Anti-wrinkle injections — who I treat, and the patients I turn away

Most patients come in asking for "Botox for the forehead." That's almost never the right opening question. Anti-wrinkle injections work — when used precisely, in the right patient, on the right muscle, for the right reason. Outside of that they produce expressionless faces, dropped brows, frozen mouths, and the kind of result that gives the whole industry a bad reputation.

Here is the framework I actually use.

What anti-wrinkle injections do (briefly — the longer version is on the treatment page)

Botulinum toxin (the active ingredient — Botox is one brand among several) temporarily blocks the signal between the nerve and a specific muscle. The muscle relaxes, and the lines created by repeated muscle contraction soften. The effect lasts three to four months on average. Done correctly, it preserves expression while reducing the dynamic creasing that becomes static lines over time.

The key word in that sentence is "specific." This is a treatment of individual muscles, not a treatment of an area.

1. Are these dynamic lines or static lines?

The first thing I assess is what the lines actually are. A line that appears only when you move the muscle is a dynamic line — and that's exactly what anti-wrinkle injections are designed to address. A line that's etched into the skin even at rest is a static line. Static lines may soften over time as the muscle relaxes and the skin smooths, but they often need additional intervention — Profhilo, polynucleotides, or in some cases filler — to fully resolve.

Patients with mostly dynamic lines benefit most from anti-wrinkle injections alone. Patients with predominantly static lines often get a partial result from anti-wrinkle and then ask, disappointed, why "the Botox didn't work." The answer is that it did — the lines that needed more than Botox needed more than Botox.

2. What is the muscle actually doing?

The frontalis (forehead) lifts the brow. The procerus and corrugators (between the brow) pull the brow down and inward. Treating the frontalis without treating the depressors will cause the brow to drop. Treating the depressors without treating the frontalis will cause the brow to rise too much. Treating one side more aggressively than the other will cause asymmetry.

What this means in practice: I won't treat one area in isolation if the muscle balance requires treating others. A patient who insists on "just my elevens" without addressing the forehead frontalis often ends up with an unnatural brow position. I'd rather decline the partial treatment than create the wrong result.

3. What is the patient's resting expression?

Some patients have low brows naturally — a strong brow ridge, a heavy upper lid. Aggressive frontalis treatment in this group makes them look perpetually tired or unhappy. Other patients have very mobile, expressive faces — actors, singers, public speakers — for whom a fully relaxed brow would compromise their professional expression. The dose has to fit the person.

I never treat to maximum effect by default. I treat to the lightest dose that achieves the visible improvement, and we titrate up if needed at the two-week review.

4. What's the patient's age and skin quality?

In a patient under thirty, anti-wrinkle injections are usually preventative — softening the muscle pattern before lines etch in. In a patient in their forties or fifties, the treatment is corrective — softening lines that are forming. In a patient in their sixties or beyond, the conversation shifts: anti-wrinkle alone often isn't enough. Skin quality, laxity and volume changes mean a combined plan is usually the right answer.

Who I won't treat

I won't treat patients who want "no expression at all." I won't treat patients with body dysmorphic concerns where I believe the underlying issue isn't the wrinkle. I won't treat patients in pregnancy or breastfeeding. I won't treat anyone with a history of certain neuromuscular conditions without specialist clearance. And I won't treat anyone whose previous treatment was in the last twelve weeks — adding more before the previous dose has resolved is how patients become resistant to the toxin over time.

Where it fits in the REGEN Method

Anti-wrinkle injections sit at the lighter end of the Generate pillar — not regenerative in the strict sense, but corrective work that buys time for the skin and prevents dynamic lines from becoming static. They work best alongside a homecare regimen from Elevate and benefit hugely from the underlying skin quality work that Profhilo or polynucleotides provide.

The honest closing

If you've had anti-wrinkle injections elsewhere and felt the result was either too much or too little, the issue is almost never the product — it's the dose, the placement, and whether the assessment was right in the first place. If you're considering it for the first time and you're nervous about looking "done," that's a sensible instinct, and the right consultation will respect it.

That's what the Reveal Consultation is for. We assess your face properly, discuss what the right plan looks like for you specifically, and only then talk about treatment.

— Dr Chris, Founder and Medical Director, REGEN Clinic

Want the full clinical detail and pricing? Visit the Anti-Wrinkle Injections treatment page.