Botulinum toxin is injected, using a fine needle, into the target muscle to temporarily block the nerve signal resulting in weakening of the muscle action which can result in an improvement in the appearance of lines of facial expression. Botulinum toxin can only treat lines of expression (dynamic lines). Lines that are present
when the muscle is not contracted, and the face is relaxed (static lines) generally do not improve botulinum toxin.
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum.
Botulinum toxin has been licensed for the temporary improvement in moderate to severe lateral canthal lines (crow’s feet at the outer corners of the eyes), glabellar lines (frown lines between the eyebrows) and horizontal forehead lines. There are other areas which are less commonly treated with botulinum toxin
Although this is ‘off label’ (not specifically licensed for this treatment), these are well established and have evidence to support their use.
Facial expressions occur when the brain sends nerve signals to the facial muscles causing them to contract in response to voluntary control, automated or emotional response. Botulinum toxin blocks the transmission of the chemical signal from the nerve reaching the target muscle. Without this signal, the muscle is unable to contract and remains
in a resting state, therefore facial expressions are relaxed. It is not always possible or desirable to stop all movement as a completely frozen look may not be aesthetically pleasing. It is important to discuss your expectations prior to any treatment.
The effects of botulinum toxin are not instant, and most people will start to notice the results after about 4 days, having the full effect by about day 10. A follow-up appointment will be offered at 2 weeks, when the effects of treatment can be reviewed. Additional botulinum toxin may be administered at this time if needed.
Over approximately 3 to 4 months, the nerve terminal recovers and movement in the treated area restarts. Treatment can be repeated to maintain the desired results. It is not recommended to repeat treatments at intervals of less than 3 months. Static lines that are present at rest, may soften once the botulinum toxin has taken effect and with repeated treatments may continue to improve as the skin recovers and is no longer being created by constant muscle action. There are no known long-term side-effects from having repeated treatments, although there may be some muscle wasting (atrophy) over time.
Millions of botulinum toxin treatments have been performed worldwide and it has an excellent safety profile. However, as with any medical aesthetic procedure, there are certain risks and side-effects which should be discussed with you during your initial consultation.
Side-effects may be more likely due to the following factors:
Patient factors:
Poor condition of the skin,
Loss of elasticity,
Heaviness of the forehead,
Certain autoimmune or chronic medical conditions.
Injection site pain
Bleeding and/or bruising at the injection sites
Redness, itching, irritation at the injection site
Swelling, including under eye puffiness
Headache, which may last several days
Nausea and/or hot flushes
Poor cosmetic results
Uneven effect on one side
Drooping or heaviness of the brow or eyelid
Abnormal appearance of the brows (Mephisto or Spock brow)
Blepharitis (inflammation of the eye lids)
Eye pain or visual disturbance
Paraesthesia (abnormal sensation)
Muscle twitching
Flu-like symptoms
Anxiety symptoms
Rarely, muscle or joint pains
There are many different brands of filler available within the UK, but some have better safety profiles than others. Individual brands differ in the properties of the filler, including particle size, concentration and cross linking which affects their resistance to degradation (how long the filler will last), elasticity and volumising effect. Most brands produce a filler specifically designed for lip treatments.
Different parts of the lip can be treated depending on your requirements. Dermal fillers can be used to increase volume, enhance definition and improve shape.
The areas of the lip that can be treated:
Main body of the lip
Vermillion border
Cupid’s bow
Philtral columns
Oral commissures
Smoker’s lines
Hyaluronic acid dermal fillers are extremely ‘hydrophilic’ or water-loving. When they are injected, they boost the skins volume, so the area becomes revitalised and volumised. Adding volume to the lips can enhance their fullness, improve hydration, correct any imbalance, provide greater definition and address the shape of the lips to a more desired appearance.
It is important that you discuss in detail what you would like to achieve with a filler treatment to your lips during your consultation.
It is usual to use 1ml or less of filler (one syringe) when treating the lips.
Most dermal filler syringes contain a small amount of lidocaine, which is a local anaesthetic to help reduce any pain experienced during the procedure. Even with the addition of local anaesthetic, it is not a pain free treatment and it will depend on the injection technique, whether a cannula or needle is used and the individual’s pain tolerance.
