Botulinum Toxin is a prescription only medication. It is injected, using a fine needle, into the target muscle to temporarily block the nerve signal, resulting in weakening of the muscle action which can result in an improvement in the appearance of lines of facial expression. Botulinum toxin can only treat the lines that are present.

Facial expressions occur when the brain sends nerve signals to the facial muscles causing them to contract. Botulinum toxin blocks the transmission of the chemical signal from the nerve reaching the target muscle. Without this signal, the muscle is unable to contract and remains in a resting state, therefore facial expressions are relaxed. It is not always possible or desirable to stop all movement as a completely frozen look may not be aesthetically pleasing. It is important to discuss your expectations with your practitioner prior to any treatment. The effects of botulinum toxin are not instant, and most people will start to notice the results after about 4 days, having the full effect by about day 10. You will be offered a follow-up appointment at 2 weeks, when the effects of treatment can be reviewed. Additional botulinum toxin may be administered at this time if needed. Over approximately 3 to 4 months, the nerve terminal recovers and movement in the treated area restarts. Treatment can be repeated at this time to maintain the desired results.

Botulinum toxin is injected using a fine needle, similar to the size used on an insulin pen. It is generally not painful and most people will only experience minor discomfort. Some people describe the sensation like plucking an eyebrow. Very rarely, for people who cannot tolerate the procedure, a topical anaesthetic cream or ice may be applied prior to treatment to reduce the sensation.

Treatment results are often more successful when the skin is in a good condition, with good elasticity, where facial expressions are not excessive and there are no or only minimal static lines in the area to be treated. You may not be suitable for treatment if any of the following apply: · Botulinum toxin is generally only recommended to those aged between 25 to 65, although it may be used off-license for people outside this age range. · Botulinum toxin cannot be given to pregnant or breast-feeding women and is not recommended if you are actively trying to get pregnant. · Patients with certain neurological disorders (such as myasthenia gravis). · You are currently taking certain medicines (including antibiotics, such as clindamycin). · You have previously experienced adverse reactions to any botulinum toxin treatment. · Treatment is not recommended if you are suffering from any skin infection in or near the treatment area, including cold sores.

Millions of botulinum toxin treatments have been performed worldwide and it has an excellent safety profile. However, as with any medical aesthetic procedure, there are certain risks and side-effects which should be discussed with you during your initial consultation. Most common side effects include: · Injection site pain · Bleeding and/or bruising at the injection sites · Redness, itching, irritation at the injection site Less common: · Swelling, including under eye puffiness · Headache, which may last several days · Nausea and/or hot flushes · Poor cosmetic results · Uneven effect on one side Rare side effects: · Drooping or heaviness of the brow or eyelid · Abnormal appearance of the brows (Mephisto or Spock brow) · Blepharitis (inflammation of the eye lids) · Eye pain or visual disturbance · Paraesthesia (abnormal sensation) · Muscle twitching · Flu-like symptoms · Anxiety symptoms · Rarely, muscle or joint pains

Dermal filler injections are administered using a small needle or cannula. The syringe will contain a clear gel like substance, which consists of a water-based gel, hyaluronic acid, and may contain lidocaine, which is a local anaesthetic to make the treatment more comfortable. Hyaluronic acid is a naturally occurring substance, which is a major component of our skin and has a function in wound repair, hydration, and cell to cell communication. One of the main characteristics of hyaluronic acid is that it effectively binds water like a sponge, which is why it is an effective tissue filler. Most brands of Dermal filler will have several products in their range to enable treating different areas, ranging from softer fillers to treat fine lines and lips to firmer fillers to provide contour and shape.

During the normal ageing processs, the fat compartments of the face lose volume and the ligaments holding them in place become weaker leading to a sagging appearance. Hyaluronic acid dermal fillers are extremely ‘hydrophilic’ or water loving. When they are injected, they boost the skins volume, so the area becomes revitalised and volumised. By placing the dermal filler in specific anatomical positions, this can also create a lifting effect. Adding volume helps to address issues such as volume loss, laxity and sagging of the skin, having a positive effect on lines and wrinkles. They can also be injected directly beneath lines to help soften and improve them.

