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We may give them lots of affectionate names like laughter lines, smile lines, crow's feet, worry lines or elevens, but at the end of the day they are still more commonly known as wrinkles and lines, and they're the reason men and women turn to toxin injections.
Toxin is being used by millions of people around the world. Some for medical reasons and some for cosmetic reasons. Skin 1st can treat both medical indications such as, hyperhydrosis, bruxism, migraine and also cosmetic appearance uses.
AM I SUITABLE TO HAVE TOXIN INJECTIONS?
Although toxin is used in children for medical reasons, Andrea does not treat, nor have anyone on the premises under the age of 18. There are very few medical conditions that prevent the treatment being given. Conditions that prevent this treatment being given are Myasthenia Gravis & Lambert-Eaton syndrome, being pregnant or breastfeeding. Andrea has treated terminally ill clients, Bells Palsy clients and many other clients with bespoke requirements. Other than medical contraindications, other reasons regarding suitability to have treatment are whether your expectations are realistic. Any injectable procedure carries the risk of bruising and as such we cannot guarantee you will not bruise. Correction of facial features within a couple of millimetres is not a realistic aim, due to the nature of movement of skin, muscle and flesh and differences in bone structure on each side of your face. When you first start with anti wrinkle treatments, your muscles are stronger than the injections inserted. But over time, with repeated treatments, this changes and the treatment weakens the muscles so that they stop causing lines and wrinkles. Please read the manufacturer product leaflets above, Azzalure, Bocouture & Botox are all used in this clinic.
WHAT SHOULD I DO BEFORE I BOOK MY APPOINTMENT?
You should not have the treatment repeated within 12 weeks of your previous treatment, touch up appointments are not included in this time frame. Having Botox too frequently increases your risk of developing neutralising antibodies to anti-wrinkle treatment. This means Botox will not work and this cannot be reversed.
You should be realistic about what improvements you will achieve personally and over time as every face is different and every person will get different responses. Be guided by Andrea, who will advise you at the appointment what to expect. Try to avoid drinking alcohol within 24 hours of your appointment as this increases the risk of bruising.
Make up must be removed before your appointment as this prevents you accidentally rubbing the treated areas while removing your make up later on in the day. If you have been advised to take zinc supplements, Zytase, to improve toxin results start taking these 5 days before your treatment appointment.
WHAT IS A TOXIN TREATMENT AREA?
In the UK we inject muscle groups, which are classed as "areas."You can choose how many areas you want treated during your consultation. Common areas are frown lines between the eyebrows (glabellar), horizontal lines across the forehead (frontalis) and the wrinkles around the outer eyes (crows' feet). Treating all three of these areas would be priced at three areas, for example. You can have any area or combination of areas treated. As a general rule, the upper face is commonly treated with toxin and the mid/lower face treated with filler. Advanced & masterclass trained professionals like Andrea can inject outside of these areas.
WHAT HAPPENS AT MY APPOINTMENT?
At your first appointment you will complete a medical questionnaire which will be sent via email, to make sure you are suitable to have this treatment, it is very important to complete this truthfully and comprehensively to ensure your safety and to obtain the best results. This information is held confidentially in accordance with the Data Protection Act 1990. At follow up appointments you must inform us if any of your medical history or medication has changed. If you are pregnant or breast feeding you will not be able to have this treatment as we do not know if it will harm your baby.
If you are wearing makeup this MUST be removed prior to your treatment to avoid the risk of infection and misplacing the toxin-NO EXCEPTIONS! We have removal products available for your use complimentary at our beauty bay.
You may also have pictures taken of the treatment areas, which helps to assess your response to the treatment. Pictures are taken at maximum muscle contraction, which shows how strong the muscles are and how deep the wrinkles, or lines are. We will advise you if you are on a:
Preventative plan, these are clients with no visible lines when the face is at rest, only lines when expression is made. These clients are easier to treat, get longer results and need the treatment less frequently, generally or,
Maintenance plan, these clients have achieved the look they desire, and generally, only need to maintain the results over time often only needing treatments every 6 months or so and only need additional treatments as the natural ageing process occurs, or
Repair plan, these clients are the most difficult to treat. The lines are visible when no facial expressions are made and the face is at rest, they have either smoked for many years, have sun damage to the skin and still expose their skin to sunbeds, have tooth loss or gum disease, are generally older and need repeated treatments very close together to achieve the best results. These clients need Botox treatments close together every 3-4 months, and various other treatments to help too, skin peels and dermal fillers for example. However, don’t despair if you fall into this category as you will still see results but you will need to be patient and have realistic expectations. Andrea will advise you if you are in this category.
