Anti-Wrinkle Injections: How Can It Go Wrong?

Wrinkles are an inevitable part of the aging process. Over time, skin becomes thin and less elastic, and smiling, frowning, and laughing lead to the formation of lines and creases in the skin. While some people embrace these changes as a natural part of growing older, others may feel self-conscious and look for ways to reduce them. People may use creams, serums, or other topical treatments to try and reduce wrinkles, but these products may not achieve the desired results. For many, injectable treatments are a more effective option.

Anti-wrinkle injectables, such as botulinum toxin (Botox), are an increasingly popular cosmetic treatment that can temporarily soften the appearance of wrinkles. The injection works by relaxing the muscles that contract and cause wrinkles.

While anti-wrinkle injections are generally considered safe when administered by a qualified, experienced therapist, there are some potential risks and side effects associated with the treatment.

What are anti-wrinkle injections?

Anti-wrinkle injections are cosmetic treatments that can temporarily reduce the appearance of wrinkles. The most common type of anti-wrinkle injection is botulinum toxin (Botox).

Botulinum toxin is a neurotoxin that comes from the bacterium Clostridium botulinum. It's the same toxin that causes botulism, a rare but potentially fatal form of poisoning that transmits through food, open wounds, or contaminated soil.

In small, diluted amounts, however, botulinum toxin can be used to temporarily reduce muscle activity by blocking the chemical signals from nerves.

When injected into the facial muscles that cause wrinkles, it paralyzes them and prevents them from contracting. As a result, wrinkles smooth out, giving the face a more youthful look.

Other types of anti-wrinkle injections include dermal fillers, which can help plump up the skin and make wrinkles less obvious. These include treatments such as Juvéderm, Restylane, and Sculptra.

Therapists deliver anti-wrinkle injections via a series of injections into the skin, usually in small areas such as crow's feet around the eyes, frown lines between the eyebrows, horizontal lines on the forehead, and marionette lines at the corners of the mouth.

What can go wrong with anti-wrinkle injections?

Anti-wrinkle injections are considered safe, providing that a qualified and experienced practitioner administers them. However, as with any medical procedure, there are some potential risks associated with these injectables, including:

  • Bruising, swelling, or redness at the injection site
  • Headaches or face pain
  • Nausea
  • Infection
  • Eye dryness or tearing
  • Droopy eyelids
  • Uneven smile

Rarely, the toxin in the injection can cause problems throughout the body. These symptoms require immediate medical attention:

  • Muscle weakness
  • Eyesight problems
  • Difficulty speaking, swallowing, or breathing
  • Weak bladder

Before having anti-wrinkle injections, you should always consult with a qualified and experienced practitioner to discuss the potential risks and side effects associated with the treatment.

Who shouldn't use Botox?

Certain people shouldn't use Botox, including:

  • Pregnant or breastfeeding people
  • Children
  • Anyone with an allergy to cow's milk protein

Additionally, people with certain medical conditions should avoid Botox, including:

  • Myasthenia gravis. A chronic autoimmune disorder where antibodies destroy the communication between nerves and muscles.
  • Amyotrophic lateral sclerosis. Also called Lou Gehrig's disease. ALS is a progressive neuromuscular disorder.
  • Multiple sclerosis. A chronic condition where the immune system eats away at the protective covering of nerves.
  • Eaton Lambert syndrome. A disease where the immune system attacks the connections between nerves and muscles.

What to expect from anti-wrinkle injections?

Before undergoing anti-wrinkle injections, it's important to understand the procedure and the results you can expect.

Before the procedure

Although the injections usually cause only minor pain, you can avoid the discomfort with numbing cream. Your therapist or doctor can apply topical anesthesia containing lidocaine around 30 minutes before the procedure. Studies show that the cream can reduce pain by around 60%.

Botox comes in vials containing differing numbers of units. Your doctor will discuss how many units you'll need before they begin. Some facial areas require more units and a stronger effect to relax the muscles and smooth wrinkles.

Here's approximately how many units you'll need for different treatment areas:

  • Crow's feet. Four to 15 units per side.
  • Frown lines. Eight to 40 units.
  • Forehead lines. Eight to 25 units.

However, this is a guide, and your doctor may make different recommendations during your consultation.

During the procedure

The exact treatment procedure may vary depending on the treatment area and the type of anti-wrinkle injectable used. Typically, the doctor inserts a thin, sterile needle into the target muscles to deliver small amounts of toxin at several points across the area.

The injections take a few minutes to administer, and you should have no significant marks once finished.

After the procedure

You may experience some mild swelling and redness around the injection sites after the treatment, which usually dissipates within a few hours. However, some people find this can last for up to 24 hours.

Here are post-treatment recommendations:

  • Avoid rubbing or massaging the injection sites and reschedule beauty treatments like facials. This minimizes the risk of complications, such as the toxin spreading to nearby muscles or bruising.
  • Use the targeted muscles repeatedly for about one hour immediately following the treatment, such as frowning or smiling. This helps the muscles to absorb the toxin. Then avoid moving the facial muscles for the next 12 hours
  • Keep upright for the first four hours to allow the toxin time to settle into place.
  • Apply any makeup or creams in a light dabbing motion instead of rubbing or spreading.
  • Sleep on your back rather than your stomach to avoid pressure on the face.
  • Do not exercise or partake in strenuous activities for the next 24 hours.
  • Avoid excessive alcohol consumption for the next 24 hours.

Anti-wrinkle injection results

When injected correctly, Botox injections usually begin working 1–4 days after treatment, with full results after about seven days.

The effects of the injections typically last for 3–4 months, after which the muscles gradually return to their pre-treatment state, and wrinkles reappear. However, you can maintain results by having follow-up treatments every few months.

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