Just Relax: Q&A Muscle Relaxants

Believe it or not, when patients visit our clinics for injectables or any other treatment, everyone generally has the same questions!

Have you read our in-depth blog regarding Fillers? Take a peak here

We asked incredibly talented and experienced Registered & Cosmetic Nurse, Jasmine to answer the most commonly asked questions in our clinic regarding, muscle relaxants.

How do muscle relaxants work?
Cosmetically, muscle relaxants are injected into the muscles of the face in order to block nerve impulses to the tissue that allows the facial muscles to contact.

When we express with our facial muscles they contact, causing the skin to furrow and fold.  Muscle relaxants work beneath the skin’s surface by targeting this underlying muscle activity by weakening the target muscle in order to prevent formation of expression lines. 

With muscle activity reduced, a smoother look to the skin is achieved as the muscle beneath it is no longer able to crease the skin.

At a cellular level, nerve endings send chemical messengers called

Acetylcholine to the muscles to tell them to contract.  Botulinum toxin works to surround this chemical and essentially ‘block’ these messengers, therefore keeping the muscle relaxed so that it cannot contract and cause wrinkles in the skin.

What is it made of?  What will happen if I am allergic?  What is the difference between dysport and botox?
Although botulinum toxin products have some similarities in the way they work, no two botulinum toxins are exactly the same. 

Differences between products have clinical implications that may impact on patient satisfaction – such as potency, likelihood of diffusion from the injection site and duration of response.

‘Botox’, which is manufactured by Allergan, is unique and highly purified with protective accessory proteins. It is also a homogenous formulation containing large molecular complexes of 900 kDa.

Botox contains the ACTIVE ingredient Botulinum toxin type A which is a purified neurotoxin produced by a fermentation of the bacterium Clostridium botulinum Type A. 

INACTIVE ingredients used are human albumin which is a common protein in plasma, and Sodium Chloride (salty water) which is also added in the dilution process, enabling it to be injected.

Another muscle relaxant offered by Face Plus is Dysport, which is manufactured by a company called Galderma.  Dysport contains the same ingredients as Botox plus lactose.  As Dysport may contain trace amounts of cow’s milk protein, patients known to be allergic to cow’s milk protein should not be treated with Dysport.

Although allergic reactions are extremely rate, at Face Plus we conduct a thorough health history with each patient before treatment in order to reduce this risk even further. 

A check list is completed with the patient, ruling out any contraindications for the treatment.

Does it hurt?
Whenever a needle enters the skin some discomfort is always felt, however the degree of discomfort differs with the individual’s pain threshold. 

Usually though, most patients find the procedure very tolerable with only slight discomfort. Some patients report that it feels like a quick ‘pinch’.  We use ice to help numb the area and decrease the chance of bruising, and although not usually necessary for most patients we do offer adjuncts such as topical numbing cream if a patient is particularly concerned about discomfort.

What is the size of the needle?
At Face Plus we use the finest and shortest needle possible: 31 gauge BD syringe.  We also minimise the risk of bruising and discomfort by frequently changing the needles to ensure fresh sharps always used (each injection into the skin causes the needle to become blunt causing resistance and increased discomfort).

Are there any side effects or adverse effects?
Expected ‘side effects’ are usually minimal.
Slight swelling (raised bumps) and/or redness is common, and minimal, and should go away within a few hours.  Many patients will actually come for treatment on their lunch breaks or before they commence work.

Bruising is uncommon but can occur.  Although our injectors are skilled in identifying visible veins and avoiding injecting near them, some patients are more prone to bruising than others. 

Bruising is usually minimal and takes around 4 days to subside.  Arnica tablets, Hirudoid or Arnica creams can also be applied to reduce the bruise.

Occasionally, a temporary ‘tight’ feeling, or headache can also occur post treatment. When administered by a highly trained injector, unexpected ‘adverse effects’ are very unlikely, but can happen, and can sometimes occur due to the anatomy of the individual patient. 

According to Allergan, the manufacturers of Botox, the most common adverse reactions are 1 ) eyelid ptosis which occurs in 3% of patients being treated for frown lines.  And eyelid oedema which occurs in 3% of patients being treated for crows feet.

Patients with heavy upper eyelids are also more likely to experience brow ptosis when undergoing treatment for horizontal forehead lines, and this area will always be treated with

caution by our injectors.  This muscle will often be under treated in the first instance, with additional units at follow up in order to reduce the chances of brow ptosis.