When treating the lips, it is common to use a topical anaesthetic to provide
additional pain relief. This will be applied to the skin and left on the surface for 20-40 minutes to take effect.
If using a cannula, your practitioner may inject a local anaesthetic into the area prior to introducing the cannula.
Once the anaesthetic has worn off, there may be some tenderness which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment, you must contact your practitioner as this could indicate that you are developing a complication.
Hyaluronic acid is a naturally occurring substance present in the skin and the product itself is considered very safe. Side-effects may be more likely due to the following factors:
Condition of the skin
Age
Certain medical conditions
Certain medications.
Pain: Lips are more sensitive than other areas of the face and even if you have had fillers in other areas previously, you are likely to experience a degree of pain during the procedure.
You may also experience some discomfort post-treatment. If you do have more pain than expected, it is essential to contact your treating practitioner immediately as this may indicate a complication, such as a vascular occlusion.
Redness: This is normal and usually resolves quickly. If the treatment area becomes red a few days
after treatment, particularly if heat is also present, this may indicate an infection and you need to contact
your practitioner straight away.
Swelling: Some swelling or oedema is normal after treatment and may be worse the following morning after the procedure. Lips are more prone to swelling than other areas of the face. However, persistent swelling should be reported to your practitioner as there may be treatment to help relieve this.
Bruising: This can be anything from a small mark on the lip to extensive bruising which extends beyond the area treated and can take up to 2 weeks to resolve. Lips are very vascular and therefore have a higher risk of bruising. Rarely, bruising can lead to permanent staining of the skin.
Infection: Your treatment should be conducted in an appropriate clinical environment with adherence to infection prevention measures
Herpes (Cold sores): Treatment around the lip area can exacerbate an outbreak of herpes, which may be worse than a normal outbreak and may require treatment.
Sometimes preventative medication is required for certain treatments in people who are prone to cold sores. It is important that this is discussed as part of your medical history.
Lumps: Lumps may be present immediately after treatment due to product misplacement or migration of the product or may appear several weeks or months later in some cases. Lumps may appear as soft
swellings or as hard nodules. They sometimes occur following an acute illness.
Vascular Occlusion: This is a rare but serious complication from dermal filler injections. In this situation, your blood supply has been compromised by filler that has caused a blockage or obstruction of normal blood flow. If this is not correctly managed, the skin and tissue supplied by the blood vessel does not receive sufficient oxygen and can result in tissue loss, scarring and secondary infections. A vascular occlusion will \\
poor capillary refill. It will often appear immediately during treatment or soon afterwards and once this has been identified, your practitioner will have the necessary products at hand to effectively manage this.
Blindness: This is an extremely rare and devastating complication that can occur with dermal filler treatments. There are certain areas of the face that pose a higher risk if they are injected, but it has arisen following lip filler treatments. This should be discussed during your consultation with your practitioner, because if blindness occurs, it is likely to be permanent.
Stroke: Another extremely rare but documented complication of dermal fillers.
If a topical anaesthetic cream is to be used, this will be applied and removed after 20-40 minutes to allow it to take effect. The area to be treated will be cleaned and disinfected. If a needle is used, you will experience several pin pricks or a scratching sensation and possibly a mild burning sensation as the product is injected. If a cannula is used, the practitioner may first inject a local anaesthetic to numb the insertion site, this itself can cause a burning or stinging sensation. Cannulas can create an odd pulling or tugging sensation as they are moved into place beneath the skin.
Treatment time will likely be between 15 to 30 minutes once the topical anaesthetic has been removed. Following your procedure, the practitioner may massage the area and then clean the skin.
You may not be suitable for treatment if any of the following apply:
Pregnant or breast-
If you suffer from keloid scarring or have active skin conditions, such as acne or psoriasis.
If you have certain medical conditions, such as diabetes, rheumatoid arthritis, autoimmune conditions, blood clotting disorders, cancer, immunosuppression (either medical or drug-related).
If you are suffering from any skin infection in or near the treatment area, including cold sores.
If you are suffering from any other infection, including dental, throat, ear, chest or sinus infections
If you are unwell, including coughs and colds, on the day of treatment.
