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Facial Aesthetics

Introduction

For many of us, looking and feeling healthy breeds self confidence. This doesn’t change with the passage of time. However age related changes to our skin and facial muscles can lead to unwanted lines, creases and wrinkles.
Here at Clifton Down Dental, we can soften these facial lines and reinvigorate the skin and support structures of your face using botulinum toxin injections.
Contact us to arrange a free no obligation consultation.
We review all our treatments at 1-2 weeks and offer a free top up to any areas that have not responded as expected.

Anti-wrinkle muscle relaxing injections

What are anti wrinkle injections?


Relaxation and softening of facial lines and creases can be achieved by selective and precise injection of botulinum toxin type A into certain facial muscles. The toxin temporarily blocks the signal from nerves to muscles resulting in decreased muscle contraction and therefore less wrinkling of the overlying skin.


What is botulinum toxin type A?


Botulinum toxin type A is a naturally occurring protein produced by a bacterium called Clostridium botulinum. A purified form has been used in medicine for over 20 years to help people with painful muscle contractures and spasm. More recently, it has been used to induce temporary relaxation of facial muscles thereby reducing frown lines, forehead lines and crow’s feet. Cosmetically, it is most effective when used in the upper third of the face.


In 2006, it was licensed in the UK to treat glabellar (frown) lines. There are currently a number of brands on the market such as Vistabel (Botox in the USA), Azzalure, Dysport and Bocouture. We use Bocouture (also known as Xeomin) as it is free of protein complexes and therefore less likely to cause an immune or inflammatory reaction.


All preparations are prescription only medicines and must therefore be prescribed by a doctor, dentist or nurse prescriber. Most cosmetic treatments involve the use of botulinum toxin in an “off licence” manner.


How quickly will I see a difference?


It takes 2-4 days to start to take effect and about 2 weeks to reach optimal muscle relaxation. Deeper lines may not disappear entirely and repeated treatments may be necessary to smooth these lines out.


Are the effects permanent?


The effects of botulinum toxin wear off after about 3-4 months. Repeated treatments are safe and often necessary to reduce muscle bulk and give overlying skin time to rejuvenate without being repeatedly creased. This results in a smoother appearance.


Response to treatment varies greatly for those who have not had botulinum toxin treatment before. After a number of treatments the interval between injections usually becomes longer as the muscles weaken and the level of the muscle activity is reduced.


Will treatment eliminate all my facial lines?


Botulinum toxin can be used to treat wrinkles which are the result of normal facial movement (dynamic lines). It is not a suitable treatment for permanent wrinkles unrelated to muscle movement such as those caused by excessive exposure to the sun. The most commonly treated areas are the forehead, between the eyes (glabella) and lateral to the eyes (crow’s feet). Injections to the lower face can be used to help with down turned lips, pebbling of the chin and in certain cases, fine vertical lip creases.


How do I prepare for treatment?


An initial consultation is necessary to find out what you would like to achieve and to assess suitability for treatment. This involves a thorough medical history, check on current medications, an examination and clinical photographs. It is useful to attend this appointment without wearing make up. Product information leaflets will be supplied and if you are happy a consent form completed.


Guidelines from the General Medical Council (via the Royal College of Surgeons) suggest a cooling off period between consultation and treatment to allow time to absorb the information provided.


http://www.gmc-uk.org/Guidance_for_doctors_who_offer_cosmetic_interventions_210316.pdf_65254111.pdf


Once you are happy to go ahead the procedure can be easily arranged and only takes about 15 mins.


If it is the first treatment, a review appointment is made after approximately two weeks to assess response, administer a top up if necessary and take some post treatment photographs.


What does the treatment entail?


The treatment is simple, quick and safe. Very fine needles are used to inject the product into the facial muscles. It is not particularly painful but topical local anaesthetic cream can be used if required.


What are the side effects and complications?


The most common side effects are headache and injection reactions e.g. redness, swelling, irritation, rash, itching, numbness, pain, stinging, bruising and bleeding. Normally these reactions are mild, reversible and occur in the first week after treatment.


