Some things people bring to a med spa need a doctor rather than a treatment room. Some things people bring to a med spa are not aesthetic problems and need a doctor rather than a treatment room. See a physician or a dermatologist, not us, if you have a mole or a mark that has changed shape, colour or size, or that bleeds, itches or will not heal; a sore anywhere that has been there more than three weeks; a rash you cannot explain; a patch of skin that is newly numb, hard or ulcerated; sudden hair loss in patches, or hair loss alongside fatigue or weight change; or swelling, heat and spreading redness that could be an infection. And if you have had filler treatment anywhere and the area becomes white or mottled, severely painful, or your vision changes, that is an emergency — telephone us immediately if we treated you, and go to an emergency room if you cannot reach somebody within minutes. We would far rather you rang a doctor and never rang us at all.
A very small quantity of a purified protein is injected into a named muscle. Over three to ten days that muscle stops contracting as strongly, and the skin folded by that contraction stops folding. Three to four months later the effect wears off completely and the muscle works exactly as it did before. There is nothing permanent about it and nothing is being filled: the injection changes movement, and the change in the skin is a consequence of the change in movement.
That mechanism is also the limit. Lines that appear only when you frown, raise your eyebrows or smile — the horizontal forehead lines, the two vertical lines between the brows, the fan at the outer corner of the eyes — are what this treatment is for, and it handles them well. Lines that are visible when your face is completely relaxed have become creases in the skin itself, and relaxing the muscle beneath them helps a little at best. If a clinic tells you an injection will erase a static line, they are describing a result the treatment cannot produce.
The other thing worth saying plainly is that it is possible to have too much of this, and that the people who end up with a frozen upper face very rarely asked for one. It happens gradually, over years, a little more each time, because each visit is judged against the last one rather than against a face. We treat conservatively for that reason, we photograph nothing, and we would rather you came back at two weeks for a small addition than left with too much on the day.
What it treats well, and what it does not
The honest division. Three of these are what the treatment is for; the fourth is what people ask for and do not get.
Lines between the brows
The two vertical lines that appear when you concentrate or frown. This is the area the treatment handles most reliably, and for many people it is the only area worth treating. It also happens to be the area most often read by other people as anger or worry, which is why softening it changes how a face is perceived out of proportion to how much it changes the face.
Horizontal forehead lines
These respond well but need care, because the muscle that makes them is also the muscle that lifts your eyebrows. Treat it too enthusiastically and the brow drops, which looks heavier rather than fresher and takes three months to undo. We under-treat this area deliberately and add at the two-week review if it needs more.
Lines at the outer corner of the eye
The fan of lines that appears when you smile. Softening rather than erasing is the realistic goal here, because some of what you see at the outer eye is skin quality rather than muscle, and the part that is skin quality needs resurfacing rather than an injection.
Lines that are there when your face is still
This is the honest no. A deep crease visible in a relaxed face has become a structural fold in the skin, and relaxing the muscle underneath softens it slightly over months of repeat treatment rather than removing it. Static lines want resurfacing, microneedling, sometimes filler, and time. Anybody who promises you an injection will clear them is either mistaken or selling.
What actually happens, hour by hour
Including the parts people are not told until they are already in the chair.
The appointment
Twenty minutes for a first treatment, ten for a repeat. Your face is cleaned, you are asked to make several expressions while the clinician marks where the muscle actually pulls in your face — which differs person to person far more than the diagrams suggest — and then a handful of injections with a very fine needle. Most people describe it as a sharp scratch repeated a few times.
The first evening
Small raised bumps at each injection point which settle within about half an hour. Occasionally a bruise, more likely if you take anything that thins the blood or had a glass of wine at lunch. Stay upright for four hours, skip the gym that day, and do not rub the area. Nothing else is required.
Days three to ten
The effect arrives gradually rather than at once, and it is normal for one side to soften before the other. Do not judge anything before day ten and do not telephone us on day four convinced it has not worked, though you are very welcome to.
The two-week review
Free, and in our diary automatically. This is when we look at the result together in daylight and add a very small amount if one area has been under-treated. Judging at two weeks and correcting then is the difference between a natural result and the gradual creep towards too much.
Risks, and who we will not treat
Serious problems are genuinely uncommon here. The list still exists, and it is part of the consultation rather than a form you sign in the chair.
The common side effects
Bruising, small bumps for an hour, a mild headache in the first day or two, tenderness. All settle without treatment. Bruising is the one people mind, so if you have something on next weekend, book this at least a fortnight before it.
The uncommon ones
A drooping eyelid or a heavy brow if the protein spreads to a neighbouring muscle, an asymmetric smile if the lower face is treated, and occasionally an eyebrow that sits higher on one side. These are temporary — they wear off with everything else across roughly three months — but three months is a long time to look at something you did not want, which is why we treat conservatively.
We will not treat you if
You are pregnant or breastfeeding; you have a neuromuscular condition affecting how nerves signal to muscles; you are unwell or have an infection in the area; you are under eighteen; or you have had a reaction to this class of treatment before. We also decline when somebody has had a treatment elsewhere within the last eight weeks, because adding to work we cannot see is guesswork.
We may also simply say no
If your face does not need it, if you already have as much as a face can carry, or if what you have described to us would not be fixed by relaxing a muscle. That answer costs the price of the consultation and it is the most useful thing some people get here.
Wrinkle-Relaxing Injections in western Queens
A small amount of a purified protein placed in a specific muscle so it stops pulling as hard. It softens the lines that appear when you move. It does very little to the lines that are there when your face is still.
