Anti-wrinkle Treatments: Botulinum Toxin

There are several formulations of botulinum toxin available worldwide. In New Zealand, there are three Medsafe-approved botulinum toxin products. These are:

• Botox®
• Xeomin®
• Dysport®

Botulinum toxin is commonly used for:
Reducing the appearance of fine lines and wrinkles on the face, particularly around the forehead and eyes. 

• Lifting the brow or eyelids
• Softening facial expressions such as frown lines
• Treating medical conditions such as excessive sweating (hyperhidrosis), migraines, and muscle spasms
• There are multiple off-label uses of botulinum toxin that are utilised by medical professionals for both medical and cosmetic reasons

Botulinum toxin works by blocking the nerve signals that tell muscles to contract. When injected into specific muscles, it temporarily prevents those muscles from contracting, leading to the smoothing of wrinkles and the reduction of certain facial expressions.

Botulinum toxin treatments are suitable for adults seeking to reduce the appearance of dynamic wrinkles caused by repeated facial movements, such as frowning or squinting. It is generally not recommended for people who have certain neuromuscular conditions or certain medications (like aminoglycosides). A consultation with a qualified practitioner will help determine whether the treatment is appropriate for you.

Botulinum toxin and dermal fillers are both injectable treatments used in aesthetic medicine, but they work differently and are used for different concerns.

• Botulinum toxin (e.g. Botox®, Dysport®, Xeomin®) relaxes specific facial muscles to reduce the appearance of dynamic wrinkles, those caused by repeated facial movement, such as frown lines or crow’s feet.
• Dermal fillers are gel-like substances, most commonly made from hyaluronic acid, that add volume to specific areas of the face,often where this is lost due to the ageing processes. They are frequently used in areas such as the cheeks, lips, and jawline.

The effects of botulinum toxin generally last between 3 to 6 months, depending on the individual, the area treated and the amount of botulinum toxin used. Over time, the body gradually reinstates the temporarily blocked nerve signals, and muscle activity returns to normal, which is why regular re-treatments are required to maintain results.

Botulinum toxin treatments are regulated by Medsafe, the New Zealand Medicines and Medical Devices Safety Authority. Medsafe approves only certain botulinum toxin products that meet stringent safety and efficacy standards. Botox®, Xeomin®, and Dysport® are all Medsafe-approved products that are deemed safe for use in aesthetic treatments.
It is important to ensure that your practitioner uses only Medsafe-approved products which have been obtained from the approved distributor, as non-approved products may pose unknown risks. When administered by a trained and qualified practitioner, botulinum toxin treatments are supported by extensive clinical research and a long history of safe use.

Botulinum toxin treatments in New Zealand must be performed by a registered healthcare practitioner such as a medical doctor, dentist, or nurse who is trained and authorised to administer these injections. Practitioners must work within their professional scope of practice and should adhere to high standards of safety, hygiene, and training. Each governing body has its own set of rules and standards around the level of training required to administer botulinum toxin, and either professional oversight is required or not. The rules for doctors are set out by the New Zealand Medical Council, "Statement on cosmetic procedures". 
NZSCM recommends choosing a provider who:

• Is registered with the Medical, Nursing, or Dental Council of New Zealand
• Has specific, high quality training and experience in administering botulinum toxin injections.
• Uses only Medsafe-approved products such as Botox®, Xeomin®, or Dysport®
• Follows proper clinical procedures and hygiene standards
• Provides a thorough consultation and informed consent process

Patients can trust that NZSCM-accredited doctors as they have had thorough, assessed training across all of these domains. 

To ensure the best results and reduce the risk of bruising or swelling, it is advisable to:

• Avoid alcohol, anti-inflammatory medications (such as ibuprofen), and certain herbal supplements (e.g fish oil tablets) for 24-48 hours before treatment (unless advised otherwise by your practitioner).
• Inform your practitioner of any medical conditions, medications, or allergies that you have. 
• Ensure you have time for a full consultation, where you can discuss in depth, your aesthetic goals, treatment expectations, medical history and any potential side effects. 

Before agreeing to treatment, it’s important to ask the following questions:

• What type of botulinum toxin will be used, and why?
• How experienced are you in administering this treatment?
• What training have you undertaken? (NZSCM-accredited doctors complete a 2-year-long Post Graduate Diploma, which takes over 500 hours and involves multiple levels of assessment and examination.)
• What results should I expect, and how long will they last?
• What are the risks, and how would any complications be handled?
• What does aftercare involve?

During your consultation, your practitioner will:

• Review your medical history and assess your facial structure to understand your aesthetic goals
• Discuss which areas of your face you wish to treat and explain the expected results
• Go over the benefits, potential risks, and the procedure itself
• Obtain your informed consent before proceeding with the treatment
• The treatment involves a series of small injections into specific facial muscles. Most patients experience minimal discomfort during the procedure, as the needles are very fine, and some practitioners may apply a topical numbing cream to the area beforehand.

After treatment, you may experience some mild temporary side effects, including:

• Mild redness, swelling, or tenderness at the injection sites (which typically resolves within a few hours to a few days)
• Small bruising, which may take a few days to subside
• Temporary headache or flu-like symptoms in rare cases

You should follow these guidelines:

• Avoid strenuous exercise
• Avoid any excessive compression or rubbing of the treated area
• Avoid makeup on the treated area for the first 24 hours unless advised otherwise
• Results often start to become visible within 2-3 days, but the final outcome can take up to two weeks to take full effect

If you experience unusual symptoms such as sudden or severe pain, difficulty swallowing, vision changes, or any other concerning side effects, contact your practitioner immediately. While these events are extremely rare, it’s always important to be proactive in seeking medical advice.

• Botox®, Prescription Medicine
  For the treatment of frown lines and crow’s feet around the eyes
  Botox® has risks and benefits. Ask your doctor if Botox is right for you
  Botulinum toxin type A 50, 100, 200 Units.
  For product information, check with your doctor or Consumer Medicine Information on medsafe.govt.nz   Click for further details.
  Allergan, Auckland.
• Dysport®, Prescription Medicine
  For the treatment of frown lines and crow’s feet around the eyes.
  Dysport® has risks and benefits. Ask your doctor if Dysport is right for you
  Botulinum toxin type A 300 or 500 Ipsen Units
  For product information check with your doctor or Consumer Medicine Information on medsafe.govt.nz. Click for further details
  Galderma, Auckland.
• Xeomin® (incobotulinum toxin) Prescription Medicine
  for the treatment of upper facial lines: glabellar frown lines, crow’s feet around the eyes, horizontal forehead lines
  Xeomin has risks and benefits. Ask your doctor if Xeomin is right for you
  (incobotulinum toxin A, purified Botulinum toxin type A 50 Units and 100 Units
  For product information check with your doctor or Consumer Medicine Information on medsafe.govt.nz. Click for further details
  Pharmacy Retailing NZ Ltd t/a Healthcare Logistics, Auckland.