Botulinum toxin injections

Non-surgical cosmetic procedures, such as Botox and fillers, can be used to alter your appearance without the need for surgery. They are a popular alternative to surgical procedures.

However, these procedures aren't regulated in the same way as cosmetic surgery and practitioners of many treatments do not require medical qualifications.

Different non-surgical procedures are carried out in hospitals, clinics and beauty salons by doctors, dentists, nurses and beauty therapists.

You should make sure that the person offering the treatment is adequately trained and experienced to enable them to deliver the treatment competently and safely. You should also make sure you know what the procedure involves, what the possible complications and side effects are, and who you should contact if you have any issues afterwards.

See considering non-surgical cosmetic procedures for more information about ensuring these treatments are as safe as possible.

Information about the following common non-surgical cosmetic procedures can be found below:

• botulinum toxin injections (such as Botox)
• chemical peels 
• dermal fillers 
• laser hair removal 
• microdermabrasion 

Botulinum toxin injections (Botox)

Botulinum toxin injections, such as Botox, are used to help relax facial muscles and make lines and wrinkles less obvious.

Botulinum toxin is a prescription-only medicine which can only be prescribed by a doctor, dentist or nurse independent prescriber. The treatment shouldn't be carried out by beauty therapists who lack the necessary medical training. 

During the procedure, your skin is cleaned and small amounts of botulinum toxin are injected into the area to be treated. Several injections are usually needed at different sites.

The injections usually take effect about three to five days after treatment and it can take up to two weeks for the full effect to be realised. The effects generally last for about three to four months.

What are the risks?

Although botulinum toxin injections are generally safe, the risks of treatment include:

• you may experience flu-like symptoms for the first 24 hours after treatment and there may be bruising at the injection site
• your facial features in the treatment area may be weak and droopy after the injections, although this usually improves as the effects of the treatment wear off (for example, your eylids may droop temporarily if the injections are used to treat the vertical “frown lines” between your eyebrows)
• your body may develop a resistance to the treatment if it's repeated too frequently
• in rare cases, serious problems can develop in the hours, days or weeks following treatment – including blurred or double vision (if the area around the eyes is injected) and breathing difficulties (if the neck area is injected)

You should seek immediate medical attention if your breathing or vision is affected after having botulinum toxin injections.

Chemical peels

Chemical peels are liquids designed to remove dead skin cells from the surface of the skin and promote new cell growth. They are used to improve the appearance of the skin, including reducing uneven pigmentation and acne.

There are three types of peel – superficial, medium and deep.

Superficial peels

Superficial peels are used to remove skin cells from the top layer of the skin (epidermis). They can be performed by some qualified beauty therapists as well as medical staff.

A superficial peel is only left on the skin for a few minutes. Afterwards, your skin may feel tight for a couple of hours.

The effects of superficial peels are only temporary, so regular treatment is needed to maintain the effect.

Medium peels

Medium peels are used to remove skin cells from both the top and middle layers of the skin (the upper part of the dermis). They should be performed by qualified healthcare professionals.

Medium peels are only left on the skin for a few minutes. You may experience a burning or stinging sensation during the application of the peel and the skin may go brown or red in the days after the peel. It can take up to six weeks for the skin to return to normal.

Treatment is required every six to twelve months to maintain the effect.

Deep peels

Deep peels affect the skin right down to the lower part of the dermis. The procedure should be carried out by a healthcare professional with relevant skills and experience.

A local anaesthetic and a sedative may be needed during treatment. While the peel is applied, you may experience a "freezing" sensation. The peel can be left on the face for up to 30 minutes or more, depending on the desired affect.

There will be some peeling, redness and discomfort for a few days depending on the type of peel used. Some people experience swelling for up to two weeks and skin redness can last up to three months.

A deep peel is a "one-off" treatment with lasting effects, so it doesn't usually need to be repeated.

What are the risks?

