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Botulinum Toxin Wrinkle Treatments

Early treatment helps prevent progression of wrinkles.

Botulinum toxin or ‘BOTOX” treatments helps fight against visible wrinkles to maintain youthfulness.

botulinum toxin wrinkle treatment
Natural looking results with botulinum toxin wrinkle treatments

Table of Contents

Botulinum toxin wrinkle treatments can provide a natural look that doesn’t affect your expression. Repetitive frowning, smiling and worrying over the years can cause facial wrinkles. Botox cosmetic treatments can help to smoothen out wrinkles leaving you looking more youthful and refreshed.

OUR APPROACH

botox treatment

With a focus on safety, efficacy, and patient satisfaction, Dr Ng delivers Botox treatments that is tailored to each individual’s unique anatomy and aesthetic goals, ensuring natural-looking results that enhance facial harmony and expression. As a cornerstone of aesthetic medicine, Botox continues to redefine standards in non-invasive rejuvenation, empowering individuals to achieve timeless beauty and confidence in their appearance.

What is botulinum toxin treatment?

Botulinum toxin helps to relax muscles at the neuromuscular junction. With treatments spanning over 2 decades, looking natural by reducing wrinkles can be maintained with the use of neuromodulator injections. The aim is to give you a natural outcome by softening your wrinkles and not one making you appear ‘frozen’ or expressionless. Precise injections are strategically placed into your facial muscles to soften your look, restoring facial balance and harmony. Being one of the most popular aesthetic treatments around the world, it has minimal downtime while enjoying a high safety profile.

There is evidence to suggest that regular botulinum toxin wrinkle treatments prolongs the effect, giving you a longer lasting natural look. Interestingly, combination with procedures such as fillers has a synergistic effect on the aesthetic outcome because tackling the effects in ageing occurs at multiple levels of the human face.

how botox works
Botulinum toxin stops acetylcholine release from nerve to muscle

How Does Botulinum Toxin Wrinkle Treatment Work?

Botulinum toxins work by blocking the communication between nerve and their surrounding muscles, thus they are also called neuromodulators. They are medical grade biological products, derived from the bacteria Clostridium Botulinum, and subsequently commercially purified for medical and cosmetic use. It works by inhibiting the neurotransmitter acetylcholine release from the nerves, and thereby slowing down muscle contraction. It also blocks the release of sweat, leading to improvement in conditions such as hyperhidrosis. Cosmetically, doctors use botulinum toxin wrinkle treatments to improve lines & wrinkles on the face (e.g. frown lines, crow’s feet), vertical necklines and for non-surgical jaw reduction.

Botulinum Toxin Treatment Areas

Upper face

Frown lines, also known as glabellar lines or “11 lines,” are the vertical wrinkles that appear between the eyebrows on the forehead. These lines are often associated with facial expressions involving frowning, squinting, or concentrating. Over time, the repeated contraction of the muscles between the eyebrows can lead to the formation of these lines.

The forehead lines may be appear after your 30s and is the only muscle to lift your eyebrows. They form due to ageing, repetitive facial expression, UV exposure and genetics.

Otherwise known as Crow’s feet, these are wrinkles radiating from the corner of the eyes when you smile.

By targeting different muscles around the eyes, we can create a brow lifting effect in harmony with the surrounding facial areas.

glabella wrinkles
Frown lines
lower eyelid wrinkles
Crow's feet or lateral canthal lines

Mid face

Infra-orbital wrinkles are lines on the lower eyelids which are more noticeable when you smile. Dr. Ng uses a microdroplet technique to soften these lines.

Precise injection into the lower eyelid can lower the inferior ciliary margin to achieve this effect.

Many individuals find the widening of the nostrils unsightly, but precise botulinum toxin injections can quickly improve this condition.

“Bunny lines” refer to the horizontal wrinkles or lines that appear on the bridge of the nose when a person scrunches or wrinkles their nose. These lines are so named because they can resemble the twitching of a rabbit’s nose, particularly when it moves its nose rapidly or twitches it.

