By Mark Gorman, Aesthetic Fellow
Though best known for its ability to smooth wrinkles in the face, the well known anti-wrinkle treatment may treat a surprising number of conditions, from chronic migraines through to excessive sweating. With a long tradition of aesthetic excellence, The McIndoe Centre offers many of these treatments.
Administered by a licensed professional, anti-wrinkle treatment is generally safe, but is not without risk. As highlighted by organisations such as the British Association of Plastic Surgeons (BAPRAS) such non-invasive procedures should not be trivialised, guarding against its use by those not adequately trained, in unregulated environments. Though rare, complications do occur and it is in these circumstances that you need an expert. With this in mind, we will briefly examine the history, differing benefits, and the potential risks.
Aesthetic Fellowship at The McIndoe Centre
Part of a Plastic Surgeon’s aesthetic training, from non-invasive to invasive surgical procedures often involves a ring-fenced ‘fellowship’ period – a finishing school in all things aesthetic! Like many of the surgeons at The McIndoe Centre, prior to completing their training, they were previously aesthetic fellows. The initiative of Martin Jones (Consultant Plastic and Reconstructive Surgeon) combined with Horder Healthcare, and new Manager Maggie Middleton, has rekindled this training scheme; myself being the first to re-start the role. It’s this sort of training that develops the right expertise needed to keep patients safe, and leads to reliable, optimal outcomes in aesthetic and non-invasive treatments.
The need for staff regulation
Since it was introduced to the market, over 30 years ago, it is the most popular brand of botulinum toxin. It works by preventing signals from the nerve cells reaching muscles, effectively leaving the muscles without instructions to contract, therefore paralysing them.
Though potentially deadly, in the tiny concentrations used, it is generally very safe. However, it has been linked to some serious, side-effects, such as vision and breathing problems. As a result, the U.S. Food and Drug Administration (FDA) requires it to carry a ‘black box warning’—the strongest type of warning label on any drug.
So how worried should you be? With regards to serious side effects, the answer is not very; they are extremely rare. The caveat being that when treated by an expert, such events should be avoided, or managed successfully if they do occur.
Common side effects
More common, but less serious side effects relate mainly to undesired weakening of muscles, such as drooping eyelids (‘ptosis’) when treating wrinkles in that area. The only effective treatment for true lid ptosis is the application of eye-drops (e.g. Iopidine), which stimulate an eyelid-lifting muscle (Muller's muscle) to counteract the effect. If left, ptosis resolves spontaneously in about 4-6 weeks, but can last up to 3 months.
Studies have shown that the average practitioner, injecting in the forehead, may experience varying degrees of eyelid ptosis in up to as many as 1 in 20 people (5%), where-as in the those considered experts, this reduces to less than 1 in a 200 (<1%)! Simply put, you’re 10 times less likely to have a problem if treated by a licensed expert.
It’s also important to know that there are different types of botulinum toxin, as the most well-known type of anti-wrinkle treatment may not be effective for all individuals. Around 1% of people receiving injections can develop antibodies to the toxin that make subsequent treatments ineffective, and in this instance may try other brands.
Excessive sweating – hyperhidrosis (FDA approved 2004): When doctors noticed that their patients being treated for facial spasms were sweating less, armpits became an obvious target! Over-active sweating (‘hyperhidrosis’) can occur anywhere in the body, other areas include the feet, hands and face. Injections work again by blocking signals, this time between the brain and sweat glands. Effects last for on average between 4-6 months. Other than the common side-effects of short-lived injection site bruising, the most bothersome risk is compensatory sweating - another part of your body sweating more to make up for the treated area.
Migraines (FDA approved 2010): Back in the early ‘90s, Dr Binder, a Beverly Hills Plastic Surgeon noted that patients for wrinkles also had fewer headaches. The theory being, that relaxing the muscles around the head and neck region, reduces the tension and pain signalling pathways that lead to migraines. Effects tend to last for 3 months and are thus repeated as required. The main adverse effect is potential neck pain, experienced in approximately 5% of cases. The UK’s National Institute for Health and Clinical Excellence (NICE) recommends that injections can be considered as an option for the prevention of headaches for people who have chronic migraines (headaches on at least 15 days of every month, at least eight days of which are migraines) that has not responded to at least three prior preventative drug treatments.
Other interesting uses for ‘off label’ treatments not FDA approved or advocated by NICE and not provided by The McIndoe Centre range from severely cold hands, through to depression and premature ejaculation. Allergan is currently testing for such issues - we await future developments in these areas! In the meantime, using these injections to reduce facial wrinkles, overactive sweating and migraines, can be life-changing.