Anti Wrinkle Injections: 10 questions you’ve always wanted to ask a doctor.

Anti Wrinkle Injections: the not-so-new frontier.

There is nothing new about cosmetic injectables. They’ve been used successfully in the medical profession for well on 20 years now, but probably in the last 10 years has become a mainstream cosmetic procedure for the reduction in dynamic wrinkles

Most commonly known as muscle relaxing injectables, a toxin is injected into a muscle which will, after a few days relax the muscle contraction.  This relaxation of the injected muscle usually lasts about 3 months, sometimes more, sometimes less depending on where it has been injected and your physical anatomical makeup. 

But what comes with popularity is sometimes complacency.

Muscle relaxing treatments have become one of the most popular and accessible cosmetic procedures currently available, so much so it has become as common as getting your hair coloured every couple of months or so, but perhaps with a lot fewer chemicals!!  But despite being around for more than 20 years, it should never be taken for granted.  You should be well versed in exactly what this cosmetic procedure is and what it can do for you and any associated risks.

Muscle relaxing cosmetic treatments are a prescription drug and should always be administered under the care of a cosmetic doctor. Personally, despite the availability by visiting doctors or nurses in beauty salons and even hair salons, I believe the best place to have this medical procedure is in a clinic with a fully accredited cosmetic doctor or a registered nurse working under the supervision of a cosmetic physician.

This week I chatted with Sydney cosmetic doctor, Dr Naomi McCullum, who practices out of her clinic in Paddington.

Dr Naomi has a philosophy that resonates with me. Her goal is to demystify the cosmetic industry and it comes with a compelling message.


Dr Naomi writes,

The shadowy parts of the cosmetic surgery industry frustrate me. I want transparency to reign, and to let real information be free to reach cosmetic patients. I want readers to gain power by learning the reality of my industry. I want to reduce the knowledge differential between cosmetic patients and cosmetic doctors.. 

My interview with Dr Naomi McCullum

1. What’s being injected into the muscle?

A purified protein that is used to relax muscles. There are various brand names however, they all work well and can cause the muscles to relax and diminish the appearance of wrinkles. 

2. What areas of the face gives the best results when it comes to using muscle relaxing injectables?

By far the most popular in my clinic is crow’s feet and the vertical frown lines of the forehead.  The horizontal forehead lines, although popular can be more tricky to resolve as people age. Muscle relaxants such can also be used in the masseter muscle of the jaw to slim the lower face, this is a really popular treatment at my clinic.

It can also be used for the Depressor Anguli Oris muscle (the muscle that pulls down the corners of the mouth). Treating this muscle with muscle relaxing injectables makes the mouth less droopy. It can be used in the lip lines to give a slightly fuller appearance and in the brow area for a brow lift. It can also be used in the neck for what is known as a “Nefertiti lift”, where it’s injected into the platysmal bands to soften this area. 

3. How long will my results last?

It depends on the dose and also the patient’s metabolism. With a typical dose and patient, the product is injected, with the maximal effect at four weeks. At eight weeks, the movement starts to slowly return and at twelve weeks, there is about 50% of your normal movement back and at sixteen weeks there is approximately 80% of your normal movement back. Most patients choose to have treatment every 3-4 months to maintain results. 

4. How do I avoid a ‘frozen’ appearance?

This involves the injector choosing the right dose and placement of the product. I believe it’s far better not to overdo the dose, in particular, the horizontal forehead lines as this will leave the patient with a frozen forehead, not always a good look.  When it comes to the crow’s feet it is important for the injector to get this just right so there is still natural cheek movement.

5. Are there any side effects?

Being a medical procedure, there are side effects and risks. The most common ones are red dots at the injection sites, small areas of swelling at the injection sites, bruising and a mild headache. The more significant side effects are eyebrow or eyelid droop, but fortunately, these are uncommon. If you are worried always raise any concerns with your cosmetic doctor before commencing your procedure.