Over time, the nasal tip may droop downwards as a result of changes to muscles, cartilage and its surrounding structure. 

A gummy smile, also known as excessive gingival display, is a term used to describe a smile in which a significant amount of the upper gums are visible. When someone with a gummy smile smiles, a larger portion of their gums is exposed, sometimes overshadowing the teeth.

Lower face

This refers to the excessive or heightened activity of the mentalis muscle, which is a facial muscle located in the chin region. The mentalis muscle plays a role in controlling the movement and positioning of the lower lip, and its overactivity can be associated with certain facial expressions or habits.

Masseter overactivity refers to the excessive or heightened activity of the masseter muscle, which is one of the muscles responsible for jaw movement. The masseter muscle is the primary muscle used for chewing and is located at the jawline. Overactivity of the masseter muscle can lead to various issues and symptoms such as bruxism and a broader lower facial appearance.

Perioral lines, also known as perioral wrinkles or “smoker’s lines,” refer to the fine lines and wrinkles that appear around the mouth, specifically the lips. These lines typically radiate outward from the edges of the lips and can become more pronounced with age. Perioral lines are a natural part of the aging process, but factors such as sun exposure, smoking, genetics, and repetitive facial expressions can contribute to their development.

The platysma is a thin, broad muscle that extends from the chest and shoulders to the lower face and neck. It plays a role in facial expressions and neck movements. Platysma bands, also known as platysmal bands or neck bands, refer to the vertical bands or cords that can become visible in the neck area. These bands are formed by the contraction of the platysma muscle.

mentalis overactivity
Mentalis hyperactivity at the chin

What medical conditions can Botulinum Toxin treat?

Botulinum toxin has been in use since the late 1970s. The ability to enhance muscle relaxation and reduce muscle tension underpins its main therapeutic effect. Botulinum toxin is FDA-approved for the following medical conditions:

  • Chronic migraine
  • Cervical dystonia (abnormal head twitching)
  • Blepharospasm (eyelid spasm)
  • Strabismus (lazy eyes)
  • Cosmetic
  • Axillary hyperhidrosis 
  • Hemifacial spasms
  • Urinary incontinence from detrusor overactivity (overactive bladder)

What botulinum toxin brands are there?

types of botox
Different brands of botulinum toxin

The current FDA-approved and HSA-approved Botulinum toxin brands in Singapore are:

  • Botox (OnabotulinumtoxinA)
  • Dysport (AbobutulinumtonxA)
  • Xeomin (IncobotulinumtoxinA)

These botulinum toxin type A toxins have similar onset of action, takes about a week to achieve results and effects lasts three to five months for cosmetic use for facial wrinkles.

The differences mainly lie in the preparation, dilution and the number of units. This can be quite confusing, and many people assume that the units used for one brand is interchangeable with another. This is not the case. For example, 4 units of Botox is not equivalent to 4 units of Dysport. Depending on dilution, 1 unit of Botox is about 2.5 units of Dysport. What is important for any successful treatment is the experience of the doctor using the particular brand who can administer the appropriate quantities skilfully. 

What is the cost of botox in Singapore

The price of Botulinum toxin cosmetic treatment varies greatly in Singapore. The pricing depends on factors such as the area or areas injected, the number of units injected, the brand used and the experience of the doctor.

The price per treatment area can range from $150 to $500 per visit.

The price per unit depending on brand:

  • Botox: $15-$25 per unit
  • Dysport: $8-$18 per unit
  • Xeomin: $12-$20 per unit

The number of units used per treatment area differs across individuals. For instance, a man with stronger muscles at the frown lines will typically need more units injected than a female with moderate frown lines. 

Indications
Botox Units
Dysport Units
Injection Points
Glabellar (frown) lines
12 to 40 units
35 to 100 units
3 to 7
Horizontal forehead lines
8 to 25 units
20 to 60 units
4 to 8
Lateral canthal lines (Crow's feet)
6 to 15 units/side
15 to 35 units/side
1 to 5

What are the Contraindications to Botulinum Toxin Treatment?