Every treatment here starts the same way: a full hour at a table in a room with no treatment couch in it, a proper medical history, your skin looked at in daylight, and then a plain statement of what we think would achieve what you described. You are told what it costs, how many sessions it usually takes, how long it lasts, what the recovery looks like and what can go wrong — on paper, to take home and read somewhere other than a treatment room. If the honest answer is a different treatment, or nothing, or a dermatologist, that is what you get instead, and it costs exactly the same.
Aesthetic treatment is elective medicine, and this page is not medical advice for you. Aesthetic treatment is elective, it is medicine wherever it breaks the skin, and nothing on this website is medical advice for you in particular. We do not diagnose disease. Every treatment here begins with a consultation and a medical history, because your health, your medication, your skin type and what you have had done before all change what is safe and what is sensible. Some people are told no. Being told no is a normal outcome of a consultation here rather than a failure of one, and it costs exactly the same as being told yes.
No before-and-after photographs, and no promised outcome. There are no before-and-after photographs on this website and there never will be. Every set you have seen somewhere else was chosen from a much larger pile, and the second picture is usually taken in different light, at a different angle, at a different time of day, often with makeup and frequently after retouching. Even an entirely honest pair shows you what happened to somebody else's face. What we publish instead is what a treatment typically changes, by roughly how much, how long it lasts, how many sessions it usually takes and how often people are disappointed. We do not guarantee an outcome, we cannot, and anybody who does is either guessing or selling.
The risks, plainly. Every treatment on this site has side effects and some carry real risks. The common ones are minor and short-lived — redness, swelling, tenderness, bruising, a day or two of looking like you have had something done. The uncommon ones matter more: burns, blistering and long-lasting pigment change from light-based treatment, which is a greater risk on deeper skin tones and on recently tanned skin; infection anywhere the skin is broken; and lumps, asymmetry and, very rarely, a blocked blood vessel from injectable filler, which is the one true emergency in this field. We screen for what makes each of these more likely, we tell you your own risk rather than the average one, and we decline to treat when the answer should be no.
What a med spa does not treat. We treat the appearance of healthy skin, hair and body. We do not diagnose or treat disease. If you bring us a mole, a changing mark, an unexplained rash, a sore that will not heal, skin that has become hard or numb, psoriasis, eczema, an autoimmune skin condition, or hair loss that came on suddenly or in patches, what you will get is the name of a doctor rather than a treatment plan. Aesthetic treatment applied on top of an undiagnosed skin problem can mask it, delay the diagnosis and occasionally make it worse. We would rather lose the booking.
Questions
Wrinkle-Relaxing Injections — the questions we are asked most
Will my face look frozen?
Not from one conservative treatment, and not from us. A frozen upper face is the result of a lot of treatment repeated over years, each session judged against the last rather than against a face, and almost nobody arrives asking for it. We treat less than most, we review at two weeks and add if it is needed rather than guessing high on the day, and we will decline to treat somebody who already has as much as their face can carry.
Is it painful?
A sharp scratch, repeated between three and fifteen times depending on the area, over about two minutes. Most people find it much less unpleasant than they expected and no numbing is normally used, though we will apply some if you would like it. If you are frightened of needles, say so when you book rather than when you arrive, and we will give the appointment more time.
How long before I can go back to work?
Immediately. There is no downtime beyond a few small bumps that settle within half an hour and the possibility of a bruise. Avoid the gym, a hot yoga class, a sauna, a facial and lying flat for the rest of the day, and do not press or massage the treated area.
Will the lines be worse if I stop?
No. This is a persistent myth and it is not true. When the treatment wears off, the muscle works exactly as it did before and the lines return to where they would have been. They can feel worse because you have spent three months not seeing them, but nothing has been made worse by having had it — and if anything, years of reduced folding tends to leave the skin marginally better rather than worse.
Can I have it while pregnant or breastfeeding?
No. We do not treat anybody who is pregnant or breastfeeding with any injectable. This is not because harm has been demonstrated — the studies that would show it either way are not done on pregnant people — but because no cosmetic benefit justifies an unknown. We are very happy to see you afterwards.
What brand do you use?
We will tell you in the room, as part of consenting to treatment, and we will explain why we have chosen it for your face. What we will not do is advertise a manufacturer's name, and no product is named anywhere on this website. Brand names in aesthetic advertising exist to borrow authority and to make you shop for a box rather than for the person holding the syringe.
Related
Often seen alongside this
Injectables & Facial Balancing
Dermal Fillers
A gel placed under the skin to restore volume or change a contour. It works immediately and lasts months to years. It is also the treatment in this building with the smallest margin for error.
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Injectables & Facial Balancing
Lip Enhancement
Filler placed in the lip to restore what has thinned, improve a shape or balance an asymmetry. Done well it is unremarkable. Done to excess it is the most recognisable treatment in aesthetics.
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Under-Eye Treatment
The hollow under the eye is the most technically demanding area on the face and the one most often treated badly. Half the people who ask for it here are advised against it, and the reasons are on this page.
Read moreA written plan and a written price before anything is booked
Book a consultation
Pick a clinician and an hour from the calendar — it shows only the times each of them genuinely has free. A consultation is a full hour at a table with no treatment couch in the room, and it costs $85, or $120 with the medical director. If you go ahead, that comes off your first treatment. If we tell you the answer is nothing, or a dermatologist, it costs exactly the same.