As a cosmetic nurse injector, I constantly get asked “is this anti-wrinkle injection going to freeze me”, or “will I look like those girls off MAFS.” By all means, if that’s the look you’re going for, I’m not one to judge. I love the results you can achieve with these medications in regards to glamorization and enhancement, but I do caution against their overuse. ‍

Are you aware of the long term effect these ‘looks’ can have?

Did you know that starting too young or with the overuse of these medications it can have the reverse effect and result in you looking older, not younger and more masculine than feminine or vice versa.

Societies obsession with all ‘things’ celebrity, social media and our own fears of aging and has created a dependence on these anti-wrinkle and dermal filler treatments, in some cases an addiction.

It is easy to see that Celebrities and reality TV stars have a lot of anti-wrinkle injections however, it does not always have a more aesthetically pleasing result. Remember the backlash gorgeous Lindsay Lohan received while hosting the masked singer last year. At just 33 years old she looked puffy and very similar in age to her much older co-stars. Flawless features and shiny ‘foreheads’ look beautiful on social media.  In person, with no makeup on and during animation or conversation, it often looks very different. And when coupled with too much dermal filler causing an overfilled and plastic appearance, it creates what I like to call the “Brats Doll Effect”.

Cosmetic nursing is not as straight forward as injecting dermal filler or anti-wrinkle agents and hoping for the best. 

In the right hands' anti-wrinkle injections are incredibly safe and effective tools to refresh, and enhance your appearance, however, in the wrong hands or overused they can cause the dreaded “Brat doll effect” or “young /old look”. 

The cosmetic injector needs to have a holistic or total face approach to achieving your desired results, both in the short and long term.  To create a plan, it is essential to determine if your lines are caused by repeated, active muscle movement, or loss of volume, age, genetics, and sun damage as each of these factors will affect the treatment options available. 

The facial muscles lift and pull in a multitude of directions creating various facial expressions that convey our emotions, and allow effective non-verbal communication. 

These anti-wrinkle medications consist of a powerful muscle relaxant which when injected blocks the signal from the nerves to the muscles, meaning they are unable to perform their usual action. Understanding the anatomy and physiology of the facial muscles,  knowing whether it is an elevator or a depressor, where it pulls from and the direction, its strength and how these medications impact them is vital to achieving the best possible outcomes. If the wrong muscle is injected or frozen it can cause a very different result than expected. For example, it can cause drooping of the eyebrow or eyelid instead of lifting, or result in a crooked smile.

Did you know the horizontal lines across your forehead indicate your body is working hard to keep your eyes open?

The most commonly treated area of the face with anti-wrinkle injections is often referred to as the upper third. The muscles in this area are responsible for frowning, raising your eyebrows and smiling. It is the cosmetic injectors responsibility to know which muscles are safe to “freeze” and which ones can and should have movement and advise you accordingly.  It is also essential to know that your injector has to work with your anatomy, and sometimes “freezing you” may not be in your best interest in the long run. Whether it is to prevent or treat wrinkles each client should be treated individually, no two clients will need the same amount of anti-wrinkle in these 3 main areas.

The frontalis muscle is responsible for causing horizontal lines straight across your forehead and can be difficult to inject. The top half of these muscles pull from the hairline down, whilst the lower half pulls from the eyebrows up.  If injected too low the muscle relaxant can cause heavy eyebrows, while injecting too high can cause the tail end of the eyebrows to spring up resulting in “shocking”. If you have a genetic predisposition to low brows or heavy eyelids it makes treating this area even the more difficult. Static lines across your forehead when you are younger, or if your make up is sitting in the lines usually indicates the frontalis muscle is working overtime to keep your brows up and your eyes open. When muscle relaxant injections are used to smooth these lines it can prevent you raising your brow and cause heaviness that can make you look and feel more tired. Therefore, correct dosing and injecting carefully along this muscle will reduce forehead movement and smooth wrinkles.  However, in many cases to reduce the risk of heaviness or drooping it is essential that some slight movement above the eyebrow region will remain.

The ‘11s’ or frown lines can be very deep and prominent. They are caused by the repeated movement of two very strong muscles, the procerus and the corrugator supercilii muscles but factors such as aging and bone reabsorption, sun damage, and volume loss also play a part.  These muscles pulldown and furrow in between the eyebrows resulting in a worried or angry appearance.  

Muscle relaxing medications work by inhibiting the muscles to perform their usual actions. Careful placement will stop the downward pull of these muscles, and once relaxed results in a lifting effect causing the eyes to appear more open, while also softening the lines. 
‍

To reduce deep frown lines these muscles are often fully paralysed.  Frozen is good here! It is essential otherwise the treatments won’t be successful. If there is any movement left after the anti-wrinkle treatment has ‘kicked in” the muscles will fight the relaxing agent. This means your treatment may not last as long as expected, the lines are still prominent, or worse the muscles will get stronger. Your injector is the expert and will advise you on what is the recommended dose to get the result you desire. The good news is these muscles respond incredibly well to treatment and the results continue to get better with time.  With regular treatment, those pesky “number 11” lines will soften out and you will not only look better but also feel better.

Lastly, the crow’s feet or smile lines are more complex to treat than most people give credit.

The orbicularis oculi is a “sphincter” muscle that surrounds the eye, and is responsible for opening and closing the eyes and smiling. Factors such as genetics, aging, skin integrity, bone changes and volume loss also play a vital role in the appearance of the crows' feet.  Thus, treating this area is not as simple as just chasing lines and using muscle relaxants in 1/2/3 injections points. It is imperative all these factors are taken into account to ensure you get the best possible results.

When we are in our late 20’s to early 30’s we start to develop straight lines from the corner of the eye spreading outwards, usually due to smiling and other facial expressions.  Treatment with anti-wrinkle injections is very effective in younger clients wanting prevention. It often results in little to no movement leaving the client with a smoother outer eye area, and a wider, more awake look without changing their smile. 

However, as we age the crows' feet are trickier to treat and may actually result in a less than desirable appearance. The lines become deeper due to repeated muscle movement, the eye socket and temporal bones start to reabsorb and the surrounding skin loses’ elasticity and begins to sag, tear troughs develop, and sometimes bags or puffiness occurs under the eyes.  Muscle relaxants can cause more puffiness, affect your smile, or result in what we in the cosmetic industry refer to as shelving. Usually, these clients will require a combination of strategically placed anti-wrinkle injections, dermal fillers to replace volume loss, and other treatments such as plasma, skin needling, peels, laser therapy or even surgical intervention to get the best possible result. 

To avoid looking puffy, overdone or older than you are, the key is Less is more. 

My advice is to do your research and choose a highly experienced cosmetic injector who understands the anatomy and physiology of the facial muscles and structures. Knowing facial anatomy, allowing movement to return before re-treating clients and learning the individual client’s muscles will avoid any “Dr Spocks”, “Brats Dolls” and most importantly TOTALLY FROZEN FACES.

Be educated about who is injecting you, with what, and ensure that they have explained the potential side effects and long term consequences of the treatment. Anti-wrinkle Injections can really help soften lines and prevent things from getting out of hand, but other treatments may serve you better in the long run. Ensure you know all the options available to you and remember sometimes a quick fix can seem like a good idea but often can cause bigger problems later on.