With 20 years of experience, Dr Joseph Hkeik is one of Australia’s most trusted cosmetic physicians in the industry. He is dedicated to guaranteeing natural-looking results for his patients. Founder of All Saint Clinic, his clinics offer facials and peels, skin rejuvenations and injectables.

In this session ofMamamia'sThe Skin Summit,Mamamia'ssenior beauty writer, Erin Docherty, asked Dr Hkeik all your questions about anti-wrinkle injections.

How do anti-wrinkle injections actually work?

Dr Joseph Hkeik:Well, anti-wrinkle injections or a muscle relaxant, it's a product that we inject either under the surface of the skin or inside the muscle. And that muscle will relax in about seven days. And the result will last anything between three to four months after the procedure has been done. Because wrinkles occur because of movement on the face - what we call dynamic wrinkles. When you relax that muscle, these lines will disappear for that period of time.

Do anti-wrinkle injections work on the nerve or the muscle?

Dr Joseph Hkeik:It works on the muscle. When you found, for instance, you're seeing two types of muscle or three different small muscles on the forehead. And these muscles contract and as they contract that creates a wrinkle on the forehead. When you're in your 20s, sometimes, you don't get those wrinkles. But as you progress with life, and especially in Australia, we tend to get more dynamic wrinkles. So when you put anti-wrinkle injections in those muscles and those muscles are relaxed, the muscle cannot contract enough to create these wrinkles.

Who should get anti-wrinkle injections? Who is the ideal candidate for anti-wrinkle injections?

Dr Joseph Hkeik:This is a million-dollar question. But we need to make it simple. Anyone who's got concerns about facial wrinkles is probably the right candidate.

If we talk about the dynamic wrinkles in a forehead, horizontal forehead line, the frown line, crow's feet - when people smile, and they get wrinkles around the eyes and these wrinkles are bothering them, they are probably at the right time to get the procedure done. If they frown, and they get a wrinkle, or if they're getting what we call the 'static line' in the same area. I'm talking about if you start to get a wrinkle run in the centre of the forehead, or the one or the 11 even when you're not moving your forehead, you definitely are the right person to start to get anti-wrinkle injections if you're concerned about those wrinkles.

Who should not get anti-wrinkle injections? What would make you think that someone isn't quite right for anti-wrinkle injections?

Dr Joseph Hkeik:Well, often you see people come forward, and we see them here sometimes saying 'I'm here because I think anti-wrinkle injection is the fashion'. Even when they don't have wrinkles. These clients, we often talk to them about their skincare, other ways to prevent some damage, and other procedures that can actually help to make their skin healthier. But we'll talk them out of getting anti-wrinkle injection for that reason.

What are the things to consider before getting anti-wrinkle injections?

Dr Joseph Hkeik:I always say it's best to see a professional and I'll always say start by seeing a professional doctor that specialises in that field because when they understand really the suitability of each client, usually they're non-commercial. So, they're going to be very honest with you about if anti-wrinkle injections are right or not right for you. So, I'd say have a proper skin consultation. Let the doctor analyse your face, analyse your skin, and determine if solutions like skincare products or other procedures, like micro-needling or other alternatives can actually help your skin more. If we think that none of these procedures [are] gonna remove those wrinkles for you, and then anti-wrinkle injections will become the right procedure for you. And then we can talk about that as a solution.

I'm not a big fan of people who go into an anti-wrinkle injection party, and then everyone getting the procedure done whether or not they need it. I think this is not ethical, and I will not support it.

Are there areas of the face where you should not be getting anti-wrinkle injections?

Dr Joseph Hkeik:Let me start by saying that the common three areas that we treat with anti-wrinkle injection is obviously the glabella frown or the frown line between the eyebrow, the surprise horizontal line, the crow's feet - they're the three common areas that everyone, usually when they're starting to get wrinkled, they would like to have these areas treated.

There are other specialised areas on the face that we can also treat with anti-wrinkle injections. And that's basically the wrinkle on the nose, or we call them bunny lines. We can flip the lip with a tiny little bit of anti-wrinkle on the sides. We can drop the chin a little bit for the crease that happened just above the chin - between the lip and chin, you can put some product in there. I mean, in the right hands, you can use the anti-wrinkle injection in all these areas - there's nowhere on the face that you could not really treat safely if you know what you're doing. But for someone getting the procedure for the first time, and if the injector or the doctor treating the person is not experienced enough, of course they can get some issues with it. And, so if you're a beginner injector, I say, you're only focused on the upper face, you don't go to the lower face because it's more specialised, and it's more tricky. And there you're more likely to get side effects from anti-wrinkle injections.

What are the side effects of anti-wrinkle injections?

Dr Joseph Hkeik:Obviously, you can get side effects by having too much anti-wrinkle in the muscle or if you inject the wrong muscle.

And then this probably brings you back to the question you're talking about the areas, about maybe two centimetres above the lateral brow is a kind of danger zone if you put too much anti-wrinkle in because what it does, it drops your eyebrow. And then if you put an anti-wrinkle injection within two centimetres over the lateral brow, you can drop that brow and you can make someone look very sleepy and then the eyelid will start to swell. So, this is one of the side effects that people are often scared about. And hence why it's important to see an experienced injector.

The other reason where, sometimes, people get side effects from wrong placement or wrong amount of anti recommendation is when they start to inject around a lip. And that's become really quite fashionable. And I use that word fashionable, because I don't believe in fashion when it comes to facial aesthetics. If you need it, we do it, if you don't need it, we don't actually offer it.