Individuals with the following conditions are not suited for Botox treatment. These include:

  • Neuromuscular disorders
  • Amyotrophic lateral sclerosis
  • Pregnancy or planning to get pregnant
  • Breastfeeding
  • Infection to the area to be injected
  • Botulinum toxin or its additive allergies
  • Bleeding disorders or on anticoagulants
  • Drugs such as aminoglycosides and calcium channel blockers

What are Important Things to Note Before your treatment?

Before your treatment, a consultation is necessary to assess your suitability for the procedure. A medical history and clinical examination is carried out together with an exploration of the treatment options and their potential side effects.

If you are experiencing any infection or inflammation of the skin, these need to be treated first. 

If you are on any medications, these must be declared during your visits as some drugs may interfere with your Botox treatment.

Customized-Tailored Approach

An individualised, integrated approach to assessment and treatment planning is essential. A comprehensive facial assessment includes both dynamic and static wrinkles observation. During the consultation, several factors are assessed to determine the dose and injection placement. These include:

  • Muscle mass
  • Anatomy
  • Contraction pattern

The best botox treatment is one that considers your goals while understanding anatomical and functional analysis in the context of facial morphology and the aging process.

What is the treatment procedure like?

After thoroughly cleansing and disinfecting your skin, a topical anaesthetic is applied if appropriate before the start of your treartment. Some patients would prefer ‘ice packs’ for numbing instead of topical anaesthesia. Others prefer a combination of both methods. 

Botox is injected into the areas to be treated. You may feel a fleeting stinging sensation which is tolerable in general.

Can We combine btx with other treatments?

This would depend on the individual skin condition, skin quality and age.

The objectives for younger patients would be to prevent the worsening of the wrinkes, delay the aging process and maintaining a youthful look.

Apart from wrinkles, facial aging also encompasses soft tissue deflation and changes to the underlying supportive bony tissues. Age related treatment goals must therefore take into account these changes. A multimodality approach with Botox, fillers, lasers and energy based devices are tools to holistically improve your facial appearance at every stage.

Frequently Asked Questions About Botulinum Toxin Wrinkle Treatments

Botulinum toxin injections are mainly indicated for dynamic wrinkles. These wrinkles are obvious with facial movements; smiling, frowning and looking surprised. Static wrinkles, on the other hand, do not respond to botulinum toxin injections. From studies, static wrinkles are better treated with laser or energy-based resurfacing procedures.

The price of botulinum toxin wrinkle treatment per area is from $250 per visit. 

Common areas include the forehead lines, glabellar (frown lines) and wrinkles around the eyes (Crow’s feet)

A review is done within 2 weeks, and a touch up is done free of charge within this time if necessary.

Between the 3 common brands (Botox, Dysport, Xeomin), the average time to see results is 3-7 days. Some individuals would be able to appreciate a difference within 24hours.

The cosmetic effect of botulinum toxin treatments initially lasts for 4 months, but gradually increases to 6 months or more with regular treatments as the muscles are more relaxed.

For the treatment of axillary hyperhydrosis, a significant reduction in sweating is noticed within 2 weeks, and results lasts 6-7 months.

  • Mild injection site redness and swelling are common, which fades in a few hours. Mild bruising may be encountered and resolves in a 7-10 days. 
  • Some individuals may experience a headache following treatment. This is common and simple painkillers will usually address the issue.
  • Some patients may notice asymmetry in certain areas due to differences in muscle strength and dosage applied.  The Mephisto (spock)  effect is a relatively common side effect where the sides of the of the forehead muscles are still active where the central parts are relaxed. Fortunately, these can be corrected at follow up visits by injection to the active areas.
  • Uncommonly, some individuals may notice a lowering of the eyelid or eyebrow (ptosis). These effects are temporary taking a few weeks to resolved.
  • Peri-orbital swelling
  • Compensatory muscle hypertrophy
  • Rarely, one may be allergic to botox treatments, which can range from mild rashes to anaphylaxis.

