Superficial lines to the face, usually in the upper face, can be approached in a few different ways. The types of lines discussed here are lines of the upper face such as:

• Vertical between the brows
• The horizontal forehead lines
• Crows feet
• Lip lines

A proper assessment is always needed first. Some types of lines are amenable to using dermal fillers. Our preferred semi-permanent filler is Juvederm 2. It is soft and pliant and fills the line leaving a natural appearance and in most cases lumps are easily avoided. More than one treatment is usually needed. This approach works very well in the lip area too. A dental block is needed for lip work.

Another popular approach is to treat the underlying muscle which can be relaxed using a specialised muscle relaxing injection technique. This has the effect of softening the appearance of the overlying wrinkles. This method has been used in cosmetic medicine for over a decade. A natural appearance can be achieved.

Muscle relaxing injections have been used in main stream medicine for two decades in the treatment of muscle spasms in cerebral palsy, migraine, squints and torticollis.

However extreme caution and specialised knowledge is needed.

In the right hand cosmetic treatments using muscle relaxation injections have a high safety profile. However a thorough understanding of anatomy and knowing how to use various approaches is necessary, as each person is different.

This technique is suitable in women and men. Men usually have a requirement for more treatment with muscle injection, as the muscle mass is denser. Men also need a more meticulous approach in order to ensure the end result is natural and does not result in a "high arched brow", which can look oddly false in a male.

Several injections are usually needed. A tiny needle is used and it is usually very well tolerated The most popular area to treat is the vertical line between the brows because the technique is usually quite swift.

• The skin is cleaned
• The area is marked out using a soft marker pen
• Ice is applied before hand
• You will be asked to make the expression as each injection goes in; each site needs between two to five injections
• There are small needle marks visible for an hour after
• Small bruises can occur with crows feet treatment
• A variety of injection types are available and we will advise what is best for you.

Onset of reaction is between three to fourteen days, so you must plan ahead for a special occasion. In some cases it comes on rapidly, in other more gradually. Everyone is different.

Usually treatment last for three to four months. In the first year it is anticipated three to four treatments are needed. Try to keep up the treatment to maintain the effect. Thereafter perhaps three or in some individuals only two per annum may be needed. With time and on-going treatment, even etched in lines can de-etch on a long term basis as the skin repairs.

• Do not bend down to the floor or lie down for four hours. Bend the knees if you drop something;
• No alcohol that night;
• No heavy exercise that night;
• No saunas or facial massages for two days;
• Do not massage the area yourself.

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