6. Is there anything I can do or use at home to prolong the results?

There are many things that patients should be doing at home, such as a great skincare regimen and other non-invasive but effective treatments like dermal roller and LED.  However, they are not prolonging the results; they are just improving your skin which will mean an overall better result when seeking a more youthful appearance.

7. What is the difference between muscle relaxants and dermal fillers?

One relaxes the muscles, and in the case of dermal fillers, these are gels placed under the skin. A dermal filler is used to volumise and fill lines, wrinkles and folds and also to augment certain areas of the face such as the chin, lips and cheeks.

8. I’ve also heard I can get a brow lift with this type of procedure? Do you recommend this?

It is true; please check out the numerous before and after photos I have of my patients on my blog to see the results. I use it regularly. The lift is only minor, usually between 1-2mm at best (which sounds small but is quite noticeable in the eye area).

The relaxant is injected into the orbicularis muscle, which pulls the eyebrow down, especially when the patient is smiling. When this muscle is relaxed, the muscle above the eyebrow, the frontalis, can work unopposed and lifts the eyebrow.

NaomiI recommend it to many patients. The only patients I don’t recommend it is patients who have very low brows where the brows are too close to the patient’s orbital rim as I worry about causing an eyelid droop, so I would rather avoid that problem. In these patients, I would just inject the crow’s feet area and hopefully, they get a small lift from those safer injection sites.

9. When it comes to pricing there seems to be a disparity amongst clinics or the various places where you can get these injections? Do you have a view of advice on this?

I think between clinics that are of the same standard or quality, patients will find that pricing is in general quite similar.

The “sausage factory” clinics which have recently been investigated, were losing money with every patient if the dose they claimed to be giving is believed. Patients should be cautious with their trust when this is occurring. 

There are clinics where the patient doesn’t have a consultation with a doctor first. This practice is illegal, and these clinics tend to be cheaper. Patients should be wary about clinics who are breaking the law in their procedures. 

There are chain clinics where there may be a video link “consultation” with a doctor, and then a nurse who may have learned how to inject yesterday treats the patient. These clinics also tend to be cheaper. They are hanging onto the law by a thread. This practice has been banned in the UK last year in relation to cosmetic procedures, and I hope Australia will be sensible enough to soon follow suit.

If a patient wants to see a doctor with years of experience and thousands of injectable procedures under their belt, then patients should expect it to be more expensive, given the superior training requirements and experience. Strangely, in our industry though, experienced nurse injectors tend to charge at the same level as doctors, even though their training is not in medicine. The market needs information about this type of thing.

In my clinic, we have tiered pricing for the nurse compared to the doctor. 

There are of course outliers in the industry who charge high prices that shock me, but in general, in the injectable industry, at least in Sydney, where it’s awesomely competitive, you typically get what you pay for.

10. How long will your results last?

How long botox lasts depends on the area being treated, the dose and also the patient’s metabolism. With a typical dose and patient, the product is injected, with the maximal effect at four weeks. At eight weeks, the movement starts to slowly return and at twelve weeks, there is about 50% of your normal movement back and at sixteen weeks there is approximately 80% of your normal movement back. Most patients choose to have treatment every 3-4 months to maintain results.

A few final thoughts.

In my own experience, I would always choose to visit a cosmetic clinic where the practitioners are fully accredited in cosmetic medicine and inject every day on many faces. 

While there is no ideal age to start, the quality of your skin condition will determine your results and if you are going to take the leap as millions of others already have, then ensure you choose your cosmetic doctor wisely.

If you’re not given a full consultation to discuss your areas of concern and all the possible side effects prior to your first injection then you really should keep looking for someone who offers you a professional and safe experience. If you feel worried or things do not seem quite right, then ask for the credentials of the doctor. In Australia, any doctor who practices cosmetic medicine should have full accreditation from the Australasian College of Cosmetic Surgeons with a diploma in Cosmetic Medicine.  

If you’re interested in a bit more on my point of view in getting the best outcomes, I have written about finding the right skincare professional here and my view on anti-wrinkle injectables here

And now you?

If you have any other questions drop me an email here or if you’d like to share your own experiences then leave a comment below. 
See you next time,