Expressive wrinkles; treatments, myths and more.

We use our facial muscles all the time, sometimes even in our sleep! Repetitive contraction of these muscles eventually starts causing the formation of lines. Yes, lines which if not treated, will keep on getting deeper and visible even at rest.

Whilst ageing gracefully is the name of the game, deep frowning lines do not really add any grace to anyone. Thankfully there are non surgical treatments which contribute to prevent deep lines from forming and temporarily block certain parts of the facial muscles from contracting.

Neurotoxin administration to targeted muscles in the face is now the most widely spread treatment worldwide. It started off as a treatment for Strabismus and Blepharospasm. Researchers realised that the Glabella had also relaxed in the meantime, subsequently leaving the skin smoother. This lead to Medicinal companies to up their research to discover cosmetic uses which are still being used till this day.

Which areas are usually treated?

The upper half of the face may be considered as the most expressive half, therefore, it comes without saying that expression wrinkles are usually more prominent in that portion. The areas treated are:

  • The smiling lines; better known as ‘Crow’s feet’
  • Frowning lines; better known as ‘The Elevenses’
  • Horizontal forehead lines

Doses of Neurotoxin are injected strategically in these areas to stop the muscle from contracting, smooth out the skin and cause an attractive eyebrow lift when requested.

Our expert Doctors are also trained to inject this neurotoxin in the lower part of the face; the corners of the mouth, the upper lip (the moustache area), the masseters and also the platysmal chords. Injection in these areas require a higher level of experience.

For optimal results, the use of dermal fillers may be suggested in order to fill out deeper lines still visible at rest and to create a more harmonious effect.

Myths Uncovered:

Will I look worse if I decide to stop doing the treatment?

Of course not! You would have just stopped your skin from creasing for the time period where the treatment was being done.

Will I look fake or frozen? 

No, a correctly done treatment will still allow you to express all possible emotions anyway. Remember that expressions are executed by using the whole facial muscles rather than one or two muscles.

If you would like to know more about this treatment, then a consultation with the Doctor will help you answer all your questions. Get in touch with us and let us guide you accordingly.

How long does the procedure last? Is it painful?

  • The finest needles are used to inject the substance into the muscle, and it is practically painless.
  • Pain is also minimized by use of ice or topical anaesthetic to numb the skin prior to injecting.
  • The procedure lasts up to half an hour.

When are the effects seen?

  • The initial effects become visible within 2 to 3 days. The maximum effect is reached in 1 to 2 weeks.
  • A top up within 2 weeks may be recommended if there is an unsatisfactory response to the first session.
  • The effect of one treatment usually lasts 4 to 6 months and becomes longer with further treatments.

Any precautions before and after treatment?

Before: Stop antioxidants (vitamin A, C and E), aspirin/NSAIDs 1 week before.


  • Work the muscles involved so that the drug localizes better in the muscle.
  • Avoid lying down for 3 to 4 hours after the procedure.
  • Avoid alcohol and exercise for 3 to 4 hours after the procedure: the increased circulation will wash away some of the drug intended for the muscle.
  • Avoid flying immedately after procedure.

Any side effects?

Uncommon and reversible (i.e. they are not permanent). Include:

  • Bruising or swelling at injection site.
  • Brief visual disturbances. Drooping of eyebrow or upper eyelid.
  • Dry sensation in eyes. Dry mouth.
  • Headaches.

Any contraindications?

  • Pregnant/breast feeding women.
  • Certain conditions of weakness of muscles (myasthenia gravis, multiple sclerosis)
  • Blood clotting disorders.
  • Allergy to albumen.
  • Medications – certain antibiotics, muscle relaxants. Recent anaesthesia

What are the alternatives to treat wrinkles?

Fillers, chemical peels, laser resurfacing, surgical face lifts. These will be discussed by the doctor during consultation.

Who will perform my treatment ?

Dr David Grech MD has been a medical practitioner since 1996 and has practised cosmetic procedures since 2001. He was trained(Allergan) by Dr Anthony Benedetto (US) and by Dr Katie Goldie (UK), and has attended further advanced training at KT Medical Aesthetics Training in Harley Street.

He has performed over 2000 recorded wrinkle treatments to date. He is a member of the European Society of Cosmetic & Aesthetic Dermatology (ESCAD) and attends annual medical congress updates in Paris and London every year.

Dr Grech is certified to deliver the treatment to all areas of the face and neck, including less commonly requested procedures such as the Nefertiti Lift.

What treatment fees* should I expect ?

Consultation fee is that of € 30, waived if treatment is done on the same day of consult. Fees are from € 120 for one facial area to € 275 for a full upper face. Bespoke quotes for lower face. One follow up session is normally timed at 10-14 days after treatment, and is free including any required Botox dose top ups if applicable.

* these fees are periodically revised