The secrets to staying safe in Botox Britain
More and more of us have been seduced by Botox. Once, the wrinkle-reducing jab was considered a treatment for ageing Hollywood stars. But now it’s estimated that more than one million Botox injections are performed in the UK every year.
However, the results of research by University College London (UCL) into side effects makes for scary reading. Of 511 patients who responded to an online questionnaire about their experiences, four out of five said they suffered side effects, including headaches, dizziness, and brain fog after receiving the anti-wrinkle jab. Anxiety was the most common complication, affecting 85 people, but six people reported that the jab had left them disabled. One even claimed that side effects of their wrinkle-reducing treatment had cost them ￡1 million in “monetary values or time they took off work”.
The statistics however have raised eyebrows – at least in those still able to move their features. Especially as a separate survey from the British College of Aesthetic Medicine (BCAM), which represents doctors and dentists practising aesthetic medicine, reports that the “rate of adverse events following botulinum treatments remains low at 0.33 per cent (3.3 per 1,000 treatments)”.
Researchers from UCL advertised the survey on social media earlier this year, and although 655 people replied, only 287 answered all 17 questions, some answering so few that only 511 were analysed.
Dr Kam Auluk is a dentist and clinical director at the Skin Culturist clinic in London says, “It is important to emphasise that only 44 per cent of the patients answered all the questions in the survey, of which 77 per cent reported adverse affects. We can assume that the majority of 56 per cent of non-respondents had no adverse effects and consequently did not report, although it is difficult to prove this.” It’s also true that self-selecting studies like this tend to be biased.
However, Dr Auluk adds that what the study really highlights “is that the facial aesthetics industry is poorly regulated”. In the survey, only half of patients reported having their treatment in an aesthetics clinic, with one claiming to have had the procedure done in a supermarket.
Dr Aggie Zatonska is a former ear, nose and throat surgeon who performs cosmetic treatments at her clinics in Surrey. She is also a trustee and board member at BCAM. She agrees that no cosmetic treatments are risk-free, particularly when performed by under qualified practitioners. “Complications include localised pain, inflammation, swelling, localised infection, bleeding, and bruising. Furthermore, reactions such as headaches, eyelid ptosis (droop), muscle weakness and facial discomfort are common following treatment.”
So how can you stay safe and look good if you opt for treatment?
1. Don’t rush into it
Anyone can find themselves dispirited by a glance in a magnifying mirror after a poor night’s sleep. The lure of a board outside a beauty clinic offering bargain Botox may seem like an irresistible solution. David Jack is an aesthetic doctor with a background as an NHS plastic surgeon. He says, “It’s important to plan and research your practitioner before you opt for treatment. You need to find someone who is appropriately qualified, has years of experience and whose results you like.” Legally Botox and similar botulinum toxin products are prescription-only medicines. It is illegal to advertise them and they must be prescribed face-to-face only by a nurse prescriber, pharmacist prescriber, doctor or dentist. The injections themselves can, at present, be given by anyone, but they must be under the direct personal supervision of a prescriber, who is legally responsible for the results. However, you should insist the treatment is performed by a qualified, trained and experienced medical practitioner.
Dr Preema Vig is a former GP with decades of experience as a cosmetic doctor. She says, “You can check a practitioner’s credentials on the Nursing and Midwifery Council or General Medical Council websites (see box), but it’s also worth looking at patient testimonials, reviews and personal recommendations. Don’t opt for someone just because they are cheap or have a deal.”
2. Think twice if you are an anxious person
If even the thought of having the treatment worries you, this might be a sign to pass. Dr Zatonksa says, “If someone has anxiety and panic attacks, I might suggest they have some psychological advice before jumping into treatment. Or it might just be the wrong time for them. Botox is different every single time. It can feel too much or tight, and the effects can fluctuate during the first two weeks before it settles. My job is to assess the patient to see if they can deal with that.” Dr Auluk says, “Trust your instincts. A qualified injector should make you feel comfortable, address all your concerns, and provide detailed explanations about the procedure. If you have any doubts or feel rushed, it may be a sign to seek another provider.”
3. Don’t start too early
Do flawless 20-somethings need Botox? No. So when is the best time to start? Dr Zatonska says, “We have patients in their 30s who have treatment to reduce tension headaches because they always frown or destroy their teeth by grinding and clenching their jaws. But a good time is when lines start to transition from dynamic lines, which only appear when you make an expression, to static lines, which are visible when the face is at rest.”
The phrase “baby Botox” is, says Dr Zatonska, “purely a marketing term used to suggest a lighter, more natural-looking result but, in reality, the prescription needed will vary from person to person. “Sometimes people have powerful muscles when they first come to see me, and they need more toxin.” And you can wait too long. “The longer you leave it, the harder lines can be to reverse with toxin alone,” says Dr Vig. But says Dr Jack, “If you use sunscreen every day from early in life, you probably won’t need Botox at all.”
4. Start slowly
“Every first-time treatment in my clinic starts with a detailed consultation,” says Dr Zatonska. “Where I discuss the patient’s expectations. If we go ahead, I inject less toxin than they will eventually need. The aim is to find the sweet spot where they see an improvement but still have expression,” she says. “Most things can be corrected apart from too much toxin,” says Dr Jack. You can always add more but can’t take it out.”
Dr Zatonska reviews all new patients after two weeks. “Ask whether you will have to pay for a top-up or tweak,” says Dr Jack. “I don’t charge for top ups during the first four weeks after treatment.”
5. Be realistic about what Botox can –and can’t – do
Says Dr Jack, “Botox is used to soften lines and wrinkles and, these days, to reverse excessive downward pull of facial muscles while leaving the lifting muscles.
“Botox doesn’t fill anything, stimulate collagen or plump lips or cheeks. After treatment, you should still have some lines, so you look age appropriate, but your eyes should look more open and your face more rested.” It’s important not to totally freeze muscles as this can make them shrink so faces look more haggard. Plus, says Dr Jack, “It looks super weird.”
6. Don’t panic if you experience a complication
Facial asymmetry, brow heaviness, and a minor headache are annoying but harmless, and improve as Botox settles or wears off. Your practitioner may offer more injections to even up the face, or for headaches, suggest taking paracetamol. Eye drops can be prescribed to reverse eyelid droop and infections can be treated with antibiotics. Sometimes, says Dr Zalonska, patients experience symptoms that are purely coincidental or related to anxiety. “It can be quite stressful to have treatment for the first time,” she says.
Dr Vig says, “As with all medical treatments, complications can happen, even to a reputable practitioner.” That’s why, she says, “It is important that you see someone medically qualified and competent not just to perform treatments but to handle complications. Someone who can, for example, prescribe antibiotics.” Dr Auluk says, “While mild headaches are relatively common and usually subside quickly, severe or persistent headaches should be reported to the injector for further evaluation.”
You should leave with details of how to contact your clinic and practitioner if you have any questions or problems. “I always give patients emergency numbers,” says Dr Zatonska.
7. Make sure your injector offers more than just Botox
“Ageing is a complex process. A little bit of Botox will eventually not be enough to keep patients looking fresh,” says Dr Zatonska. She recommends patients look for a practitioner who offers other treatments, such as lasers, which can improve skin quality and boost collagen.
8. Men can join the Botox party – but be careful
“Men account for about 30 per cent of my practice,” says Dr Jack. “They might need a higher dose as the muscles are stronger. The brow naturally sits lower, so it’s important not to create arching of the eyebrows. I would recommend seeing a practitioner who has experience in treating men.”