is not a replacement for surgery but in some people can delay the need for surgery or enhance the outcome of surgery. It works essentially by disconnecting the nerves from those structures they supply – this includes muscles but also sweat glands so it can be used effectively for excessive sweating. There are now different makes of botulinum toxin that need to be used slightly differently. Because muscle is paralysed it is important that the person using Anti-wrinkle Injections are familiar with the anatomy of the muscles under the skin – as I operate on those muscles the anatomy for me is straightforward.

The use of Anti-wrinkle Injections in the face relies on paralysing some muscles whilst leaving others untouched. The use of Botox involves exchanging wrinkles for facial expression so there can be a downside. The best use in the face I think is for the wrinkles between the eyebrows as no one wants that particular expression; the next best use is for the laughter lines at the corners of the eyes, not to remove them as that would remove character, but to soften them. Other areas include forehead and brow including improving the angle of the eyebrows and it can also be used at the corners of the mouth to improve one’s natural expression.