Beauty Clinic: Can Botox help my frown furrow?

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Q. I have a frown furrow down the centre of my (middle-aged) forehead and wonder if botox would help smooth it out? If so, how do I find a safe practitioner?

A. Consultant dermatologist Dr Nicholas Lowe of the Cranley Clinic, London, who is also Clinical Professor Dermatology at UCLA School of Medicine in Los Angeles, was a pioneer in botulinum toxin (Botox) research and when we spoke to him recently in the USA for this column was speaking at a conference on this topic.

His response is that Botox could indeed improve your forehead furrow but, depending on the depth, you may need more than one treatment. Assuming you have not had Botox before, he suggests going back after 10 days for an assessment of how much improvement there has been.

If the clinician recommends another treatment in four to five months, a small particle hyaluronic acid filler (Dr. Lowe likes to use Volite) would help plump out the furrow temporarily.

Now to your second question: a recent review of complaints by Save Face, a national register of practitioners accredited by the professional standards authority, recorded 224 complaints related to botulinum toxin (saveface.co.uk). The most common problem was bruising and swelling, followed by asymmetrical results, drooping of eyebrow/eyelid or, for a small number, a ‘frozen’ look. Four complainants suffered blurred vision and 38 saw no result.

Worryingly, 76% of people who complained didn't know Botox is a prescription-only medicine, 68% didn't have a face- to-face consultation with a prescriber, 37% didn't know the qualifications of their practitioner and 11% of treatments took place at a Botox party.

Those statistics give you a pretty good idea of how important it is to check out a practitioner before you put your face in their hands.  In this country alone, there is little regulation of practitioners. There are several ways of finding a reputable, qualified and experience practitioner. Talk to friends who have had Botox about their practitioners and then double check them.  Ideally, go to a clinic led by a consultant or doctor who has registered a cosmetic dermatology or plastic surgery speciality with the General Medical Council.  They will often be members of the British Association of Dermatologists (bad.org.uk), or the British College of Aesthetic Medicine (bcam.ac.uk). Some nurses are also well qualified and experienced; they should be members of the British Association of Cosmetic Nurses.

Dr. Lowe (drnicklowe.com) feels that Botox treatment has increasingly been over-simplified. He stresses the importance of assessing the right dose for the individual patient. Problems include giving too small a dose, which can cause the furrow to reappear faster and deeper leading to more frequent and higher doses of botox. Injecting into the centre of the forehead can also affect the muscles that control your eyebrows; as he says, ‘you want to avoid the Dr Spock look…’

Lastly, Dr Lowe stresses the importance that anyone proposing to have Botox should be in good general health. ‘You shouldn't have Botox if you have a risk of some muscular weakness, for instance myasthenia gravis.’ Also, some antibiotics and other drugs can affect the strength of Botox and increase or decrease its effect, he adds.