There is a small possibility of slight drooping of the eyelid, facial asymmetry and visual problems (in the event of temporary eyelid droop).


Very rarely botulinum toxin may result in weakness in muscles distant to the injection site. If this occurs seek urgent medical help especially if there are any difficulties breathing, speaking or swallowing.


Can I drive afterwards?


Usually this is not a problem. However should you feel that your vision is blurred or altered or that you have generalised muscle weakness post treatment, do not drive or operate machinery.


Who should not have treatment with botulinum toxin?


Contra-indications include:


- Pregnancy or breast feeding
- Previous allergic reaction
- Active skin conditions at proposed injection sites- eg acne, eczema
- Neuromuscular conditions including MYASTHENIA GRAVIS, EATON LAMBERT SYNDROME or AMYOTROPHIC LATERAL SCLEROSIS
- Peri ocular surgery in the last 6 months
- Use of drugs that affect blood clotting- Warfarin, rivaroxaban, dabigatran

Other Uses for Botulinum Toxin injections

Masseteric injection


The masseters are a pair of very strong muscles used to close the mouth. The are attached to the lower jaw near the back teeth and to the skull in the region between the eye and ear. Some people grind their teeth quite heavily (known as bruxing), often whilst asleep. This can cause discomfort and pain in the muscles of the face but it can also cause pain in the jaw joints and teeth. Severe grinders can irreversibly damage their teeth as a result of the very strong forces generated by grinding and clenching. Botulinum toxin injections can be used to weaken the masseter muscles and decrease the forces transmitted through the muscles to joints and teeth. This can alleviate symptoms such as pain and discomfort and also decrease the rate of repeated fracture of dental restorations and teeth. This is an “off licence” use of botulinum toxin.


This technique can also be used to aesthetically to reduce and soften a strong or square jawline.


Excessive underarm sweating (Axillary Hyperhidrosis)


Botulinum toxin can be used to switch off the signal to sweat glands preventing the release of their secretions. This is a very safe and predictable treatment for excessive underarm sweating.


Ideally botulinum toxin treatment is for people who:


• constantly worry about the problem
• have to carry supplies (medication, deodorants, extra clothes, powder or pads)
• find it affects confidence and social interaction
• have stained clothing and uncontrollable odour


For further information http://www.sweathelp.org/English/Index.asp and http://www.hyperhidrosisuk.org/.


A starch test is carried out to accurately locate the sweat glands in the underarm region and a number of very small volume injections administered. The effect lasts for 4-6 months. This is also an “off-licence" of botulinum toxin.

Prices

Botulinum toxin to treat facial lines


1 area (eg frown lines/glabella)  -  £175
2 areas (eg frown and forehead lines)  -  £225
3 areas (eg frown, forehead and crow’s feet)  -  £275
Masseteric injection  -  £220 per side
Underarm excessive sweating  -  £450 both sides

ROBERT TYRRELL - B. Dent SC. MFDS (2006) MBChB MRCS (2013) Rob graduated as a dentist from Trinity College, Dublin in 2000. He undertook a house officer job at the Dublin Dental Hospital in his first year after graduation and developed an interest in oral surgery. He spent time in general practice in Ireland for a number of years prior to relocating to Bristol to gain further experience in Oral and Maxillofacial Surgery. He worked as a Senior House Officer in North Bristol NHS Trust in 2006/7 and remained involved in the speciality during his time studying medicine at Bristol University achieving an honours degree in 2011. Having qualified as a doctor, he gained experience in general surgery, ear, nose and throat surgery, cardiothoracic surgery and vascular surgery. He has successfully completed the membership exams to both the faculty of Dentistry in the Royal College of Surgeons (MFDS) in Ireland and the Royal College of Surgeons in England (MRCS). He is currently completing an MSc. in dental implantology at Bristol University. Rob’s background in both dentistry and medicine coupled with his surgical training enables him to deliver safe, skilled and high quality facial aesthetic treatments.