Depending on which plan you are put on informs you of expected results and likely gap between treatments required to get the results you require. If Botox will not give you the results you require on its own, we will inform you of this during the consultation and advise on other complementary treatments to get you to your goal. We never “hard sell” treatments, giving you only honest advice.
There are only 3 brands of toxin available in the UK, which all come in a large vial and small vial they are:
Botox/Vistabel (2.5ml/1.25ml) Click for product leaflet: Botox Product Leaflet
Azzalure/Dysport (0.63ml/2.5ml) Click for the Azzalure leaflet: Azzalure Product Leaflet
Xeomin/Bocouture (2.5ml/1.25ml) Click for the Xeomin Leaflet: Xeomin Product Leaflet
Andrea may discuss changing your brand, altering your dose or injection pattern, if deemed necessary to get you better results. No one brand works for everyone. Andrea uses all brands available to give you best results.
The products all come in a dry powder vial and need to be reconstituted with a special diluent to be able to inject. All brands, except Xeomin/Bocouture, need to be stored in a pharmacy refrigerator. How the product is stored and mixed can affect treatment results. Andrea stores all products in accordance with manufacturer advice, will mix your vial correctly at your appointment and use only this vial on your treatment.
Andrea uses tiny needles to inject you which are the smallest on the market at this time, and hardly leave a mark. However, the risk of getting a bruise cannot be completely eliminated, You can take arnica to help minimize bruising. The treatment is actually not painful only tiny stinging at some points.
You will be offered to book a complimentary follow up appointment 14-28 days after your treatment via the online booking system. Andrea recommends you take this offer so your response can be assessed and response pictures taken. If you cancel this appointment within 48 hours, or do not attend we cannot schedule a further one. Please see our terms and conditions.
WHAT SHOULD I DO AFTER MY APPOINTMENT?
This is extremely important that you follow this advice to get the best results. No results can be guaranteed as every face in the world is different, but follow these guidelines to get the best results.
You will have small bumps which reduce within 10 minutes which is the solution just settling into the muscles.
Do not pull or stretch the treated skin, it's best to just leave it alone.
Do not rub, massage, have eyebrow waxing, semi-permanent makeup, rub creams, or have facial treatments, around the treated areas while the Botox is settling in, for 2 weeks. Be aware if you are a persistent facial rubber/picker that you will wear/move the Botox out.
Do not exercise within 6 hours of your treatment.
Do not wear tight caps, hats or helmets within 6 hours of your treatment.
Do not have saunas, sunbeds, and hair treatments, avoid activities that cause facial flushing, bend down excessively and do not lie down within 6 hours of your treatment.
Avoid making extreme facial expressions, CACI and facials, as doing this adversely effects your treatment.
Washing and makeup application must be done VERY VERY gently during the 2 weeks after having anti wrinkle treatment, so as not to rub or move the toxin.
Avoid alcohol for 24 hours as it causes bruising as it thins the blood and facial flushing which adversely effects the toxin.
Do not have CACI or electrical facials while having toxin treatments, as they reverse the effects of toxin.
Address your lifestyle issues that work against toxin, and contribute to premature ageing, for example, smoking and UVA/UVB exposure. Both damage the skin at cellular level, so toxin has difficulty working and the skin and body age prematurely .
Wearing SPF 50 every day helps protect your skin and assists the toxin as does using nightly retinol improving collagen in your skin. Andrea will advise you on this if you require it.
If you are a blood donor you will need to inform them you have this treatment. Skin 1st is fully compliant with infection control measures so having any treatment at Skin 1st will not prevent you from giving blood. Skin 1st will not offer treatments to any client who has previously been injected by a non medical professional.
ARE THERE ANY SIDE EFFECTS FROM TOXIN?
There are no permanent side effects however there are several well known minor side effects that are temporary and DO NOT require any intervention and DO NOT need to be reported to the clinic.
Bruising, avoiding fish oils, vitamin E supplements, alcohol, green tea, sunbeds, NSAIDS painkillers (Ibuprofen, naproxen, aspirin) will all reduce bruising risk. The only way to guarantee no bruising is not to have treatments involving a needle.
Headaches, usually very mild and transient, relieved with simple analgesia however Botox is known to improve migraines.
Asymmetry/Twitching usually noticed within the first 10 days and settles spontaneously or is corrected at your follow up appointment.
Eyebrow/eyelid ptosis/dry eyes, is seen in 1-2% clients and is temporary lasting treatment and is usually not noticeable to others. This is more common if you have heavy eyelids/brows or excess skin laxity in this area. This will repair itself in approximately 2 weeks, if this happens you will have to wait for it to correct itself, there is no antidote. If you have lax eye skin/heavy eyelids, Andrea will advise you of this. Clients who have excess skin usually compensate by lifting their brows very high. Ultimately surgery will be required and its best not to treat the forehead to avoid this heavy feeling.
