Anti-wrinkle injections Sydney North Shore

Anti-wrinkle injections are more commonly called by their commercial names, which we cannot name here due to Australian law.

These are all types of botulinum toxin A (BoNTA) – which is a purified, medical preparation of a protein that is known to block transmission of signals that cause muscle contraction. This protein has been used for a long time in medicine to treat muscular spasms around the eye (blepharospasm), the neck (torticollis), and other areas (in the gut, bowel, gallbladder system).

In cosmetic medicine and cosmetic plastic surgery, BoNTA has an excellent application – it acts on the junction between the nerves and the muscles thereby preventing or helping to reduce the muscles in the treated area from temporarily contracting.

Therefore by careful titration, a gentle, pleasing relaxation of certain facial muscles can be achieved to bring about a smoothening of wrinkles especially those that occur with repeated facial movements, like frown or forehead lines. Only muscles treated will respond to BoNTA whilst remaining areas will still be able to animate.

The other medical application of these injections include excessive sweating (hyperhidrosis).

The Skill in Anti-wrinkle Injections: Why Come to a Plastic Surgery Practice?

  • The skill in administering anti-wrinkle injections for facial rejuvenation is based on a precise understanding of the underlying anatomy of facial muscles.
  • In a plastic surgery practice the surgeon him/herself may perform the anti-wrinkle injections or they may be performed by experienced practice nurses working in the practice. Nurses working with a plastic surgeon have received direct training from both the surgeon as well as industry leaders to allow them with the skill, knowledge and experience that allows a surgeon to trust them with their patient and reputation.
  • Seldom do we want to completely paralyse muscles or muscle groups as this can create bizarre, ‘frozen’ and unwanted appearances as these can look ‘done’ and unnatural. Because botulinum toxin is not an all or none effect – but rather the number of nerves blocked is directly proportional to the dosage and placement of the toxin – the skill is in gently, and harmoniously weakening certain muscles which can produce improvements in facial features (such as positioning of the eyebrows) as well as softening of facial wrinkles.
  • Furthermore being a plastic surgery practice, we will only suggest anti-wrinkle treatment if it’s the right thing for you – for instance if your wrinkles are the result of loose skin, you may require a different treatment or surgical procedure, in which case spending time and money on anti-wrinkle injections may not be worthwhile.

Procedure Information

  • An initial consultation with our practice nurse is conducted to discuss and prioritise your facial concerns. During the consultation, specifically looking at a holistic ageing process, possible benefits and likely treatment outcomes. A full medical history is taken to determine your suitable to have possible treatments. Some patients may have underlying conditions that will contraindicate anti wrinkle injections, in which case other alternatives may be suggested.
  • The injections are performed by our practice nurse, under the supervision of Dr Aggarwal.
  • Most injections are performed the same day except in patients:
    • Who are taking blood thinning medications, or other over the counter agents that thin the blood.
    • Who have an infection, cold sores, or other wounds at or near the site of potential injection.
    • Who have other contraindications such as a neurological or muscular disorder, have had a previous allergic reaction to injections, may need extra consideration as to the suitability of treatment.
  • The injections are performed in our procedure room, at our main Gordon practice.
    • After an initial consultation and assessment by our practice nurse, a treatment plan is made.
    • Clinical photographs are taken before to look at muscle strength, wrinkles and skin quality.
    • o The injections are conducted in our procedure room in absolute privacy – for your comfort they are conducted using an ultra-fine needle and syringe.
  • After treatment, you can return to work immediately. Some bruising and discomfort may occur during injection, and you are best to apply an ice pack to the area to reduce this post-treatment. It is important not to massage the area after treatment as this spreads the product to other muscles that may not have been intended to be blocked by treatment.You will be given aftercare guidelines and how to care for your newly injected area.
  • The initial consultation and injections take approximately 1 hour.
  • Effects begin after 2-3 days and can take up to 3weeks for full effect. They last 3 to 4 months. The duration depends on location of the injections, the muscles being targeted,   and the patient’s overall metabolism, as well as if maintenance dosing is given – we recommend that patients are regularly reviewed and a top up dose applied to restore effects.
  • In general we will ask patients to return at the 2 week mark, to evaluate the effects, and it is typical for dosing to be added at this stage to produce desired results, rather than a large dose at the first sitting.
  • Thereafter we suggest a return to clinic at 3 – 4 month mark for assessment  and retreatment.

