Month: May 2015

Botox® side effects

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the potential side effects.
Botox® treatments are well tolerated and have very few side effects.

Botox® injections are extremely safe when undertaken by an experienced and qualified partitioners. The most common side effects reports by individuals include some swelling or bruising around where the injection was applied, headaches or flu-like symptoms. If the Botox® injections are not applied correctly, the toxin may spread to surrounding tissues and causing the following problems:

Eyelid droop
Cockeyed eyebrows
Crooked smile
Dry eye or excessive tearing

There have also been a number of other side effects that can potentially occur, such as:

Mild injection discomfort
Swelling around the injection or treatment area
Numbness around the injection area
Malaise – general feeling of uneasiness or ‘being of sorts’
Mild nausea
Temporary upper lid or brow ptosis
Weakness of the lower eyelid
Neck weakness or stiffness
Diplopi – known as double vision
Bleeding in the area where the injection was administered
Blurred vision
Drooping of the eyelids
Decreased eyesight
Dry mouth
Wheezing or difficulty breathing
As always, if you are worried please call your botox practitioner immediately.
For more information about botox hertfordshire, please call us on 0800 006 2266.

Botox® in lower third of face – Part 2

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox in the lower third of the face.

Corners of the mouth

Some patients have a reverse smile where the corners of the mouth are going downwards. This is the result of an over active Depressor Anguli Oris (DAO) which is responsible for lowering the corners of the lips and subsequently Marionette lines. The DAO is a triangularly shaped muscle. The easiest way to locate this muscle is to get the patient to do a sad face and you will see the muscle contracting just above the jaw line. It can also normally be found by drawing a line from the corner of the nose down to the corner of the mouth and continue this line just above the jaw. I inject 10 botox units per side, perpendicular to the muscle and superficially.

Complications can occur if you inject too medially. The toxin can potentially diffuse into the Depressor labii inferiors and cause a protrusion of the lower lip, known as a Gomer Pyle appearance. if you inject too laterally, the toxin can diffuse into the Buccinator, causing the patient to bite and traumatise the buccal mucosa.

Gummy smile

This is the result of an over active Levator Labii Superioris Alaeque nasi (LLSAN) muscle. By administration toxin into the LLSAN you can lengthen the upper lip. You are looking to inject in the naso facial groove which is adjacent to the Ala. I inject at 45 degrees, deep and 5 botox units per side.

It is worth being in mind Rubin’s 3 classifications of smile patterns:
Mona Lisa smile – dominated by the Zygomaticus Major which elevates the oral commissures as the highest point of the smile. Do not treat with botox as this will exaggerate the Mona Lisa smile pattern.
Canine smile pattern – dominated by the Levator Labii Superioris where the highest part of the smile is the central upper lip.
Gummy smile – excessive display of the upper gingival when smiling

I will sit the patient down and will get them to look at a mirror at eye level. then i will push the upper lip down by 3/4mm to show then the expected result and if agreeable, then will carry out the procedure.


Over activity of this muscle can cause a square jaw look and potentially bruxism. I would get my patient to clench their teeth and observe where the bulk of the muscle contracting and bulging. I normally give 3 injection sites per side and would start of with 15 botox units per injection site and then review in 2 weeks for any top ups. Over dosing can reduce their biting force. I would inject deep into the belly of the muscle at 30 degrees to the muscle.

The Mentalis is responsible for pushing out the lower lip and contributes to chin wrinkles, also known as ‘orange peel’. This appearance is more common amongst gummy smilers and in anterior open bites. Even though the Mentalis is a pair of muscles, my preferred injection technique is for one injection site in the midline, very deep at 90 degrees. I would normally inject 10 botoxunits.

Contraction of the Platysma can lead to bands and premature ageing of the neck region. Toxin is rarely used in isolation in this area and normally treatments to improve the skin complexion such as mesotherapy will yield the optimal results for the patient. Ask the patient to contract their neck via clenching their teeth and then mark along the bands. I would normally inject between 4/5 sites per band and 10 botox units per site very superficially whilst the non injecting hand is pulling out and squeezing the band.
In conclusion,I would rather under dose and get the patient back for any necessary top ups than be over optimistic on the first visit and over dose causing complications. By baby stepping in the lower third of the face you will greatly reduce the risks and have a happier patient and less sleepless nights.

