When Botulinum Toxin is not an Option – Botulinum Toxin Alternatives


For those patients who are wary of undergoing botulinum toxin injections, there are fortunately other alternative treatments available to erase one’s fine lines and wrinkles. Dr Reza Mia reports on the top rejuvenation procedures that are toxin free.

They are many reasons why patients may not want to have botulinum toxin injections; some do not wish to have reduced expressions, others may not like the way it feels to have certain muscles relaxed – and of course there are those who cannot have botulinum toxin injections because they do not work for them (such as patients who have formed antibodies).

Fortunately for these patients there are alternatives, and of course, for all patients the best results are achieved by implementing a mix of various treatments. However, it must be noted that some areas of the face cannot be injected with toxin because of the risk to surrounding structures.

Some of the alternatives available today


Institute Hyalual Switzerland has produced a novel product for managing many of the signs of ageing. The product is a mix of hyaluronic and succinic acid, and therefore works to produce collagen and elastin. Fine lines may be injected, with their appearance markedly improved to treat crows feet, frown lines, forehead lines, bunny lines and even ‘smokers lines’ (lines by the lips and the smile lines around the mouth).

‘Smokers lines’ were previously difficult to treat because of their proximity to the muscles used for smiling and pouting. The elastin produced also allows for the treatment of the jowels and turkey neck, as one is able to tighten the skin to create a lifting effect. In addition, there are other benefits to this type of treatment, such as treating pigmentation marks and acne scarring. Wherever collagen is induced, the skin becomes thicker and firmer – moving as a unit without collapsing in on itself. In this manner, dynamic lines (and therefore static lines) become more difficult to create.

Pulsed Light

Energy devices such as the Orlight pulsed light machine are also effective methods for producing collagen, stimulating the dermis and improving the appearance of fine lines around the face. Skin lifting and tightening are also possible as described under redermalization. I have used this method in patients who cannot undergo treatments with needles due to needle phobias or high dosages of anti-coagulants, where stopping the therapy is not an option.

Cross-linked superficial HA fillers

Superficial fillers such as Restylane Skinboosters may be injected into fine lines to produce collagen and to smooth the skin in the areas described under redermalization. The cross linked HA makes this type of product more useful where firmer support is needed, but care should be taken not to inject this too superficially to avoid creating bumps.


Chemical peels such as TCA peels (Tri-chloroAcetic Acid) or herbal peels such as the ‘Green peel’, remove the most superficial layers of accumulated keratinocytes. These are the cells that make up the layer of the skin that we are able to see (the Dermis). When the cells are allowed to accumulate freely, the skin may appear dull or dry and show more fine lines and wrinkles.

When used correctly, these peels can improve the appearance of these lines, whilst also stimulating the dermis to increase the cell turnover. This results in a fresher looking skin. In addition, chemical peels make the skin more permeable, which gives us the opportunity to introduce active ingredients into the skin.

Platelet Rich Plasma

This procedure gained a lot of exposure after numerous celebrities, such as Giselle Bundchen and Kim Kardashian, underwent a form of this procedure called the vampire facelift. Although a trademarked name, this term seems to have become the everyday reference to platelet rich plasma treatments. The patients’ blood is drawn, spun in a centrifuge and separated.

The platelet rich component is then injected into the patient’s face and neck to stimulate new collagen and other proteins through the platelet derived growth factor. This procedure has also shown promising results in hair loss treatment – and shows initial success in non-surgical breast enhancement (especially when combined with redermalization treatments).

Hyaluronic Acid Dermal Fillers

Dermal fillers may be used to improve the appearance of many fine lines and wrinkles. In some areas of the face, the skin is stretched (as a balloon would) to reduce the appearance of fine lines and wrinkles, such as in the cheek and around the lips. This all creates a lifting effect.

Additionally, using filler to accentuate the jaw line may also achieve a lift (where toxin is not available to treat jowels). With experience, doctors may even use these fillers – which were designed for bulkier filling – in small quantities, to treat superficial fine lines.


A company called Iovera has created a device designed to disrupt the signals to the Procerus muscle to treat frown lines. However, the device is not yet widely available in South Africa.

Threads with bi-directional cones

These threads are more useful as a means of lifting sagging skin than for treating fine lines. Where toxins need to be avoided, these are effective in treating turkey necks and jowels.


Needling, such as Dermapen treatments, induce collagen and effectively treat fine lines and wrinkles.

Take home message

It is important to remember that for the average patient, the ideal result is obtained through the combination of these treatments along with botulinum toxin injections.

A2 Disclaimer: This article is published for information purposes only, and should therefore not be taken as an endorsement or advertisement for any product or medical treatment –  nor should it be regarded as a replacement for sound medical advice. 

Issue 20 – Dec 2016 (Summer)

This article was written by Dr Reza Mia and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine December 2016 Edition (Issue 20). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skin care, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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About Author

Rochelle Friedman

Rochelle is co-owner of A2 Aesthetic & Anti-Ageing Magazine - she looks after A2's Blog and the Sales & Marketing for the A2 Magazine. Follow her on twitter by clicking the birdy on the top right of this block.

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