Flu-Like Illness, for reasons not understood some patients develop a flu-like illness with aches and pains and temperature lasting a few days while the toxin settles in.
Also for reasons not understood some people are resistant to the effects of toxin. In these people treatment will not work as well or for as long as expected. Current research suggests a lack of Zinc in the body can affect results. If you think you may be one of these people a product called Zytase is available to purchase and commence 5 days before treatment.
Andrea may change brands on you and alter injection points and unit dosing or suggest other treatments to get you to your goal.
HOW LONG WILL MY TREATMENT LAST?
The average response is 3-4 months however some get 6-8 months others only 2-3 months. Toxin gradually over the weeks diminishes in strength so the “wearing off” process takes a period of time. This period of time varies person to person. After approximately 6 weeks the results can start to reduce.
Depending on which treatment plan you are on can affect the duration of your results, preventative, maintenance, repair.
How strong your muscles are and how fast your body repairs the effects of toxin is also very individual and affects duration of treatment.
If you follow the aftercare advice you will get longer results, and if you avoid smoking and UVA/UVB your results will last longer.
Results are best in hypokinetic clients (those people who are not overly expressive), compared to hyperkinetic clients (people who have lots of facial expressions), please ask which you are and Andrea will happily inform you.
If you are very slim or lose/gain more than 7lb -10lb in weight this can affect your facial features and ultimately your results in a positive/negative way. Andrea will tailor your treatment to try and work with your individual needs.
WHEN WILL I SEE MY RESULTS?
Again, everyone is different but usually at day 3-7 you will notice a gradual reduction of facial muscle movement and therefore improvement of lines and wrinkles. This process is usually complete at day 14-28 when your follow up appointment will be to assess the results.
Andrea always advises that when you leave after your treatment you are careful driving, looking in the mirror. It is very exciting and you want to see your results but be patient it will be a gradual process.
WILL ALL MY LINES AND WRINKLES DISAPPEAR?
Some clients lines do completely disappear but some may need other supporting treatments to improve them or in some cases, very deep lines where the skin is loose and lines are visible when no facial expressions are made, will never be completely removed.
WHY AM I ADVISED TO HAVE ANTI WRINKLE INJECTIONS TO MY FROWN LINES BETWEEN MY EYES INSTEAD OF FILLER?
Injecting the glabellar area with filler is dangerous and can lead to complications. It is always best to have anti wrinkle injections first to see how smooth it will go before considering filler. Andrea advises that you have three anti wrinkle injections treatments close together before having filler in that area.
WHEN WILL I BOOK IN FOR MY NEXT TREATMENT?
The soonest you can have the next treatment is 12 weeks from your first appointment, to avoid developing neutralizing antibodies. Clients on the repair programme should ideally keep to this treatment interval to get the best results. Maintenance clients usually need further treatments at 3-5 months and preventative clients only 1-2 times per year. The online booking system is programmed to send you an email reminder at 12 weeks, which is the soonest you can have a repeat treatment, to avoid your body developing neutralising antibodies. Make sure we have your most upto date email address and if you haven't received your reminder email check your junk folder.
HOW WILL I LOOK WHEN IT WEARS OFF?
This is a common query; you will gradually notice a return of muscle movement over a period of weeks. If you have had this treatment for a number of years and decide to stop for a while or completely, you will not excessively age and will not develop all those years of wrinkles that have been prevented.
Stubborn lines that were removed do not usually come back as deep.
WHAT IF I DO NOT LIKE THE RESULTS, WHAT CAN BE DONE?
If there is asymmetry Andrea will attempt to improve it at your follow up appointment. If it is that you have excess hanging skin around the eyes or hooded eyes, which often needs a surgical procedure called blephraplasty, or if you have deep horizontal forehead lines and loose skin, it maybe better not to treat the forehead. If you just feel that generally anti wrinkle injections are not for you, you will need to wait for it to wear off in its' own time. Unfortunately there is no reversal or antidote to anti-wrinkle injections. Once it has been injected you must follow the aftercare advice as the adverse effects of rubbing the injection points cannot be undone.
HOW MANY AREAS SHOULD I HAVE TREATED?
This is a very individual preference on how you view your lines and wrinkles. Some clients prefer a frozen, ultra smooth and shiny effect, others a more natural, subtle effect. Some clients do not want a single line, others want to keep some character lines and others only want them diminished.
Andrea will advise you at your appointment what areas to have treated to get the look you require, being mindful the more movement you have the less time it will last.
IVE HEARD TOXIN CAN BE USED IN OTHER AREAS IS THIS TRUE?
Yes, it is being used in the NHS on children with cerebral palsy, migraines, bladder irritation, oesophageal strictures, Parkinson’s disease, torticollis, teeth grinding, excessive sweating and every year they are finding more and more uses of it.
