced as changes due to the menopause make your skin drier and more prone to wrinkles.Using a combination of Botox and Dermal Fillers at this stage will  give you a rejuvenated look. This is also a good time to have Skin Booster injections. Profhilo is perfect for skin laxity on the Face & Neck and is ideal if you feel slightly nervous about having dermal fillers.

60s – You want to look fresher and less tired rather than wanting to appear 20 years younger. Using a combination of Botox and Profhilo will boost your skin and help you look great for your age.Profhilo boosts, refreshes and re-models your skin. It gives a totally natural fresh softness to your skin and adds volume without looking like you have had work done.

There is no downtime with Botox injections .

Dermal Fillers might cause bruising – Downtime is 24-48 hours. This treatment should not be undertaken within 2 weeks of an important social occasion.

Anti Wrinkle Injection Prices start at £150 / €260. Prices are based on the units of toxin injected into each area. Patients are always delighted with the longevity they get from Dr. Hamilton’s treatments.

To book a treatment :  Email  drmark@hamiltonfaceclinic.com

 

Lip Filler Questions

Lucious LipsDr. Hamilton never injects his patients with lip fillers whilst they have a cold sore. He recommends that you wait 2 weeks after the cold sore has gone before having a treatment. This is to prevent the virus being reactivated and spreading. As examination and palpation of your lips whilst the cold sore is active might also cause it spread, he would recommend post phoning your appointment until your lips have healed.

Dr. Hamilton advises, there will always be some swelling after your lip injections, especially on the next day after injections.

It is very common for the lips to look lumpy or over-corrected on the day after treatment. Occasionally the swelling may cause the lips to appear slightly uneven, despite the fact that the final result is symmetric.

Lips are very vascular and prone to swelling. Remember to avoid excessive contact & massaging of your lips. This will affect the settling of the product.  Be patient and wait for two weeks after the injection to allow the swelling to fully subside and for the product to settle into your lips.

Day 1 After Lip Filler Injections – Arnica Cream  is applied to prevent bruising

 

Day 2 After Lip filler with Juvederm Ultra

Dr. Hamilton would advise his patients to avoid strenuous workouts or activities for 24-48 hours following treatment. Taking it easy for a day or two following your treatment will better enable you to achieve the results you desire. You may be at risk of increasing your chance of swelling or bruising if you engage in vigorous activity immediately following your injections. Exercise increases your blood pressure. This leads to a higher risk of bruising or swelling

 

Best to wait 24 hours before you apply lipstick or lip gloss directly to freshly filled lips. To avoid any possible infection use a new unused Lip Balm stick when coating the lips. Never share one with anyone else. Vaseline applied with a clean cotton bud is an ideal way to keep your lips moist. A treatment will leave your lips feeling slightly tender, so it is recommended that you leave it a day before applying make-up to the treatment area.