Is it permanent? How long does it last?
The desired effects and adverse effects of muscle relaxants are not permanent.

Some patients may begin to notice results within 24 to 48 hours after injection, however maximum effect is achieved after 2 weeks post injection so it is important to be patient in this time.  At Face Plus we always recommend new patients return at this time so we can perfect the dosage as necessary.

The effects from muscle relaxants last up to 3-4 months however this may be for a longer or shorter period depending on the individual.  After this time muscle activity will resume and re-treatment is appropriate.

How much does it cost?
At Face Plus Botox is $16 per unit, and Dysport is $5.50 per unit.  Botox and Dysport dosages however are not equal due to the potency of the products.  1 unit of Botox is usually equivalent to the potency of around 2.5 units of Dysport.

The cost of your treatment varies greatly depending on the amount of areas treated, and the patient’s muscle size and subsequent strength.  For these reasons it is difficult to give a quote over the phone for muscle relaxant treatments as the injector will need to assess each patient after viewing their muscle activity and discussing their desired result.

The cost of the treatment not only includes the price of the toxin, but more importantly the skill and expertise of the healthcare professional administering the treatment. 

It is important to see an experienced injector who will take the time to understand the individual’s treatment goals and develop an appropriate treatment plan.

Why do some people have shiny heads? Does everyone get a shiny head after muscle relaxants?
Some patients may experience, or associate muscle relaxants with a shiny forehead.

The reason for this may be due to the lack of muscle movement, causing the area to appear smoother. This smooth appearance may give the illusion of a shinier forehead than usual.  This is because as muscles would move normally, the light diffuses on them differently casting shadows.  However when the muscles don’t move, the area appears more flat, the light reflects differently and the area can look shiny.

If a patient is looking to avoid this occurrence, the injector may suggest fewer units to the frontalis (forehead muscle), allowing movement and slight creasing to still occur.

When is the best age to start?
Legally, patients over the age of 18 may begin to use muscle relaxants if they are overly expressive and want to retain a smooth or soft appearance to the face.
A good time to start using botox is not so much dependent on age, but whether the patient is beginning to develop ‘static’ lines (lines that remain even after the muscle has relaxed).

When is it too late to start? What are the alternatives?
The reason for treating static lines is that if the muscle continues to contract, over time these shallow lines will continue to develop into more moderate or deep lines that will not longer be easily treated with relaxants. 

A combination of high-dose muscle relaxants and hyaluronic acid fillers may need to be used in these cases to achieve the desired result.  The reason for this is because the line is so deep that it in unable to smooth out even after muscle relaxation, and a gel filler needs to be injected to fill the line out.

Is it true when they say it’s a preventative to ageing? If I receive one treatment will I have to get muscle relaxants for the rest of my life?
No.  So far there has been no ‘cure’ for ageing.  It is however a preventative for developing deep rhytides (wrinkles) in the skin after regular treatments.
There is definitely no limit to the amount of muscle relaxant treatments your receive in your lifetime. 

If you only want to try the treatment once this is absolutely fine and will not be detrimental.  However, we often find that after first treatment people will be so happy with the effects that they will continue treatments as they look and feel more confident and refreshed. 

It is however important to remember that as skin is still ageing while we are receiving the treatment, if treatment is ceased for example 5 years after beginning it, the patient will regain movement and lines will creep back, and they will also be 5 years older.  However, with repeated use deep lines will not be able to form.

Can muscle relaxants improve the skin?
There have been several studies into the effects of botulinum toxin type A on skin condition.
A 2015 study from Journal of the American Medical Association titled ‘Alterations in the Elasticity, Pliability, and Viscoelastic Properties of Facial Skin After Injection of Onabotulinum Toxin A’ provides evidence that there is an alteration in biomechanical properties of the skin after injection with onabotulinum toxin A. This effect appears to last up to 4 months in the glabella and up to 3 months at other sites. However, it remains unclear whether this is due to an intrinsic property of the medication or another unrecognized mechanism.
A 2014 study titled ‘Skin Biomechanical Changes after Injection of Onabotulinum Toxin A: Prospective Assessment of Elasticity and Pliability’ concluded that Injection of onabotulinum toxin into the lateral orbital, forehead, and glabellar regions results in skin that has increased pliability as well as increased elastic recoil. Although this study demonstrates the positive effect of onabotulinum toxin on biomechanical parameters, it is unclear what specific histological changes are occurring

Can it be overdone? Why do people chose to do that?
Yes.  I’m sure everyone has seen either celebrities or someone they know personally with a treatment that has been too heavy, whether this is desired or undesired by the individual.
At Face Plus we aim to only relax the muscles and keep them hypokinetic, rather than causing them to be atonic (paralysed), as this is essential in retaining a natural look.  An ideal forehead treatment allows the brows to still be raised slightly. 

