Anti wrinkle injections when injected result in relaxing the muscles, preventing skin from creasing and causing wrinkles. Anti wrinkle injections are effective for treating expression lines such as frown and surprise lines, crow’s feet around the eyes and turkey neck. These injections are non-invasive, patient friendly, effective and extremely safe. Celebrities across the globe opt for anti wrinkle injections in order to look younger and rejuvenated. It is not a painful procedure and the results last for a period of 3 to 4 months.

MECHANISM OF ACTION:

Knowledge on the ‘sausage toxin’ or ‘miracle toxin’ has come a long way from being the most toxic substance known to man to how manipulation in route of administration and  working with lesser doses could work as a boon for patients than a bane

Anti wrinkle injection works by temporary chemodenervation at the neuromuscular junction by a process of receptor-mediated endocytosis. It works on cholinergic efferent motor and efferent autonomic pathways, hence its role in treatment of hyperkinetic facial lines and hyperhidrosis, respectively.

Anti wrinkle injection is synthesized as a single chain neurotoxin (150Kd) that undergoes an endogenous proteolytic conversion to a dichain molecule. This conversion is essential for clinical activity. A disulfide link holds the chains together.

Preparations Available:

There are distinct types of anti wrinkle injections available in the international market, for medical and surgical use both. Different countries have specific licensing policies restricting the use of some and permitting the other.

1. BTX-A

a. Anti Wrinkle Injection/Anti Wrinkle Injection Cosmetic

b. Reloxin/ Azzalure

c. Bocoture

e. Neuronox

The doses of anti wrinkle injections are given in units of biological activity. However, these units are not standardized, and thus doses of one product do not apply to any of the others.

Duration of Action:

The clinical response of the injected toxin is evident within 1-3 days, but may take as long as 7-14 days in some patients. This effect remains for an average period of 4-6 months.

Dilution and Storage:

1. Vials with dry powder are stored in the refrigerator (recommended 2C-8C).

2. Sterile, non preserved 0.9% NaCl for reconstitution is used.

3. Required amount of diluents are taken in a sterile syringe and the needle is pushed into the vial through the rubber stopper by removing the top seal flap.

4 The needed quantities of the toxin can then be withdrawn from the vial with an insulin syringe.

INDICATIONS:

A. Lines and wrinkle caused by facial expressions:

1. Horizontal forehead lines

2. Glabellar (frown lines)

3. Crow's feet

4. Nasal crunch line

B. Ageing neck and décolletage

C. Cosmetic enhancement and correction

D. Hyperhidrosis

E. Mesobotox

PATIENT SELECTION:

It is important to assess every patient’s concerns & needs in the first clinical examination in order to rule out all possible contraindications. Take your time to counsel the patient and answer all their queries regarding anti wrinkle injections, their fears and biases, help them set a realistic goal and make them aware about complications (if any) beforehand.

Contraindications:

1. Patients with an underlying body dysmorphophobia

2. Older patient with predominance of volumetric changes, deep wrinkles and sagging skin.

3. Evidence of brow ptosis (Risks of forehead injections are explained in these cases).

4. If patients have important events to attend, we always advise to keep a safe gap of 15 days between the procedure and the event.

5. We avoid injecting in the lower eyelid area in patients with lid laxity (positive snap test).

6. A patient with a recent history (<12 weeks) of injections with the same or another toxin.

Contraindications for anti wrinkle injection:

Absolute contraindications:

1. Known allergy to any of the ingredients in the anti wrinkle injection vial

2. History of allergy to previous BTX injections

3. Infection at the treatment site

4. Pregnancy

5. Lactation

Relative contraindications:

1. Neuromuscular disorders: Myasthenia gravis, lambert-eaton syndrome, amyotropic lateral sclerosis

2. Medication: Aminoglycosides, quinine, calcium channel blockers, cholinesterase inhibitors.

3. Patient with bleeding disorders or on blood thinners and asprin will have increased chances of bruising. We always ask our patients to avoid NSAIDs, ginkgo biloba, high doses of vitamin E, and such drugs for a week prior to treatment, to reduce chances of bruising.

PRE-INJECTION PROTOCOL

1. Consent form

2. Documentation with pictures

3. Anesthesia: Anti-wrinkle injection generally does not require anesthesia. But, for the overtly apprehensive patients, a topical anesthetic cream can be applied to the area to be injected for 30-40 minutes before injecting.

4. We cleanse the treatment area to remove make up from the area to be treated with a cleanser or alternatively we ask the patient to wash the face herself. Then the area is cleansed with betadine and spirit.

5. The patient is asked to sit up in a semi-reclined position injections. Good lighting in the injection room is ensured.

INJECTION TECHNIQUE

This depends on the site to be injected.

NEFERTITI LIFT

This technique helps to alter the dynamics of the muscle pull of the ageing face, which leads to the loss of a defined jawline. The ‘Nefertiti lift’ is a minimally-invasive, effective, and acceptable alternative for those patients seeking an effective way to delay surgery and get a mini lift for the problem.