Botox is injected into the muscle causing the muscle to relax, improving the appearance of the lines. Botox works by binding to receptors that send nerve signals for muscles to contract. Since your body is constantly making new receptors and neurotransmitters all the time, future Botox treatments will be needed to maintain the relaxed and smooth appearance.  If treatments are not kept up the wrinkles will slowly return as the muscle regains function over time. Botox takes generally two weeks to start working optimally and lasts for up to six months.

Studies have shown that treating multiple facial wrinkles are associated with improved outcomes. For example, simultaneous treatment of lateral canthal lines (crow’s feet) and glabellar (frown lines) revealed better benefit.

For some reasons, some patients may develop antibodies to botulinum toxin treatments. The risk of immunogenicity is higher with top ups within a short period of time and re-treatments less than 4 months.

  • Do not touch the area 4 hours after the procedure to avoid infection and avoid make up for 12hours.
  • Use a mineral based sunscreen (SPF 30-50) post treatment. UV radiation can potentially degrade the toxin.
  • Stay upright for 4hours following the procedure to avoid unwanted migration of the product to other areas of the face.
  • Avoid massaging the area following the botulinum toxin injection.
  • To ensure safe and long lasting results, you will be asked to exercise certain muscle groups after injection. Raising your eyebrows, frowning and smiling for 20 minutes after the procedure has shown to enhance effectiveness. This is because with increased muscle activity, the botulinum toxin proteins will concentrate around the targeted muscle group.
Dr Moses Ng dermatologist

Botox treatment

Botox treatment represents a gold standard in non-surgical cosmetic procedures, renowned for its ability to rejuvenate and refresh the appearance with precision and minimal downtime. Utilizing botulinum toxin type A, Botox injections are expertly administered to temporarily relax targeted facial muscles, effectively reducing the appearance of dynamic wrinkles and lines. This proven and FDA-approved treatment is widely trusted for its ability to smooth away crow's feet, forehead lines, and frown lines, restoring a more youthful and relaxed appearance.

Schedule a consultation for botulinum toxin wrinkle treatment in singapore

Botulinum toxin injections is an exceptional procedure that offers incredible, lasting results, especially when offered by an experienced injector such as Dr. Ng. Offering a customized treatment for each patient, Dr. Ng combines multiple treatments, techniques, and products to help each patient meet their individual goals. 

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Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

References:
  1. Frevert J. Content of botulinum neurotoxin in Botox®/Vistabel®, Dysport®/Azzalure®, and Xeomin®/Bocouture®. Drugs R D. 2010. 10(2):67-73.
  2. Schlessinger J, Dover JS, Joseph J, et al. Long-term safety of abobotulinumtoxinA for the treatment of glabellar lines: results from a 36-month, multicenter, open-label extension study. Dermatol Surg. 2014 Feb. 40(2):176-83.
  3. Yeilding RH, Fezza JP. A Prospective, Split-Face, Randomized, Double-Blind Study Comparing OnabotulinumtoxinA to IncobotulinumtoxinA for Upper Face Wrinkles. Plast Reconstr Surg. 2015 May. 135 (5):1328-35.
  4. Carruthers J, Rivkin A, Donofrio L, et al. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Repeated OnabotulinumtoxinA Treatments in Subjects With Crow’s Feet Lines and Glabellar Lines. Dermatol Surg. 2015 Jun. 41 (6):702-11.
  5. Sundaram H, Signorini M, Liew S, de Almeida AR, Wu Y, Braz AV, Fagien S, Goodman GJ, Monheit G, Raspaldo H, Group GA. Global aesthetics consensus: botulinum toxin type A—evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plastic and reconstructive surgery. 2016 Mar;137(3):518.
  6. Moers-Carpi M, Carruthers J, Fagien S, et al. Efficacy and safety of onabotulinumtoxinA for treating crow’s feet lines alone or in combination with glabellar lines: A multicenter, randomized, controlled trial. Dermatol Surg. 2015;41:102–112.