Most dermal filler injections contain a small amount of lidocaine, which is a local anaesthetic to help reduce any pain experienced during the procedure. Even with the addition of local anaesthetic, it is not a pain free treatment and it will depend on the injection technique, whether a cannula or needle is used and the individual’s pain tolerance. A topical anaesthetic, may be applied to provide additional pain relief, particularly when treating more sensitive areas, such as the lips. This will be applied to the skin and left on the surface for roughly 20 minutes to take effect. Once the anaesthetic has worn off, there may be some tenderness which is expected, but you should not experience a significant degree of pain. If you are experiencing considerable pain after the treatment, you must contact your practitioner as this could indicate that you are developing a complication.

You may not be suitable for treatment if any of the following apply: · Dermal fillers cannot be given to pregnant or breast-feeding women and is not recommended if you are actively trying to get pregnant or undergoing IVF. · If you suffer from keloid scarring or have active skin conditions, such as acne or psoriasis. · If you have certain medical conditions, such as diabetes, rheumatoid arthritis, autoimmune conditions, blood clotting disorders, cancer, immunosuppression (either medical or drug-related). · If you are suffering from any skin infection in or near the treatment area, including cold sores. · If you are suffering from any other infection, including dental, throat, ear, chest or sinus infections. · If you are unwell, including coughs and colds, on the day of treatment. · If you are taking any medicines which affect bleeding, such as aspirin or warfarin. · If you have had Roaccutane or isotretinoin in the past 6 months. · Certain allergies, including lidocaine or bee sting allergy. · Recent facial surgery or other dermal fillers in the same area. · Permanent implants, such as silicone implants in the face or pins and plates.

Hyaluronic acid is a naturally occurring substance present in the skin and the product itself is considered very safe, when it is has been purchased from a reputable pharmacy or supplier. Possible adverse effects include: · Pain: You may experience some minor tenderness or discomfort post-treatment. If you do have more pain than expected, it is important to contact your treating practitioner immediately as this may indicate a complication, such as a vascular occlusion. · Redness: This is normal and usually resolves quickly. If the treatment area becomes red a few days after treatment, particularly if heat is also present, this may indicate an infection and you need to contact your practitioner straight away. · Swelling: Some swelling or oedema is normal after treatment and may be worse the following morning after the procedure. However, persistent swelling should be reported to your practitioner as there may be treatment to help relieve this. · Bruising: As the procedure involves injections in the skin, bruising is a common finding. This can be anything from a small mark on the skin to extensive bruising which extends beyond the area treated and can take up to two weeks to resolve. Rarely, bruising can lead to permanent staining of the skin. · Infection: Your treatment should be conducted in an appropriate clinical environment, your practitioner should adhere to infection control protocols and you should receive appropriate aftercare advice to lessen this risk. Infection often develops as a warm, red, swollen area over the area that has been injected a few days after your treatment. If this occurs, make sure you contact your practitioner for a review as soon as possible. · Herpes (Cold sores): Treatment around the lip area can exacerbate an outbreak of herpes, which may be worse than a normal outbreak and may require treatment from your practitioner. The ACE Group World recommends that preventative medication may be required for certain treatments in people who are prone to cold sores. It is important that this is discussed as part of your medical history. · Lumps: Lumps may be present immediately after treatment due to product misplacement or migration or a lump may appear several weeks or months later in some cases. Lumps may appear as soft swellings or as hard nodules. They sometimes occur following an acute illness, such as a dental or sinus infection, or with exposure to excessive sunlight. If you develop a lump, it is recommended to arrange a face to face review with your treating practitioner. Extremely rare complications: · Vascular Occlusion: This is a rare, but serious, complication from dermal filler injections. In this situation, your blood supply may have been compromised by filler that has caused a blockage or obstruction of normal blood flow. Your practitioner is trained to manage this complication if it were to arise. · Blindness: This is an extremely rare complication that can occur with dermal filler treatments. There are certain areas of the face that pose a higher risk if they are injected, although it can occur from any facial dermal filler procedure. This should be discussed during your consultation with your practitioner. · Stroke: Another extremely rare, but documented complication of dermal fillers. If you develop any unexpected side-effects after treatment, it is important to contact your practitioner for a review as soon as possible, as they may be able to offer some corrective treatment. Although your practitioner may contact you by telephone or video call initially or you may send your own photographs, this is no substitute for a face to face review to provide an accurate diagnosis.