If you are taking any medicines which affect bleeding, such as aspirin or warfarin.
If you have had Roaccutane or isotretinoin in the past 6 months.
Certain allergies, including lidocaine or bee sting allergy.
Recent facial surgery or other dermal fillers in the same area.
Permanent implants in the lip.
Avoid taking anti-inflammatories (such as aspirin, ibuprofen, naproxen) for 3 days prior to treatment as this increases the risk of bruising.
Alcohol, fish oils, St. John’s Wort, Gingko Biloba, garlic and Vitamin E should also be avoided for 3 days prior to treatment to lessen the risk of bruising.
If you are unwell on the day of your appointment, contact the practitioner to reschedule.
Avoid sunbeds and tanning for 1 week before and after treatment.
Ensure your practitioner is informed if there are any changes in your medical history or medication taken before receiving any treatment.
Do not plan to have treatment within 2 weeks of an important social event or holiday as this may not allow enough time for side-effects, such as bruising to settle, or to have a review appointment.
Do not apply make-up for 12 hours after treatment to reduce the risk of infection.
Avoid saunas, swimming pools and sunbeds until swelling and redness has settled.
Try to avoid touching or rubbing the treated area until the following day, as you may affect the results of the treatment or cause infection, unless otherwise advised by your practitioner.
Avoid extremes of hot or cold and vigorous exercise until the initial swelling has resolved
If swelling persists, you may be advised to apply a cool pad to help remedy this.
Avoid very hot or cold food and drinks until normal sensation has returned to the lips
Contact your practitioner if you experience any unwanted side-effects.
Dermal filler injections are administered using a small needle, a cannula or both. The syringe will contain a clear gel like substance, which consists of a water-based carrier gel, hyaluronic acid, and may contain lidocaine, which is a local anaesthetic to make the treatment more comfortable. Hyaluronic acid is a naturally occurring substance, which is a major component of our skin and has a function in wound repair, hydration, and cell to cell communication. One of the main characteristics of hyaluronic acid is that it effectively binds water like a sponge, which is why it is an effective tissue filler.
Dermal filler brands differ in properties, including particle size, concentration and cross-linking which affects their resistance to degradation (how long the filler will last), elasticity and volumising effect. Most brands will have several products in their range to enable treating different areas, ranging from softer fillers to treat fine lines and lips to firmer fillers to provide contour and shape.
Dermal fillers can be used in most areas of the face and some areas of the body, including the neck, décolletage, back of the hands and genital areas.
Commonly treated areas include:
During normal ageing, the fat compartments of the face lose volume and the ligaments holding them in place become weaker leading to a sagging appearance. Hyaluronic acid dermal fillers are extremely ‘hydrophilic’ or water loving. When they are injected, they boost the skins volume, so the area becomes revitalised and volumised. By placing the dermal filler in specific anatomical positions, this can also create a lifting effect. Adding volume helps to address issues such as volume loss, laxity and sagging of the skin, having a positive effect on lines and wrinkles. They can also be injected directly beneath lines to help soften and improve them.
Most syringes contain 1ml of hyaluronic acid and often more than one syringe will be required to produce the desired result. This may be performed at the same time or at a later treatment session.
Most dermal filler injections contain a small amount of lidocaine, which is a local anaesthetic to help reduce any pain experienced during the procedure.
In some circumstances, a topical anaesthetic, such as LMX4 or Emla™, may be used to provide additional pain relief, particularly when treating more sensitive areas, such as the lips. This will be applied to the skin and left on the surface for 20-40 minutes to take effect.
Once the anaesthetic has worn off, there may be some tenderness which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment, you must contact your practitioner as this could indicate that you are developing a complication.
Possible adverse effects include:
You may not be suitable for treatment if any of the following apply:
After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some redness, tenderness and swelling at the injection sites. Bruising may be obvious immediately after treatment and may be quite pronounced.
Profhilo® consists of one of the highest concentrations of hyaluronic acid (HA) available in any aesthetic product. Hyaluronic acid is a naturally occurring substance, which is a major component of our skin and has a function in wound repair, hydration, and cell to cell communication. One of the main characteristics of hyaluronic acid is that it effectively binds water like a sponge.
