Botox – The facts: To ‘refresh’ or not to refresh using injectables

Have you thought about Botox?

Welcome to Mid-life

Many of us in “middle age” or midlife” are going through the peri or menopause and a myriad of changes. One of these delightful  – LOL! – changes, that seemingly happens overnight, is a new slackness to our skin. More fine lines and facial wrinkles begin to appear at an almost alarming rate due to the hormonal changes occurring within the body and the natural ageing process. 

While many of us are happy in our skin and proud of the years of laughter those lines represent, many are also interested in a little bit of ‘refreshing’ in order to boost confidence and age gracefully.

One option that pops up either in internet searches or in coffee chats with girlfriends, is Botox and injectables. These provide quick and almost instant results with little or no downtime and help reduce the haggard look caused by wrinkles and fine lines, resulting in firmer and smoother skin. 

The science of Botox

If you have ever wondered “What is Botox and what are the pros and cons?” or “Is it really for me?” then read on girlfriends…

Today we provide some science behind the ‘fine line fixer’.

Botox is the trade mark name for the commercially produced Botulinum toxin produced by Allergan Inc. Many people use this term interchangeably with the products listed below. Botox is the most potent neurotoxic protein on the planet and is produced by the bacteria Clostridium botulinum.

Commercial versions of Botulinum toxin include:
  • Botox (onabotulinumtoxin A) trademark:  Allergan Inc.

  • Dysport (abobotulinumtoxin A) tradmark: IPSEN

  • Xeomin (incobotulinumtoxin A) trademark: MERZ

  • Myobloc (rimabotulinumtoxin B) trademark: Solstice

  • Jeuveau (prabotulinumtoxin A)  trademark: Evolus

 USES for ‘Botox’:

The bacteria C. botulinum is used to prepare the treatments Botox, Dysport, Xeomin, Neurobloc and many other neurotoxic products flooding the market. These are used to selectively paralyse muscles by temporarily relieving muscle function.

C. Botulinum has other “off-label” medical purposes such as – treating severe facial pain caused by trigeminal neuralgia.

Theses neurotoxins are destructive to nerve tissue by preventing the release of acetylcholine, a chemical that is released by nerve cells that causes muscles to contract. A deficiency in this neurotransmitter and a decrease in its production, results in a weakening of muscles that the nerves service.

Botulism toxins when used medicinally, are purified and diluted and have been used successfully to treat many conditions some of which are listed below. 

HOW does it work?

“Botox” (or botulism neurotoxin) is now commonly used for cosmetic aesthetics, including the reduction of wrinkles especially in the upper third of the face.

Injections of Botulinum toxin into the muscles; under facial wrinkles causes relaxation and loss of ability for the muscle to contract. This results in the smoothing of overlying skin, thus providing a wrinkle-free and naturally a more youthful look.

Botox or Dysport?

A number of scientific studies were conducted to compare the outcomes of the two major brands used for aesthetics in wrinkle treatments to the face.  Most of them focused on comparing Botox and Dysport. The differences between these two products lies in the potency of trace proteins. 

The outcome of this concluded  that experienced users (injectors) should achieve equivalent results regardless of BoNT-A (Botulinum toxin serotype A) formulation, … Finally, whereas the products have similar efficacy when properly dosed, Dysport has a better cost-efficacy profile”

There are reports that Dysport should be used in those with moderate to severe creases or lines as it has a “feathering” effect ie It tends to spread out under the skin. Botox on the other hand has been reported to work better on the lines in the forehead.

In essence, the science behind these two injectable antiwrinkle treatments is the same and given the experience of the injector, the results achieved will be the same.

It is important to note: Neither treatment gets rid of existing wrinkles forever, but the effects are meant to make wrinkles less noticeable and hence give you a more youthful look with a smooth appearance!

What to take into consideration

There are a few things that come to mind straight away when deciding on whether to “refresh” or not: $ cost, pain, what will it look like on me and how long will it last, recovery time,  and of course, are there side effects.

Let’s start with cost $.

The best way to estimate cost is to book a consultation with your chosen therapist or consultant.

Cost is largely dependent on what size area you are looking to reduce the lines from and how ingrained those lines are, as this equates to how much is injected, which is measured in units.  The more active or stronger your muscles are, the more units are needed to weaken or paralyse them. Hence the more it will cost.  Dysport, on average, is less expensive than Botox, but injectors use more units of Dysport so, in the end, there is not much difference in price.

Average Dysport price in Australia = Between $4 -$5 per unit. Average Botox price in Australia = $13.80-19.00 per unit.  Some practitioners say they inject an average of 8 to 20 units into the forehead. Allergan, the manufacturer of Botox Cosmetic, suggests a dosage of 4 units each in five sites on the forehead, totaling 20 units.

Will it hurt??  

The administration of the treatment is via a needle, so  it will be uncomfortable and it depends on your pain threshold, needle phobia and the number of injections required, to determine any pain you will feel.

Most likely, people get anxious thinking about the injection itself and the phobia of needles is the most common reason people opt out of getting these treatments. Generally, there is “discomfort” and most people liken it to a pinch or sting upon injection. 

So now that you have had the injections, what will it look like?