An ideal crows feet treatment allows the smile to still appear natural.
Some patients may choose to opt for the unnatural look due to their desire to completely erase all lines on their face, however our health professionals at Face Plus will always guide and educate patients on the most natural and safe treatment for the individual.
Certain cases where lines are very deep the strength of the dose has to be high allowing the muscle to be completely relaxed in order to allow the lines to smooth. 

This is usually the case in patients who have either not had muscle relaxants before and their static lines have progressed to be very deep, or patients who have not had them regularly enough.

What does the muscle relaxant look like? It is a liquid or gel?
Unlike hyaluronic acid fillers which are a gel-like, all muscle relaxants are in a clear liquid form.  Mostly composed of salty water.

Can I go on a plane after I’ve had it done?
Yes.  You should just avoid placing any pressure on your face if resting your face down in this time.

Is there anything I should or shouldn’t do before I get muscle relaxants?
Treatments that have caused inflammation of the skin or that have caused the skin to no longer be in-tact should be avoided before muscle relaxant injection.
All potential contraindications will be covered in the consultation before treatment, however it is advisable to avoid blood thinning products such as aspirin or Ibuprofin as it can increase the chances of bruising.

Can I exercise afterwards?  Can I go to bed after my appointment?  I heard that if I touch it straight after my treatment it can move around?
Studies have shown that the toxin takes at least 4 hours to reach the target muscle.  Therefore, to ensure safety we advise that the patient does not rub or massage the injected area for the first 24 hours after treatment.  It is also important not to allow any direct pressure on the area such as sleeping on the face or face-down massage, extreme temperature changes, strenuous exercise, exposure to prolonged sunlight, and excessive alcohol use in the 24 hours after treatment.

Which areas can you treat?  What can you fix with muscle relaxants? 
‘Botox’ is regulatory approved in Australia for glabellar frown lines, horizontal forehead lines, crow’s feet, and severe hyperhidrosis of the axillae.
Other ‘off-label’ cosmetic uses for muscle relaxants commonly include treatment of: bunny lines, chin dimples and chin crease, platysmal neck lines and rings, and lip lines. 

Muscle relaxants also have the ability to correct asymmetry of the face in relation to brow shape and brow height, as well as correction of a gummy smile, lifting of the brows bilaterally, decreasing the descending corners of the mouth, preventing nasal tip dip, and slimming of the lower face.

Will other people notice that I have had it done?
Depending on individual requirements, if the treatment is done correctly the result will be natural and others will not likely notice.  There are certain ‘obvious’ signs of muscle relaxant treatment such as lateral brow ‘spocking’ that can easily be addressed at follow up. 

This is another reason why follow up treatments are so important, especially for first time patients where ideal dose has not yet been established.  At Face Plus we pride ourselves on providing a natural looking, refreshing muscle relaxant treatment.

Directly after injection we can provide a light foundation in order to cover any signs of treatment if this is a concern for the patient.

Why is Face Plus Medispa the best place to get this done?
The practice of medicine is not an exact science and no guarantees can be made concerning expected results, and further appointments may be necessary to complete the treatment.  For this reason, at Face Plus we offer free follow up consultations in which we would ideally like all new muscle relaxant patients to utilise so that we can ensure optimum dose. 

Due to the nature of muscle relaxants we also treat with caution initially and may add more at follow up.  We do this to decrease the chances of adverse affects and an undesired unnatural look.  At Face Plus we are also very highly trained on the use of muscle relaxants and we will do everything we can to ensure a safe and effective treatment outcome for each and every patient.

You can read about our thorough consultation process for injectable treatments here

For a thorough cosmetic consultation with Jasmine or any of our other cosmetic nurses:
Call: 02 8897 0000
Email: [email protected]

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