Procedure FAQs

  • Please visit our price list for further information.
  • In general the cost per unit is often more at a plastic surgery clinic. This is because the injections are being performed by experienced plastic surgery nurses under the supervision of a plastic surgeon. In many ‘cosmetic’ clinics there is often little to no oversight by a medical practitioner.
  • However the overall cost may not be all that different to other ‘cheaper’ clinics due to the following:
    • the skill of injections is in targeting the exact facial muscles to produce the desired effect. You may receive more product elsewhere to achieve the same effect versus precise placement of toxin, which can reduce the dose needed.
    • We believe in gentle titration of effect – so rather than give you a big dose upfront, we will give you a smaller dose at the first visit (therefore reducing cost) and will ask you to return at the two week mark. If you require additional dosing, you are only charged for the units used. By titrating the effect, we aim to reduce the cost for you.
    • We will happily suggest to you that antiwrinkle injections are not warranted if it will not produce the results you desire. Being a surgical practice, we can indicate to you if the benefits of surgery may outweigh the benefits and cost of nonsurgical treatments.

Risks & Complications

Anti-wrinkle injections are not recommended for:

  • Patients who have disorders of nerve-muscle signal transmission such as Myaesthenia Gravis or Eaton Lambert Syndrome.
  • Patients who are currently pregnant, breast-feeding or trying to become pregnant.
  • Patients with an active infection, cold sore or other breakout at the site of intended injection.
  • Patients with a previous reaction to Botulinum toxin

General risks of antiwrinkle injections include

  • Bruising
  • Discomfort
  • Swelling
  • Headache

Specific risks of antiwrinkle injections include

  • Insufficient effect – the dosing produces effect but not to the degree desired. In some ways this is performed intentionally to titrate the dosing to the required effect. The dosing varies widely between patients and it is therefore safer to titrate up to the effect desired.
  • Over-paralysis or unwanted blockade. In  rare circumstances  blockage  of unwanted muscle groups  can produce an unwanted appearance in unexperienced hands:
    • Injections near the eyebrow can cause upper eyelid droop (ptosis)
    • Injections in the forehead could cause brow heaviness (ptosis)
    • Injections of the crows feet can block muscles that aid in smiling to produce uneven smiling appearances
    • Injections near the angle of the mouth/lower lip can block other muscles causing drooling or uneven smiling appearance.
  • Asymmetry
  • Note with any unwanted outcomes, all care prior is  made to avoid these unlikely outcomes.  If you have any concerns please discuss during your consultation.


  • In hyperhidrosis (excessive sweating), botulinum toxin injections block the nerves that supply the sweat glands.
  • The injection is placed within the dermis of the skin and is very effective for areas such as the armpits, palms, and soles of the feet.
  • The average length of treatment duration is 7 months.
  • Injections of the armpit can be performed in the clinic (with anaesthetic cream), however a general anaesthetic is required as a day only procedure if the injection is for hyperhidrosis of the hands or feet.
  • A starch iodine test may be conducted prior to injection to exactly determine the area of sweating that needs to be treated.

This depends on the total number of units

  • The standard fee for axillary (armpit) hyperhidrosis is $992(for standard number of units per armpit) – this is rebatable from Medicare under item no 18362 which may allow one to claim $185 for a total out of pocket cost of $805.
  • Please note that additional units required after the first visit will be charged at our standard rates, and these will not be rebatable from Medicare.

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Why Choose Us

Highly Skilled

Highly skilled Fellowship Trained Plastic surgeon – know you are in the safest of hands with a Plastic Surgeon who is experienced, highly respected, and appointed at premier Sydney hospitals- including the SAN, RPA, POWH and RHW.


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Mode Plastic Surgery, 924 Pacific Highway, Gordon NSW 2072

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Multiple options throughout the week

85 Burdett St, Hornsby NSW 2077

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Alternate Tuesday afternoons

Level 2, Clinic D, Chris O’Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050.

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Alternate Thursdays

Level 1, 6 Ryde Road, Hunters Hill NSW 2110.

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Once a month Thursday morning.

Prince of Wales Private Hospital, Suite 10, Level 7, Barker St, Randwick Hill NSW 2031

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Once a month Friday morning.


1300 80 9000

Suite 13, 924 Pacific Highway
Gordon NSW 2072, Australia

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