Botulinum Toxin Precare Information

This page provides important information about your proposed treatment, including how it works, what you may expect, how to prepare and the potential benefits, limitations and risks. Please read it carefully before your appointment and contact us if you have any questions.

What is botulinum toxin treatment used for?

BOCOUTURE® is a prescription-only medicine containing botulinum toxin type A. It is licensed for the temporary improvement of moderate to severe upper facial lines in adults under 65 years of age where the lines have an important psychological impact. These include:

• glabellar lines (vertical frown lines between the eyebrows);
• lateral canthal lines (crow’s feet at the outer corners of the eyes); and
• horizontal forehead lines.

Botulinum toxin may also be used to treat other areas or concerns. These may include bunny lines, a gummy smile, lines around the lips, a pebbled chin, downturned corners of the mouth, brow lifting, platysmal bands in the neck and excessive underarm sweating. Some of these uses are “off-label”, which means that an authorised medicine is being used for an indication or treatment area not specifically included in its UK marketing authorisation. Off-label treatment is established in medical practice in appropriately selected patients. Your doctor will explain if your proposed treatment is off-label and why it is being recommended.

How does it work?

Botulinum toxin type A is a purified protein that temporarily reduces the nerve signals reaching the muscles into which it is injected. This weakens the action of the selected muscles and can soften lines caused by facial expression, known as dynamic lines.

Lines that remain visible when the face is relaxed are known as static lines. These may not improve fully with botulinum toxin treatment alone. The aim is usually to soften excessive muscle activity while retaining a natural appearance; it may not be possible or desirable to eliminate all movement.

Results vary according to factors including your facial anatomy, muscle activity, skin quality, treatment area and previous treatment. Improvement cannot be guaranteed.

What happens during treatment?

Small amounts of botulinum toxin are injected into selected muscles using a fine needle. Most patients experience only brief, mild discomfort at the injection sites.

What are the possible side effects and risks?

BOCOUTURE® has an established safety profile, but all medical treatments carry potential risks and side effects. Your doctor will assess your suitability and discuss any risks of particular relevance to you.

Expected injection-site effects

Temporary effects at the injection sites may include:

• mild pain, stinging or tenderness;
• small red or raised marks;
• minor bleeding; and
  bruising.

These effects are usually short-lived, although bruising can take several days to settle.

Other possible temporary effects

Some people experience a headache, a sensation of heaviness or tightness, or mild discomfort following treatment. Occasionally nausea, facial pain, eye pain, visual disturbance and flu-like symptoms have been reported. Paracetamol may be taken for discomfort if you can normally take it safely.

Infection at an injection site is uncommon but possible. Post-inflammatory pigmentation may occasionally develop following an injection, particularly in darker skin types.

Unwanted weakening of nearby muscles

Botulinum toxin may sometimes affect a nearby muscle as well as the intended treatment area, even when treatment has been administered correctly. Depending on the areas treated, this may result in:

• drooping of an eyelid or eyebrow;
• eyebrow or facial asymmetry;
• an excessively raised or pointed outer eyebrow, sometimes called a “Spock” or “Mephisto” brow;
• difficulty smiling, drinking or forming certain lip movements; or
• other unwanted changes in facial expression.

These effects are temporary and should gradually improve as the action of the botulinum toxin wears off, although this may take several weeks and occasionally longer. Prescription eye drops may be helpful in some cases of eyelid drooping.

When treating the forehead, the areas immediately above the outer eyebrows may need to be avoided or treated conservatively because injections in this area can increase the risk of eyebrow drooping. This means that it may not be possible to treat every forehead line.

Allergic reactions

Allergic reactions to botulinum toxin or to a product used during the procedure are uncommon but possible. If a topical anaesthetic has been used, an allergic reaction to this may also occur.

Call 999 or seek immediate medical attention if you develop symptoms of a severe allergic reaction, such as difficulty breathing, swelling of the face, lips, mouth or throat, widespread hives, wheezing or feeling faint.

Rare spread of toxin effect and iatrogenic botulism

In rare cases, the effects of botulinum toxin can spread beyond the area treated and cause generalised muscle weakness or a serious condition called iatrogenic botulism. Symptoms most commonly develop around 4–8 days after treatment but may occur at any time up to 4 weeks afterwards.

Warning signs include:

• difficulty breathing or shortness of breath;
• difficulty swallowing;
  slurred speech or other
• difficulty speaking;
• severe or unusual drooping of the upper eyelids; or
• facial or generalised muscle weakness.

These symptoms constitute a medical emergency. If you develop any of them following treatment, call 999 or attend your nearest A&E immediately. Do not wait for a response from the clinic before seeking emergency medical attention. Please notify the clinic once urgent medical help has been arranged.

How quickly does it work?

The effects are not immediate. You may begin to notice a change within approximately 3–7 days, although different muscles may respond at different times. The result will continue to develop over the following days and weeks.

Please wait at least 2 weeks before contacting the clinic about possible asymmetry or whether an adjustment may be required, unless you have a clinical concern that needs earlier assessment.

How long does it last?

The effect usually wears off gradually over approximately 3–4 months, although the duration varies between patients and treatment areas.

Treatment may be repeated to maintain the result. The interval between treatments should not be less than 3 months, unless there is a specific clinical reason agreed with your doctor.

Will I look worse if I stop treatment?

Stopping botulinum toxin treatment does not accelerate skin ageing or cause the skin to become worse than it would otherwise have been. Muscle activity will gradually return as the effect wears off, while your skin will continue to change in the usual way with time, ageing and lifestyle factors.

Suitability for treatment

The clinic generally offers cosmetic botulinum toxin treatment to patients aged 25–65. Suitability is assessed individually, and treatment outside the product’s licensed age range would require specific consideration by your doctor.

Please tell your doctor before your appointment if any of the following apply to you, as treatment may need to be postponed, modified or avoided:

• You are pregnant, breastfeeding, trying to conceive or think that you may be pregnant.
• You have a neurological or neuromuscular condition, such as myasthenia gravis, Lambert–Eaton syndrome or motor neurone disease.
• You have previously experienced an adverse reaction or unexpected response to botulinum toxin, such as difficulty swallowing.
• You have an infection, inflammation, rash or active cold sore in or close to the proposed treatment area.
• You are unwell on the day of treatment, including with a significant cough, cold, flu-like illness or fever.
• You have a bleeding or bruising disorder.
• You are taking anticoagulant or antiplatelet medication, such as warfarin, rivaroxaban, apixaban, clopidogrel or aspirin.
• You are taking medication that may interact with botulinum toxin, including certain antibiotics, such as aminoglycosides or clindamycin, or medicines that affect muscle function.
• You are due to have surgery or have recently undergone another cosmetic procedure.
• You have a history of severe allergy or anaphylaxis.

How should I prepare for my appointment?

Please:

• arrive with clean skin and without make-up in the areas to be treated;
• arrange your appointment at a time when you can avoid wearing make-up for the remainder of the day;
  avoid alcohol on the day of treatment;
• tell your doctor about any change in your health, medication or pregnancy status since booking; and
• allow at least 4 weeks between treatment and an important event or special occasion, in case bruising occurs or review is required.

After treatment, you will be advised to:

• remain upright for the first few hours;
• avoid rubbing, massaging or applying pressure to the treated areas;
• avoid steam rooms, saunas and vigorous exercise for 48 hours and, where possible, for up to 1 week; and
• follow the written aftercare advice provided by the clinic.

If you have any questions after reading this information, please contact us before your appointment.