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What are wrinkle-relaxing injections?
Doctors have used wrinkle-relaxing injections in medical practice for over 15 years for treatment of muscle spasticity and facial spasms. They are also successfully used to treat facial lines and wrinkles.

Acetylcholine is a chemical messenger produced in our nerves to stimulate the muscles to contract. The BotoxTM Botulinum toxin reduces the release of acetylcholine therefore reducing muscle contraction. The action on the muscle is never permanent.

How does it work to reduce facial lines?
Facial lines are caused by repeated use of the facial muscles of expression e.g. squinting and frowning. By reducing the amount of facial muscle movement the lines can be softened.

Injections are given into the muscles, temporarily putting them to ‘sleep' for a period of three to six months. The aim of the treatment is to break the habit of frowning or squinting and so reduce the appearance of the lines and also reduce the development of further facial lines.

After your treatment it will take 2-3 days for the effects to start to be seen reaching its maximum effect at 7-10 days. The treatment may last from to 3-6 months, on average 4 months. With ongoing treatment the effects may last longer.

Occasionally you may require a top-up injection at two weeks if the muscle is not fully asleep. It is always better to inject a conservative amount of the Botulinum toxin and add more if required. The Botulinum toxin will make it difficult to frown and squint and therefore reduce facial lines However if you try very hard you will be able to move the muscles a little. This does not mean the treatment has not worked.

Where can wrinkle-relaxing injections be given?
Eyes – to reduce crow's feet
Forehead and brow – to reduce frown lines

Are there any side effects?
The side effects are minimal and all are temporary. The injections may sting very slightly but they are not painful. Other side effects are minimal redness and swelling at the injection sites that usually disappears after an hour or so. There is also a small risk of bruising at the injections sites. You may experience transient headache and numbness at the treatment sites.

There is a very small risk of eyelid drooping (ptosis) and slight puffiness following treatment. In the unlikely event that this occurs, it is always temporary and usually settles after 2-3 weeks. The incidence of ptosis is about 2% but always ask your practitioner what problems they have had with treatments, as this will differ between doctors.

Who cannot have muscle-relaxing injections?
It is not recommended in anyone who is pregnant or breast-feeding or who suffers from a neuromuscular disorder. You should make your doctor aware of any medication you are taking including herbal meds.

What are dermal fillers used for?
Only doctors and nurses must administer dermal fillers. It is a simple procedure, done in the doctor's office, and not usually requiring time off work.

Dermal fillers can be used to improve:
• acne scars
• depressions or pockmarks in the skin due to injury or disease, for example, chickenpox marks
• unevenness in the skin after surgery or skin grafting

In addition
Many people have been treated with dermal fillers for:
• deep 'smile lines' which run from the side of the nose to the corners of the mouth
• 'crows feet' at the corner of the eyes
• 'frown lines' between the eyebrows
• smokers lines' which are vertical lines on the top lip
• marionette lines' at the corner of the mouth
• 'worry lines' which run across the forehead
• the definition of the lip border
• other facial lines.

Some defects can be difficult to improve with the first treatment and although you may notice some improvement, more treatments may be needed to get best results.

Dermal fillers are injectable treatments to reduce the appearance of lines and wrinkles. Collagen was the first in 1976 and is still widely used. However it is derived from the skin of cattle so there is a significant demand for alternatives that are non-animal sourced and longer lasting. Be wary of new fillers. The regulations at present are not very demanding so a product can be promoted after minimal testing.

Results depend on:
• the part of the face which is treated
• how much movement there is in the treated area
• the condition of the skin
• the experience and skill of the person performing the treatment.
The filler used in the diamondskinclinic is ‘Restylane’ which is one of the most widely used in the world. Its safety record is excellent and produces consistent results.

What is chemical peeling?
Chemical Peeling is exactly what it says - peeling of the skin using a chemical. A chemical peel removes the outer layers of the skin. This freshens the skin, removes some sunspots and rough scaly patches, and reduces freckles and irregular pigmentation.
It also reduces fine wrinkles. There is some evidence that it may reduce the risk of skin cancer. It is safest and most effective on the face. Hands can be peeled but the risk of scarring is higher and the results less predictable.

What is the history of chemical peeling?
Cleopatra and the ancient Romans used various food acids to peel their skin. In the early 1900s, European and American women underwent 'non-medical' peels in salons with secret formulae, which were probably mild acids. In the early 1950s, the phenol peel was developed.
Trichloroacetic acid (TCA), being a more gentle acid, has made a comeback in popularity because although it will not make a 50 year old look 25 again, it rejuvenates the skin without the risk of serious side effects.

Who is suitable?
Fine wrinkling can be reduced, though deeper lines will remain, (some of which can be improved by other methods) with chemical peeling. Most brown marks, freckles and pigmentation can be removed or lessened, especially age and liver spots (lentigines).
However, pigment changes can be caused by a peel in people prone to this complication due to their skin type. Those known to develop brown discolouration after injury such as a mild burn should have a test area peeled first before undergoing a full-face chemical peel. Scaly patches and rough skin (keratoses) can be removed. Very thick keratoses may need additional treatment for complete removal.
Skin that is thin and fragile e.g. sun-damaged skin; bald scalp skin can be significantly rejuvenated.
Chemical peeling is not a substitute for a facelift. It does not tighten sagging skin, stimulate collagen production or remove broken capillaries.
Chemical peeling is not appropriate for people who will continue to have excessive sun exposure.

Are there any complications?
Scarring can occur with strong acids, but is unusual with weaker ones. The most common causes of scarring are infection, and pulling off the skin before it is ready to peel. Both of these are avoidable.

Cold sores can be activated in those prone to this kind of condition. Anti viral medication can prevent this. Increased pigmentation may occur, and resolves with time. It can be largely prevented by religious use of sunscreen for three months after the peel.

What is the procedure?
The skin may have had preparation with Vitamin A, Alpha Hydroxy Acid or other preparations. Firstly the skin is thoroughly cleansed with acetone or other cleanser.

The acid is then painted onto the face and monitored. If burning or stinging is a problem, a cold pack may be helpful. Usually the treatment is carried out in sections.

What happens afterwards?
The skin will go red and swollen over the next 24 hours. Once the initial burning has worn off it is not painful, but feels tight. Over the next few days the skin dries. Vaseline can be applied several times a day to prevent cracking. Water will do no harm but soap should be avoided.
The skin will begin to peel between 5 and 7 days later, and must be left to come off at its own pace. As soon as the skin has healed, make up may be applied over the new, pink skin. Sometimes a secondary peel occurs during the second week in the form of dry scaling skin.
Sunscreen is mandatory for at least three months, and moisturisers are helpful. Chemical peeling can be repeated after three months, but this is not usually necessary. It can be repeated at any time in the future and will not harm the skin.

The habitual use of sunscreen will prevent further sun damage and therefore maintain the improved skin quality. Additionally, the use of vitamin creams, AHA creams or enzyme creams can continue to improve the skin texture and reverse some of the effects caused by years of sun exposure.

The diamondskinclinic uses glycolic acid peels, TCA peels and ICP peels all of which are widely used in the UK and have an excellent safety profile.




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