If you have ever considered having anti-wrinkle injections (i.e. Botox) you’re not alone.

Let’s face it, one of the first things we think about when we hear the word ‘aging’ is wrinkles.

They appear in very specific areas because of the way movement stretches our skin, while the components of our skin that help retain its tautness and elasticity diminish over time.


The types of wrinkles that can appear on the skin are outlined below:

  • Dynamic wrinkles become more prominent as we age and when we move our facial muscles in certain ways, such as when we squint and smile.
  • Static wrinkles are somewhat fixed on the face, don’t change much with facial expressions, and get deeper as we age.
  • ‘Crinkles’ or fine lines often appear as crosshatched lines, like what occurs on aluminium foil, which starts out smooth and flat on the roll, but becomes crinkly with any use. These wrinkles increase in number as we age.
  • Gravitational folds are wrinkles created by sagging skin as it loses its elasticity.


Our facial muscles are among the most active, and the types of wrinkles you might develop, and that become more prevalent as you age, include:

  • Worry lines – Sometimes referred to as forehead creases, these wrinkles are horizontal lines on our forehead.
  • Frown lines – Also known as glabellar or furrow lines, these vertical lines appear between our eyebrows and can resemble the number 11.
  • Crow’s feet – These are splaying creases around the outer corners of the eyes that make us look like we are squinting.
  • Bunny lines – Also known as nasal wrinkles, these form over the bridge of the nose and between our eyes, and can make us look like we are twitching our nose or squinting.
  • Nasolabial folds – We all tend to have lines that run from the sides of the nose down to the corners of the mouth and separate the cheek from the upper lip.
  • Lipstick lines – Sometimes called labial lines or smoker’s lines, these wrinkles appear over our top lip and make us look like we are pursing our lips.
  • Oral commissures – Also known as mouth lines, these wrinkles are like crow’s feet only they appear around the corners of the mouth rather than the eyes.
  • Marionette lines – These are lines than run downwards from the corners of our mouth, and can make us look a little like a puppet when we speak.
  • Parenthesis lines – These are the lines that fall from the sides of the nose towards the mouth, and are sometimes referred to as smile lines.
  • Chin dimples and creases – These are also known as mental creases.


You can use cosmetic medical treatments to reduce the appearance of these types of wrinkles.

Among the most common is botulinum neurotoxin injections. People often refer to these anti-wrinkle injections as ‘Botox’, despite the fact that is the brand name of one product. Other brands include Dysport and Xeomin.

These treatments all work by using a chemical found in a bacterium called clostridium botulinum, which is a neurotoxin.

It paralyzes a particular muscle to prevent it contracting and in turn minimizes the appearance of wrinkles.

The chemical blocks the chemical signals within the skin that trigger muscle contractions, meaning the wrinkles can’t form.

With fewer muscle contractions, the skin smooths out and fine wrinkles soften, resulting in a more youthful and relaxed appearance.

The final result is similar to how the wrinkle looks when we are asleep, when the muscle is fully relaxed.

(Remember: anti-wrinkle injections don’t work for static wrinkles – those that have the same depth and appearance whether the muscle underneath is relaxed or not. These are typically treated with fillers or volumizers.)

People are increasingly having neurotoxin injections in combination with other cosmetic procedures, including laser, resurfacing, intense pulsed light (IPL) and cosmetic surgery.

Experts believe such combinations may achieve a more polished, refined and longer-lasting result.


You don’t need to prepare much prior to having anti-wrinkle injections. Practitioners may, however, ask you to avoid taking specific common medications 1-2 weeks prior to treatment to reduce the risk of bruising.

Such medications include:

  • warfarin
  • aspirin
  • non-steroidal anti-inflammatory drugs such as ibuprofen and ketoprofen

Other less-common medications you might need to stop taking include:

  • anti-hypertensive calcium channel blockers
  • quinine (for cramps)
  • aminoglycoside antibiotics
  • penicillamine (for Wilson’s disease)

Some practitioners also recommend not taking vitamin E supplements, ginseng, fish-oil tablets, or herbal supplements with blood-thinning effects.


On the day of your treatment, you should avoid using any facial products such as makeup, moisturizer, lotion or oil.

It is typical for your doctor to take photos before the procedure to assess the results afterwards and determine if you need further treatment.

The practitioner will use a non-permanent pen to mark the injection sites to ensure they are symmetrical.

You receive anti-wrinkle injections when you are sitting up.

The practitioner cleans the target area with antiseptic, then uses a very fine caliber needle to inject the chemicals into your face.

You rarely need local anaesthetic, as pain is minimal, but you can request the doctor apply a topical numbing cream to the target area.


You shouldn’t touch the area where you received the anti-wrinkle injections for at least four hours following the procedure.

It is fine to go about your normal daily routine straight away, but you should avoid vigorous activities for 24 hours after the procedure to ensure you see the best results.


You might not see the botulinum toxin injection’s effects immediately.

Improvement in wrinkles usually occurs between 3-5 days following the procedure. The most noticeable effects, however, are usually seen 1-2 weeks later.

The effects of anti-wrinkle injections are temporary, as the paralyzed muscles gradually regain their ability to contract.

You can expect the effects to last about 3-4 months, with some people achieving 5-6 months. Your metabolism, and whether you’ve had the treatment in conjunction with other cosmetic procedures, usually affects the length of time.


Practitioners all over the world have performed millions of botulinum neurotoxin injections to treat wrinkles. The practice is well-established and there are few negative side effects.

As with any cosmetic medical treatment, however, there is always a risk you will experience some side effects.

The most common include redness, bruising, swelling, pain and increased sensitivity around the injection site. In most cases this is due to dosage and deployment at the injection site, for example.

Some people report fatigue, malaise, flu-like symptoms, nausea and rashes at sites distant from the injection area. You can usually treat these symptomatically (for example, with painkillers for headache) and they tend to settle quickly.

Qualified, experienced practitioners should perform the procedure to ensure the chances of you experiencing these side effects are minimal.

Other side effects can include:


In some cases, anti-wrinkle injections may inadvertently cause muscle weakness outside the target area.

Treating lines above the eyes, for example, occasionally causes the upper eyelid to droop temporarily (known as ptosis).

Ptosis can occur as early as 48 hours or as late as 7-10 days after the procedure.

Further, forehead crease injections can cause the eyebrows to temporarily droop (known as brow ptosis) creating a ‘cockeyed’ appearance.


Treating crow’s feet can sometimes result in double vision (known as diplopia).

Discomfort and bruising

Anti-wrinkle injections can cause bruising. Sometimes the botulinum can move beyond the injection site and cause discomfort in non-target areas.

To reduce the risk of these complications, a practitioner will always try to accurately inject the lowest effective dose in the smallest volume.

It is also important not to undergo the treatment too often, as this can lead to muscle thinning and atrophy.

Women who are pregnant or nursing should not have botulinum neurotoxin injections.


Last Reviewed: 09-Oct-2016

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