How to make Botox and anti-wrinkle injections last longer

From lifestyle changes to treatment methods, our experts Dr Simone Doreian and Nurse Practitioner Natalie Abouchar explain how to get the most out of anti-wrinkle injections. 

Indeed, clinics around the country are beginning to reopen, but the demand for anti-wrinkle injections, facials and other cosmeceutical skin-boosting treatments has never been more popular – which means waitlists are longer than ever.

If you can’t get in to see your Doctor or dermatologist – or perhaps you were lucky enough to score an appointment – or maybe you don’t feel comfortable about heading into a clinic just yet, these helpful expert tips will ensure your injectables go the distance.

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Botox basics

Let’s recap on what anti-wrinkle injections are and how they actually work. “Botulinum toxin works to reduce the power in facial muscles. The treatment results in a fresh and natural appearance, with a smoother overlying skin, better radiance, and less wrinkling, and helps prevent further wrinkling,” explains Dr Simone Doreian Cosmetic Physician at Erase Aesthetic Services. “Most patients look ‘fresh’ for three to six months between doses, depending on the dose injected, individual metabolism, skin quality, and external factors such as sun and environmental exposure.”

Can you actually help prolong the effects?

“My initial thoughts were: ‘nothing works like botulinum toxin, so don’t be conned into a bunch of creams, beams, and crazy face exercises’,” says Doreian. “But essentially, the better shape you can get your skin into, the longer the effects of anti-wrinkle injections will last. A simple analogy is comparing a muscular hand scrunching up skin that is paper thin, by thickening the skin, making it more elastic and quilt like, the scrunching will not appear as severe on the surface overlying the muscles. The movement will not crease the skin in exactly the same places when the skin is more robust and improvement can occur over time without repetitive scrunching,” she explains.

According to Nurse Practitioner and director of Privee Natalie Abouchar it’s hard to pinpoint how exactly to make injections go the distance. “Unfortunately many of the factors that increase neurotoxin metabolism are intrinsic and are hard to control, such as the persons own metabolic rate, age, genetic makeup. However there are lifestyle factors that have all shown to have an effect on reducing the duration,” she says. “It’s also wise to avoid unnecessary facial expressions such as squinting and frowning where possible.”

Where you can help…

Use good quality skincare

“Medical grade skincare is the equivalent of cleaning your teeth between dental visits: you’ll be significantly better off for it. As the skin ages, the skin barrier function begins to fail, and skin becomes thinner, less elastic and contains ever-reducing amounts of collagen,” says Doreian.

“As we age through our 20s, we are thought to lose 1% a year, and once in menopause, a massive 30% loss could be expected. Given collagen accounts for approx. 75% of skin dry weight, collagen stimulation is the aim of the game.”

Doreian suggests using skincare packed with antioxidants including vitamin C and niacinamide, peptides, retinoids and hyaluronic acid. Pair those powerful ingredients with sunscreen, too.

But when it comes to prolonging existent injectables, it’s unlikely topicals can do the trick. “Anti-oxidants, vitamins and minerals may play a role in changing your own intrinsic metabolism but generally skincare ingredients will improve the quality of the skin but not necessarily impact neurotoxin duration,” explains Abouchar.

Up your H20

Much like keeping your skin hydrated topically, keeping it hydrated internally can help, too. “Drink plenty of water and avoid sugary drinks that elevate serum cortisol,” says Doreian.

Abouchar agrees, “Drinking more water will make our skin appear more hydrated and less wrinkly, but will not necessarily have an effect on toxin duration. It can help to hydrate the skin cells and to keep any dermal filler hydrated and plump,” she adds.

Eat your skin healthy

“Adequate levels of vitamins C, E and A are a requirement of the body, and of the skin as an organ, to function well. Whole foods provide the complete package and remain in my opinion the healthiest solution to vitamin and mineral balance, so plenty of fresh fruit, oodles of vegetables, especially green and cruciferous, and a few ladles of homemade stock from chicken or beef bones, may be a good skin move,” explains Doreian.

Go easy on exercise

“Anecdotally runners and heavy exercisers may experience reduced duration of their muscle relaxants. Whether this is due to increased exposure to sun, wind and the environment, low body fat, facial expression, or higher metabolism, it’s not clear,” explains Doreian. “As with all things, moderation will see your muscle relaxant doses optimised. Some advise to not exercise heavily during the first 24 hours of injections, until the molecules are attached to the neuromuscular ruction and bound on, to avoid any dose loss. Again, evidence is scant and common sense should prevail,” she adds.

Avoid smoking and sugar

Some lifestyle factors are said to speed up the metabolism of injectables, so if you’re really hoping to prolong your appointments it’s best to steer clear of these.

“Smoking, even cutting down will reduce the noxious chemicals within your body, increase blood flow to your skin and help slow the accelerated ageing of the skin that cigarette smoking causes,” says Doreain.

“Smoking, some recreational and prescription drugs that affect metabolism may play a role in reducing duration also,” explains Abouchar. “Avoid sun exposure which will break down collagen and cause skin to become aged, wear sunscreen, avoid eating sugar to prevent glycation of skin which causes skin wrinkles, reduce alcohol intake and meditate to reduce daily stress levels.”

Advice for your next appointment…

When it comes to any kind of treatment it’s important to do your research and shop around. Only go to reputable clinics with doctor, nursers or clinicians you trust. It’s important to note that all anti-wrinkle injections and methods aren’t equal. “A well-educated and experienced cosmetic doctor will provide you with the best botulinum toxin anti-wrinkle cocktail for your needs,” says Doreian.

“Small, frequent doses every three months is more effective at treating and preventing wrinkles long term than higher dose, more widely spaced treatments. Whilst a larger dose may last longer, the longer includes an unattractive frozen period.”

The term ‘sprinkling’ is popular and works by injecting tiny doses. “Motor unit recruitment is thought to be involved in the recurrence of movement as early as a few weeks after Botox. Those muscle units that were initially relaxed are thought to be ‘recruited’ back by still active muscle units. It’s thought by some physicians that using low does but multiple injections may prolong the effects,” explains Doreian.

There’s also Skin Boosters, a form of skin hydrating and plumping ingredient hyaluronic acid. “Effective in prolonging and enhancing the efficacy and duration of botulinum treatments. Using skin boosters we can target a broad range of treatment areas including the face, neck, décolletage and hands in order to replenish the hyaluronic acid lost through ageing. Clinical studies support increased hydration, collagen development and improvement of elasticity and tone. The skin becomes less crepey in texture, has better hydration and light reflection, and wrinkles appear less deep,” says Doreian.

“Patients wanting better skin between Botox doses will do well to clue onto this very effective treatment. It needs to be specifically injected into the deep dermis or by cannula immediately under the dermis, and so takes skill to achieve reproducible results, but worth every penny with an expert cosmetic physician injecting.”

Exciting developments soon to come:

According to Doreian, a longer lasting botulinum toxin dubbed DAXI or daxibotulinum toxin A is reported to last at least six months could be hitting our shores soon. “Formulated with a peptide addition, which helps to stabilise the toxin. But be mindful to choose your physician wisely as a long duration of action = long duration of complications.”