For more information about botox hertfordshire, please call us on 0800 006 2266.

Botox® around the eyes

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the eyes.

Botox® can be used to treat the lines around the eyes which appear when you smile. These lines are either known as smile lines or Crows feet.

Before we use botox injections to treat these smile lines, we must first assess what type of smile you are. There are broadly speaking two types of smilers.

The first type use their eyes to smile and they will have lines that are high up in the upper third of the eyes.

The second type are cheek smilers and they will have smile lines in the lower third of the eyes and across their cheeks.

You maybe asking so what, what difference does this make.

With eye smilers and the lines high up, we can be confident of either reducing or eliminating these lines with our botox treatments. However the cheek smilers we need to be much more careful when treating with botox. We do not want to over freeze with botox in the border area of the eyes and cheeks. If we over freeze with botox in this area, when the patient tries to smile, the cheek will resist and cause unwanted lines across the cheek or even scrunching of the skin under the eyes

in addition to varying the dose with botox when injecting lower down, we must also inject away from the eye at least 1cm away. Botox® can spread up to 1cm, so we want to avoid the delicate and important structures within the orbital rim.

Botox® can work very well in treating unwanted lines around the eyes, but a detailed assessment of the patient is mandatory before any botox treatments is started.
For more information about botox hertfordshire, please call us on 0800 006 2266.

The majority of patients seeking treatment for fine lines and wrinkles will be mainly concerned initially with the upper third of the face, notably the forehead, frown and eye areas. In my experience once they have experienced your clinical and patient skills they will seek additional areas to be corrected with Botulinum Toxin A.

In this article I will look at the areas we can treat in the lower third of the face. Before we look at specific areas, I need to draw your attention to the slightly different approach we have for treating the lower third of the face compared to the upper third.

In the upper third of the face the muscles are large and generally independent of each other, therefore we are not overly concerned with the spread and diffusion of the toxin. However, in the lower third of the face, the muscles are generally much smaller and in close proximity to a number of other muscles. Therefore we need to be wary of the diffusion and spread of our toxin much more. I practice the technique of baby stepping when treating the lower third with toxin. I would rather they come back fro a review appointment and administer any top ups than over dose and cause unwanted side effects in neighbouring muscles.

* When discussing specific units, I will be referring to Azzalure® and Speywood units in the following examples.

Bunny Lines

Not technically in the lower third of the face, but I thought it would be advantageous to talk about this area. These lines appear on the side of the nose when the patient scrunches their nose. The lines are the result of the contraction of the naslis muscles.

I would normally inject 10 Speywood units on each side at a superficial level no more than 4mm depth maximum. you don’t want to go to deep since you will hit bone and this will be painful to the patient. You would inject where the biggest mass of muscle is.


Smokers lines

These are vertical rhytides that occur in the upper lip and lower lip region. These lines occur from the contraction of the Oribcularis Oris. This is a circular muscle around the lower and upper lip. It is responsible for the closure of the lip and pushing the lips forward (puckering/pouting). it is common, but not limited to smokers.

There are 3 ways to treat these lines:

toxin only
dermal fillers only
combination of both

My criteria for treating with toxin only is if the lines are superficial, worsen when the patient pouts their lips and the patient does not want any fillers to increase the size of their lips. I do warn these patients that we cannot guarantee to eliminate the lines. The toxin is placed very superficially and I would place as a starting point no more than 5 Speywood units per injection site. I avoid the philtrum area and inject close the the vermillion border. I warn the patient that they may feel numb and find it hard to whistle or say certain letters for a couple of days post procedure.

Dermal filers would be used in isolation if the patients main concerns are the lack of volume in the lips, lack of definition of the vermillion border and they do not want any toxin placed.

If the lines are very deep and do not worsen when they pout their lips, then I would sue a combination of toxin and dermal fillers. The toxin will help relax the muscle and the dermal filler will increase the volume of the lips/borders to help stretch the skin and reduce the appearance of these lines.

I always tell my patients that we cannot guarantee to eliminate the smokers lines and they may need additional treatments such as laser skin resurfacing.

For more information about botox hertfordshire please click the link or call us on 0800 006 2266