Profhilo® is considered a bioremodeling agent as opposed to a dermal filler or biorevitaliser.
The most treated area is the face, often by using a specifically devised treatment technique of injecting 5 Bio Aesthetic Points (BAP) each side to maximise diffusion in the cheeks and lower face to achieve the best results, minimise discomfort and for safety by avoiding important structures and blood vessels.
Profhilo® can be used all over the body, but is particularly effective when treating the face, neck, and décolletage. Although less commonly performed, other possible treatment areas include:
Profhilo® is a revolutionary technology that delivers an anti-ageing treatment into the skin of your face, neck, and other areas of the body. The low molecular weight portion is responsible for hydration and stimulating the formation of new collagen and elastin within the skin whereas the high molecular weight component provides support and a scaffolding action. Due to thermal stabilisation, the pure hyaluronic acid remains in the skin for around 28 days, however the slow release of HA stimulates 4 different types of collagen and elastin for more lasting results. Despite its high HA content, it has a low inflammatory profile coupled with pro-healing properties backed by clinical studies.
Patients can expect increased firmness, elasticity, and an overall improved quality of the skin with the effects lasting about six months.
Due to the revolutionary nature of Profhilo®, the whole face can be treated in around 15 minutes and bio-remodelling can be achieved in just two treatment sessions carried out four weeks apart. In order to maintain the results, additional treatments may be performed after 6-12 months.
Profhilo®, unlike other dermal filler treatments, does not contain lidocaine, therefore a stinging or burning sensation can be experienced. Following the procedure, there may be some tenderness, which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment, you must contact your practitioner as this could indicate that you are developing a complication.
Profhilo® is composed of a highly pure grade of hyaluronic acid and with the absence of any additives, it is extremely biocompatible and has fewer documented adverse effects than traditional hyaluronic acid fillers.
Treatment with Profhilo® will take around 15 minutes and following the procedure, your practitioner will clean the skin. It is likely that you will also be shown in a mirror the bumps that will be visible for a day or two. Following treatment, you may notice an improvement within a few days although some patients may not see the benefit for up to 4 weeks after their second treatment. The skin should look more hydrated and have a healthy glow, fine lines and wrinkles should improve and the area should have a more youthful appearance. Even very aged skin should feel tighter, smoother and show an improvement in texture.
You may not be suitable for treatment if any of the following apply:
After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some redness, tenderness and swelling at the injection sites. Bruising may be obvious immediately after treatment and may be quite pronounced.
Ellansé® is not a hyaluronic acid dermal filler, it is made up of an aqueous carboxymethylcellulose (CMC) gel containing polycaprolactone microspheres and belongs to the bio-stimulating class of dermal fillers. Unlike hyaluronic acid dermal fillers which are colourless gels, Ellansé® is white in colour. Polycaprolactone is a biodegradable material which has been used extensively in medicine as an injectable drug delivery system as an implantable biomaterial.
Ellansé® is injected in much the same way as most hyaluronic acid fillers, but unlike hyaluronic acid fillers, it cannot be dissolved with hyaluronidase. Ellansé® is comprised of 70% CMC gel and 30% polycaprolactone.
During an Ellansé® dermal filler treatment, an immediate improvement in volume and lifting is obtained from the CMC gel, in much the same way as the hyaluronic acid fillers. The difference with Ellansé®, being a bio-stimulating filler, is that the polycaprolactone microspheres encourage the body to produce new collagen. The formation of collagen around the microspheres gives a longer lasting result. The microspheres are broken down naturally by the body over time and results with Ellansé® will last from between 1 and 4 years depending on which product is used. The CMC gel will be absorbed by the body over a shorter time, around 8-12 weeks, by which time the body has started to replace it with its own collagen. The ability for an individual to produce collagen varies, and may be influenced by lifestyle, age, and metabolism.
Ellansé® can be used in most areas of the face and some areas of the body. However, it is not recommended to use Ellansé® to treat the lips or the tear trough (under eye area).