Chemical peels are usually safe treatments if performed by someone experienced and qualified, however there are some risks, including:

• your skin may appear darker or lighter than normal after treatment, which can be permanent
• if you've had cold sores in the past, there is a chance the treatment could cause them to recur
• you may develop scarring or an infection after treatment, although this is rare 

Your skin will also be more sensitive to the sun as it heals, so you will need to use sun cream for a month or longer after treatment.

The practitioner or clinic carrying out the procedure should advise you about necessary aftercare to reduce the risk of side effects and complications. You should seek medical help if you develop an infection after treatment.

Dermal fillers

Dermal fillers are injections used to fill out wrinkles and creases in the skin. They can also be used to increase the volume and definition of the lips.

Most manufacturers of dermal fillers recommend that treatments should only be carried out by medical professionals, although this is not currently a legal requirement.

Dermal fillers are made from a variety of materials and the effects can be either temporary or permanent, depending on the type of filler.

During the procedure, the practitioner injects the filler in a series of small injections and gently massages the area. Some treatments require a local anaesthetic cream or injection. The treatment time can vary from 30 minutes to an hour.

The area may be a little swollen and tender for 24 hours and during that time you may be advised to avoid things including coffee, alcohol, hot drinks and the sun.

What are the risks?

The risks of dermal fillers depend on who performs them and the type of filler used. Permanent fillers have the highest risk of problems. General risks of dermal fillers include:

• problems such as rashes, swelling, itching and bruising
• the filler can move away from the intended treatment area over time
• you may have an immediate allergic reaction to the filler, which can lead to anaphylaxis
• in rare cases, the filler may form lumps under the skin (which may need to be treated with surgery or medication), or the filler could lead to tissue death (necrosis)

Anaphylaxis is a medical emergency, so call 999 immediately if you are having a serious allergic reaction to the filler. You also should seek immediate medical help if you lose sensation in your skin, the treated area is extremely painful or if it becomes discoloured. Changes to skin sensation or colour are potential signs of necrosis, which requires immediate treatment.

See your GP if the treatment area becomes lumpy in the weeks, months or years after treatment. Your GP may refer you to a dermatologist for treatment.

Laser hair removal

Non-surgical laser or intense light treatment can be used to remove unwanted facial and body hair. The treatment should only be carried out at a special clinic by a practitioner who is properly qualified.

Laser hair removal involves using a laser to heat the small cavities in the skin from which hair grows (follicles). This damages the follicles, which prevents hair from growing.

Each treatment may take between 15 minutes to over an hour. Your eyes must be protected with specially designed goggles during the procedure and you may experience some pain. For up to 24 hours afterwards, the area may be red with a raised rash.

The number of treatments needed depends on the area to be treated and the system which is used. A course of treatments, which can last up to a year, may be needed before the area is fully clear of hair.

The results of laser hair removal are usually long lasting, but not permanent.

What are the risks?

The risks of laser hair removal include:

• your skin may blister, potentially causing mild scarring
• your skin may be unusually pale or dark for several months after treatment

Your skin will be more sensitive to the sun after laser hair removal, so you should avoid direct sun exposure and tanning beds for at least a week after treatment and you may need to use sun cream for up to a month once your skin heals.

Microdermabrasion

Microdermabrasion is a treatment that involves the use of fine crystals and a vacuum to remove dead skin cells. It's used to improve the appearance of wrinkles and skin blemishes.

During the procedure, the practitioner will use a handheld device to direct a fine stream of tiny crystals across the skin to loosen any dead cells and vacuum them away.

Depending on the strength of the device used, microdermabrasion can be carried out by a doctor, nurse or beauty therapist.

Microdermabrasion usually takes less than 30 minutes. For best results, a course of four to six treatments is often recommended.

Your skin may appear red for between 30 minutes and twelve hours after the procedure, depending on the strength of the treatment.

What are the risks?

The side effects of microdermabrasion, such as redness and swelling, tend to be short-lived. Your skin may also be dry and flaky for a few days after treatment and the suction may temporarily bruise your skin.

Your skin will be more sensitive to the sun after treatment, so you should avoid sun exposure for a few days afterwards and make sure you use sun cream.