In the private medical industry we use toxin "Off Label" for migraine treatment, excessive sweating, neck and facial muscle treatments, they are even using it to reduce the size of calf muscles! So despite historic media safety frenzy, toxin is actually very safe.
HOW MUCH DOES TOXIN COST?
This varies country to country and practitioner to practitioner. Andrea’s prices can be found on the online booking system.
Be very wary of cheap, too good to be true deals. It is professional law to be insured to carry out these treatments. Only dentists, doctors and independent nurse prescribers can prescribe toxin as it is a prescription medicine. Ensure your practitioner has clinical waste contracts, and is trained in advanced treatments. Andrea’s certificates are displayed within the clinic. It is also against our professional and regulatory standards to offer deals or offers on medical treatments. The prices are non negotiable.
Reputable businesses all have this in place and only obtain the product from reputable UK suppliers and adhere to the manufacturers guidelines on storage and mixing, administering and disposal.
Andrea offers a range of payment methods to consider spreading the cost pre–payment direct debit schemes are in place.
You can pay with a valid debit/credit card, cash and BACS transfer too. We do not accept cheques, You are responsible for paying in full at the time of treatment for your treatment.
DO YOU GUARANTEE MY RESULTS?
As every person has a different face, no results can be guaranteed unfortunately, however Andrea will endevour to achieve realistic results using the treatments available, considering the type of skin, muscles, and face you have. We do not issue refunds.
DO YOU OFFER A FOLLOW UP APPOINTMENT?
Yes you are offered a complimentary follow up appointment, within 14-28 days of your original treatment appointment. This appointment is used to assess the effects of the treatment, correct any asymmetry, if possible, and check to see if other muscles are compensating for the reduced movement. These follow up appointments cannot be rearranged within 46 hours of the scheduled booking, and if cancelled within 46 hours, or if you do not attend, you cannot reschedule another follow up for this treatment.
WHAT ARE REALISTIC EXPECTATIONS?
It is entirely appropriate to have certain expectations when you book for a treatment. Now you have had the opportunity to read all the advice and information about this treatment, we need to be assured that your expectations are realistic.
Some clients due to certain mental health issues or personality disorders or clients who are misinformed may have expectations that will never be fulfilled. This can be disappointing to both the client and the medical practitioner when this occurs.
If you are concerned you may be becoming obsessed over a certain facial feature or addicted to treatments, please go to the downloads page and complete our confidential body dysmorphia screening tool. You can also speak candidly to Andrea who will advise you too. If your expectations are unrealistic, Andrea may discharge you from the clinic until you receive further assessment.
UNREALISTIC EXPECTATIONS CAN INCLUDE:
1. Expecting dramatic or instant results from treatments,
2. Never being happy or content with how you look or how treatment results appear,
3. Wanting to appear more than 5-10 years younger than your actual age,
4. Not accepting that all treatments have limitations on what they can achieve excessive sagging of the skin, continuing smoking, sun damage & premature ageing can be difficult to repair, if at all.
5. Not following the pre treatment or aftercare advice, but still expecting the treatment to give perfect results would be unrealistic.
6. To expect not to have any bruises when needles are being used in your skin,
7. To expect the treatment results to last longer than what the manufacturer advises,
8. Expecting a treatment to give you the effect of a different treatment i.e. toxin to give a filler result,
9. Expecting the treatment results of a multi treatment procedure or a more expensive treatment given over a period of time, from only one treatment.
10. Expecting bruises, swelling or other side effects to resolve within unrealistic healing time frames.
11. Expecting to look like your favourite celebrity is unrealistic.
12. Wanting to look like a filtered, digitally enhanced, social media picture of yourself or someone else.
13. Expecting out of hours emails to be answered, or sending excessive amounts of emails about already provided information. Although this is not an absolute unrealistic expectation, or contraindication, unfortunately, Skin 1st do not have the human resources to provide this level of client support. If you feel you want this level of support, please find an alternative clinic who have the capacity and resources to accommodate you.
14. If after having treatments you worry excessively or lose sleep, you may not be suitable to have treatments. Treatments should enhance how you feel, not contribute to feelings of anxiety.
15. Expecting "bargain basement prices" when you are receiving the top brands, available on the market, performed by a regulated health professional who is an expert in aesthetics and other fields at Skin 1st.
This is not an exhaustive list but gives an indicator to whether treatments are for you and whether you are suitable to be a client. If Andrea feels that you are not suitable, no further appointments will be booked for you until you have had further assessment.
How long does toxin last? Credit to Harley Academy.
Before and after upper facial toxin treatment.
forehead line improvement using toxin.
Toxin is very effective on excessive sweating
Before and after upper facial toxin treatment.