Commonly treated areas include:
During normal ageing, the fat compartments of the face lose volume and the ligaments holding them in place become weaker leading to a sagging appearance. Ellansé® can be injected in specific anatomical positions to create volume and a lifting effect, so the area becomes revitalised and volumised. Adding volume helps to address issues such as volume loss, laxity and sagging of the skin, having a positive effect on lines and wrinkles. They can also be injected directly beneath lines to help soften and improve them.
Lidnocaine can be added to the syringe of Ellansé® which is a local anaesthetic to help reduce any pain experienced during the procedure. Even with the addition of local anaesthetic, it is not a pain free treatment and it will depend on the injection technique, whether a cannula or needle is used and the individual’s pain tolerance.
In some circumstances, a topical anaesthetic, such as LMX4®or Emla®, may be used to provide additional pain relief. This will be applied to the skin and left on the surface for 20-40 minutes to take effect.
Once the anaesthetic has worn off, there may be some tenderness which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment, you must contact your practitioner as this could indicate that you are developing a complication.
Ellansé® has an excellent safety record, has FDA approval and is CE marked.
Possible adverse effects include:
You may not be suitable for treatment if any of the following apply:
After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some redness, tenderness and swelling at the injection sites. Bruising may be obvious immediately after treatment and may be quite pronounced.
Vitamin B12 is one of the water-soluble vitamins and available as an intramuscular injectable medication called hydroxocobalamin. Vitamin B12 is required to help your body to use fat and carbohydrate for energy and it also helps to make protein and DNA. It is an essential vitamin to help maintain blood, nerve cells, and neurological function. Vitamin B12 is only found naturally in animal products and dietary sources include liver, fish, meat, eggs, dairy products, yeast extract (such as marmite) and foods that have been fortified with B12. Although there are different medications of Vitamin B12, the World Health Organisation recommends the use of hydroxocobalamin as it remains in the body longer than other formulations, which means less treatments over time. Injected B12 begins to work immediately, but it can take days or weeks to feel the benefit.
Brain Function: Low levels of Vitamin B12 have been linked to decline in brain function and recent evidence suggests there is also a link with dementia. However, there is no evidence to suggest brain function can be improved in people with normal Vitamin B12 levels.
Osteoporosis (Brittle bones): There is a link between low levels of B12 and reduced bone mass, increasing the risk of fractures.
Depression: It has been suggested that low levels of Vitamin B12 is associated with depression and long-term treatment with B12 may reduce recurrence and severity of depression.
Energy, weight loss and mood: There is actually little or no evidence to suggest that treating people with normal B12 levels with Vitamin B12 injections will improve wellbeing, energy levels, weight or mood.
Vitamin B12 deficiency is relatively common, and the main causes of deficiency include:
Symptoms and signs of Vitamin B12 deficiency:
You should not have B12 injections if:
Generally, side-effects are uncommon, often mild, and usually resolve within a few days of treatment. You may experience some pain, itching, redness or swelling at the injection site.
Possible side-effects include:
If vomiting and diarrhoea are more severe, this can affect the oral contraceptive pill and additional precautions will be required.
Rarely, adverse effects can be serious and include:
Signs and symptoms of a serious allergy may include a rash, wheezing, difficulty in breathing, tight chest or throat, trouble speaking and swelling of the mouth, face, lips, tongue and/or throat. If you experience any of these, you must ring 999 immediately.
The area for injection will most likely be at the top of your arm into the muscle, it is usual to use the non-dominant arm. The area will be inspected to find the best place for injection. The skin will be gentle pinched prior to treatment and the actual injection can cause a stinging or burning sensation that can vary in intensity. Some people find that it is quite painful, whereas most just experience a mild stinging. The actual injection will last for a few seconds only.
Most people are suitable for Vitamin B12 injections, although it is recommended that you have your B12, folate, iron and potassium levels checked prior to commencing treatment. If you have very low levels of B12, this should be investigated further by your General Practitioner.
You may not be suitable for treatment if any of the following apply:
After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some discomfort, redness, and minor swelling at the injection site, which should settle in time. If you develop any bruising, which may be apparent at the time of treatment, it is usually minor and settles within a few days. Occasionally, more significant bruising can occur. Rarely, you may develop a headache after treatment which can last a few days. Simple analgesia can be taken for this if needed.
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