Results can take up to 14 days  to be fully visible; but some people notice a difference within 48 hours. Typically, Dysport results are visible within 1 to 3 days, while Botox can take up to 5 days to begin to see any changes. Dysport injections may be deeper than Botox injections, so they can encompass a wider treatment area.

Anti-wrinkle injections can look as dramatic or as subtle as you desire.  The look you achieve is greatly reliant on your clinician and their experience. But remember everyone is different and the muscle strength varies in each person and even between each area on the face, so it may take a few treatment sessions from your technician to get your dosing perfect and achieve your desired effect.

How long will it last?

The length of effect from the treatment also varies from person to person and is dependent on the number of units used in your treatment. Both Botox and Dysport treatments are not permanent and must be repeated roughly every 3 to 4 months to continue their muscle-relaxing effect. There may be a slightly cumulative effect and many injectors claim that if kept up regularly, the muscles over time are more relaxed therefore there is less wrinkling naturally.

What is the recovery time before I can resume normal activity?

There is no recovery or downtime for these procedures as no sedatives or anaesthetics are used, you can return to normal activities directly after the procedure. Occasionally there is some minor swelling – like a ‘mozzie bite’ and minor bleeding at the site of injection which ceases almost immediately. Also, minor bruising may occur if the clinician accidentally injects into a blood vessel (of which there are many around the eyes), nothing which cannot be covered.

What might happen to me as a side effect of using injectables?

Using antiwrinkle injectables are relatively safe when performed by an experienced clinician or health practitioner. But with any medical procedure that is invasive and foreign to the body, there are risks associated.

Often the clinician will warn you there could be a small amount of bruising around the treated areas, however this is temporary. Another potential side effect that rarely occurs is a slight drooping of the eyebrow or upper eyelid, usually correcting itself in two to three weeks and the same with uneven eyebrows.  Some patients experience headaches, heaviness in the forehead and eye dryness or excessive tearing.

For most patients there are no serious side effects associated with this treatment.  But our advice would be to prioritise skill, experience, and credentials over cost or convenience of your treatments. Side effects and adverse reactions are possible with any medical treatment, so choose a provider with the credentials, experience and expertise to keep you safe.

Let’s face it, if you are injecting a toxin that causes paralysis into your face, you really need it done by someone who knows what they are doing!!

 My personal experience:

I went for antiwrinkle treatments to reduce the creases in my forehead and the horrible crease in between my brow (glabella) that everyone comments on.  “ Why are you frowning?” 

I visited along with Shelley who wanted a ‘refresh for the forehead and glabella (between the brows) also and we decided to document the process.

Sarah: Forehead Pre- treatment
Shell: Forehead Pre-treatment
Shell: Glabella (between the eyebrows)

The practitioner I chose was very experienced and uses both Botox and Dysport. We decided to use Dysport.

Shell has had this before with great results.

I had 26 units injected into  my forehead and 50 units in my brow crease. 

My initial reaction:

I had a few blood spots that stopped in seconds. It was a needle and it did feel like a pinch or an injection, but was very manageable (by the way I don’t have any needle phobias).

The next couple of  days I was fine and I could feel a heaviness in my forehead and a lack of ability to lift my eyebrows. I was lifting but nothing was happening… that’s a good thing!! 

Shell reported the same. She describes it as ‘a tight feeling across the forehead.”

Day 3 and I have a lovely, nice, smooth forehead …  and my crease is not as pronounced. I can still lift my brows.

Shell says there is some minor change in her forehead but it usually kicks in around 4-5 days for her. We asked our technician to administer a dose that would ‘soften’ but still allow movement in the brows to look natural.

Day 5 with a frown… my crease is not so prominent..and forehead is smooth, but I noticed that my eyelids were very heavy, and in fact I had to lift them off my eyelashes to apply mascara!  This is not normal…

By Day 5  for Shell, it is 100% smooth and she is very happy with the result and she can still move her brows up and down for expression which is important to her. While the glabella is still visible slighly when she frowns, it is much more softened. Thanks Matt!

Day 5 neutral pose and you can clearly see my forehead is smooth, although my left eyebrow is lower. Unfortunately, my eyes were affected with swelling and droopy eyelids. I had tired eyelids and they were very puffy with the skin feeling loose and excessive. It was like there was no elasticity holding them up.

I do have hooded eyes at the best of times, but this was way over the top. Rang our technician who says I have periorbital edema, a rare side-effect.


Sarah: Day 3
Shell: Day 3
Sarah: Day 5 Smooth !
Shell: Day 5 Refreshed with eyebrows raised!
Eyelids heavy
Eyelids heavy

Of course my experience was rare but BoNTA-induced periorbital edema (swelling in the eye socket) is self-limiting, and normally resolves in 2 to 4 weeks without medical treatment. I have been in touch with my practitioner and as suggested, I have been applying hot pads over the eyes, frequent blinking in the morning, and performing self-massage to the area in order to increase venous return.  This and time are certainly helping my eyes recover.

So I suppose the big question is will I do it again?

Day 14

Yes I will be “refreshing” again! But my practitioner will be adjusting my treatment plan to reduce the risk of the edema happening next time, fingers crossed.

Disclosure: We do not endorse or suggest anyone get facial injectables. We are not getting them to please anyone but ourselves  and are posting some facts and current info for those who are interested.