Vitamin B12 is one of the water-soluble vitamins and available as an intramuscular injectable medication called hydroxocobalamin. Vitamin B12 is required to help your body to use fat and carbohydrate for energy and it also helps to make protein and DNA. It is an essential vitamin to help maintain blood, nerve cells, and neurological function. Vitamin B12 is only found naturally in animal products and dietary sources include liver, fish, meat, eggs, dairy products, yeast extract (such as marmite) and foods that have been fortified with B12. Although there are different medications of Vitamin B12, the World Health Organisation recommends the use of hydroxocobalamin as it remains in the body longer than other formulations, which means less treatments over time. Injected B12 begins to work immediately, but it can take days or weeks to feel the benefit. Brain Function: Low levels of Vitamin B12 have been linked to decline in brain function and recent evidence suggests there is also a link with dementia. However, there is no evidence to suggest brain function can be improved in people with normal Vitamin B12 levels. Osteoporosis (Brittle bones): There is a link between low levels of B12 and reduced bone mass, increasing the risk of fractures. Depression: It has been suggested that low levels of Vitamin B12 is associated with depression and long-term treatment with B12 may reduce recurrence and severity of depression. Energy, weight loss and mood: There is actually little or no evidence to suggest that treating people with normal B12 levels with Vitamin B12 injections will improve wellbeing, energy levels, weight or mood. Before treatment, you should be given the opportunity to have any further questions answered and sign a consent form, either printed or electronically produced. The practitioner will examine the treatment area to determine the most appropriate injection sites and dosage required for optimum results.

The area for injection will most likely be at the top of your arm into the muscle, it is usual to use the non-dominant arm. The area will be inspected to find the best place for injection. Some practitioners may disinfect the skin prior to injection, but this is not a requirement. The skin will be gently pinched prior to treatment and the actual injection can cause a stinging or burning sensation that can vary in intensity. Some people find that it is quite painful, whereas most just experience a mild stinging. The actual injection will last for a few seconds only. Following the procedure, your skin may be cleaned again, or gentle pressure applied if there had been some bleeding at the site. You will be asked to remain for 15 minutes after your injection to allow time for you to recover and for the practitioner to ensure that you do not have a reaction to the injection. If you are due to have a series of injections, you will then be able to schedule your next appointment. Your practitioner will record the batch number, expiry, and site of injection on your treatment record and will provide you with appropriate verbal and/or written aftercare.

You may not be suitable for treatment if any of the following apply: · If you are under the age of 18 years. · If you are pregnant or breast-feeding. · Previous allergy to hydroxocobalamin. · If you have kidney problems or previously low potassium levels. · If you have other deficiencies such as folic acid or iron. · If you have any blood disorders. · If you have a severe needle phobia.

Generally, side-effects are uncommon, often mild, and usually resolve within a few days of treatment. You may experience some pain, itching, redness or swelling at the injection site. This will usually settle quite quickly without any intervention, however, if you experience any prolonged side-effects, it is important to contact your practitioner for a review. Bruising is uncommon, but if it does occur, it may take up to 2 weeks to fully resolve. Possible side-effects include: · Injection site pain · Bleeding and/or bruising at the injection site · Redness, itching, irritation at the injection site · Nausea and vomiting · Diarrhoea · Headaches · Dizziness · Hot flushes Rarely, adverse effects can be serious and include: · Serious palpitations due to low potassium levels · Anaphylaxis