Botulinum Toxin Wrinkle Treatments

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.

Looking Natural

Looking natural by reducing wrinkles can be maintained with the use of neuromodulator (Botox) 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 Does Botox 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.

What Can Botox Treat?

Botox has been in use since the late 1970s. The ability to enhance muscle relaxation and reduce muscle tension underpins its main therapeutic effect. Botox 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)

Botox for Cosmetic Treatment

Botox for cosmetic or aesthetic use helps to reduce the appearance of dynamic facial wrinkles. Commonly treated areas for Botox cosmetic treatment include:

  • Glabella (frown) lines
  • Forehead lines
  • Crow’s feet (wrinkles around the eyes)

Botulinum Toxin Wrinkle Treatment Areas

botulinum-toxin-treatments

Botox Brands

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. 

Botox Prices in Singapore

The price of Botox 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.

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

Botox 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

Contraindications to Botox:

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

  • Neuromuscular disorders
  • Amyotrophic lateral sclerosis
  • Pregnancy
  • Breastfeeding
  • Botulinum toxin allergies

Important Things to Note Before your Botox 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.

Patient-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 Botox 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 Botox be combined 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.

The price of botulinum toxin wrinkle treatment per area is from $249 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.

Uncommonly, some individuals may notice a lowering of the eyelid or eyebrow. These effects are temporary taking a few weeks to resolved.

Rarely, one may be allergic to botox treatments, which can range from mild rashes to anaphylaxis.

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

  • 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

With well-placed injections of appropriate quantities of botulinum toxin to the treated areas, Botox can give you natural looking results without hampering your ability to express your emotions.

Dr Moses Ng

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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.