Commonly performed in the upper face. The most common areas requested are the horizontal forehead lines, vertical frown lines between the eyebrows, and crow’s feet (or laughter lines) radiating away from the eyes. While it would probably work around the mouth and chin, it would almost undoubtedly weaken the smile and Mr Karoo does not recommend its use around the mouth. Creases around the mouth may however be improved by filling them out with a dermal filler.

In general many prescription only medicines for wrinkles are safe with little down time associated with the treatment. Occasionally slight bruising may occur and a mild headache may follow. Bruising may be greater in patients who are taking any blood thinning medicines. These products should be avoided if possible prior to the injection. Muscle relaxation is first noted at between the 3rd and 10th day after treatment; it is not immediate.

Successful therapy is signalled by muscle weakness that begins 3 and 10 days after injection with the main effect visible at about 7 days. The effect after the initial injection lasts between 3 and 5 months for most patients.

Repeat treatment is suggested every 3-5 months to keep the muscles sufficiently weakened to allow the furrows to smooth out. In practice this means coming three to four times in the first year. After the first year the intervals between treatment may be a little longer so that you need it only twice a year.

Tension headaches and migraine for some patients have disappeared. These occurred in patients who were recruiting forehead and brow muscles during periods of stress and tension. When these muscles were relaxed, the headaches faded. It has been found to help wit headache in about 30% of migraine sufferers.

Do not massage the area treated. Do not lie down for a nap – keep upright for about 3-4 hours. Do not take any aspirin for 2-3 days either side of the injections as this may help to reduce the chance of bruising. It is also advised not to perform any vigorous exercise for 48 hours after the treatment and avoid having any facials or massages where you might lie face down on a circular pillow for 48 hours.