So, when you put too much anti-wrinkle above the lip, you can drop the lip too much. And, people can have issues with sucking from a straw or kissing or, you know, just speaking some time or laughing. And I think that's sad because this is a specialised procedure, which should be done only by specialists in this field.

How long does it take to see the results of anti-wrinkle injections?

Dr Joseph Hkeik:Generally speaking, we say about seven days, but the change can occur between three days to two weeks after the injection of the product that varies between patient and patient or so it varies between the doses. So if you have a baby anti-wrinkle injection, it's going to take a little bit longer for the product to do the effect. If you use it in a bigger dose, you're probably going to get the result sooner.

Is it possible to overdo it with anti-wrinkle injections?

Dr Joseph Hkeik:I think all the studies have shown us that the anti-wrinkle injection lasts 12 weeks. So, you think that everyone will stick to that rule?

I would not encourage people to come in every four weeks. I've seen that sadly on social media at times where people say, 'I've just been four weeks since my last treatment and here I am doing it again,' and I think all it does is encourage the clients to become resistant to the treatment. And eventually, doesn't matter how much you use the product - you will not get any effects. So, that's detrimental rather than beneficial.

So, people should not really rush and get the treatment every four to six weeks or even every two months, they should really wait and wait the 12 weeks and come back. And wrinkle is not going to really kill anyone, it's not going to make anyone look ugly. I think it makes you look better. Sure. But it doesn't take away from your beauty. There are other things about the face that we need to also look after - skin, the shape, etc. So, let's not just focus on wrinkles.

Is there a certain age to wait before getting anti-wrinkle injections?

Dr Joseph Hkeik:I'd say in most cases, in your late 20s to early 30s is probably the right age to come and see someone about your lines or wrinkles. Sadly, in Australia, and I'm sure in the rest of the world, these procedures have become fashionable, amongst the very young (15 to 16), who I really don't think have any wrinkles.

Even in Australia, I think people at that age should not have any wrinkles if they take proper care of their skin. So, I'd say if they're in their mid to late 20s or early 30s and they haven't started [having] wrinkles, meaning wrinkles you can see all the time. It's probably the right time for some clients and depends on their job and lifestyle. If they started to get very strong dynamic wrinkles, meaning wrinkles when they move a muscle like smiling [or when] they get big crow's feet, and that is of concern to them.

I'm always a believer in natural beauty, so I don't endorse people getting everything on their face injected just because it's there. You don't want to risk losing your character in the process.

What is the right time to start getting anti-wrinkle injections?

Dr Joseph Hkeik:This is a question I've often been asked about many interviews that I've done over the years. If we think about preventing wrinkles and we need to think about really why wrinkles occur - and why wrinkles occur is because we lose elastin with collagen and volume in the skin. And often what causes that loss is driven by repetitive use of a muscle.

Let's just focus on the frown one more time. So, if you think of the frown, we moved the muscle too much in here ...I've got some anti-wrinkle in there right now. So far, we cannot demonstrate to you very well how it should really work. But I practice what I preach. And as we all do at the practice here.

So, when you repeatedly move that muscle, eventually you'll create a crease in the centre. So, if you're someone that uses that muscle a lot to concentrate, yes, a tiny amount of anti-wrinkle injection will help. But we cannot just focus on the anti-wrinkle injection as the hero product here, we need to think about what else is happening with that person, you know. Are they eating well? Are they taking the right supplement? Are they using the right skincare product? Are they losing too much volume? Is that because of weight loss or stress, etc? So, we need to think about all the causes that cause the wrinkle to occur and try to address them completely holistically and not just focus on one solution, because the anti-wrinkle injection, as good as it is and 99.9 per cent satisfaction rate like a quick Band-Aid solution, is not the answer to everything. We need to think about the bigger picture.

What are baby injectables all about?

Dr Joseph Hkeik:Look, I might have been a big culprit in starting this baby treatment, because from day one and 23 years ago that is, I always use small doses of the anti-wrinkle to treat people because one, my focus was on trying to make the eyes bigger rather than making them look frozen.

When you give the recommended doses of anti-wrinkle injection - that is recommended by the company - the result can be a frozen look. But, this is not how we do it here at All Saint, we see the anti-wrinkle injection to relax the muscle enough to be able to manipulate the shape of the brow and to lift the brow in the centre lifted on the outside, and just to actually give you a better, brighter look. You look rested, you look fresh, but you don't look frozen.

This is something that I've done for 23 years. And at the beginning, I was not popular because of it. But when people started to actually understand the philosophy behind All Saint and why we do what we do, all of a sudden that becomes more like a cult. So, people love this baby anti-wrinkle injection for that reason - because you don't want to look like you've had an anti-wrinkle injection. No one should look like they've had really any of these products on their face, you should look like you and "this is how I woke up this morning. And I've done nothing except for some skincare, and then in some instances, makeup, and then I'm ready to face the world".

What are the signs that the anti-wrinkle injections were a fail?

Dr Joseph Hkeik:Bad work is often because they've had either too much product injected or the product was injected in the wrong muscles on the face. So, just to give you an example, frozen faces - in my eyes, I think this is bad work. No one should really walk around with no ability to express themselves. How will you connect with your friends and family and your kids, if you have kids? How will you show emotions? If you cannot really express and show, upset or smile or show surprise, how would people understand what you're all about? So I think, to me, a frozen look is definitely a sign of bad work.

The second thing that often you notice is people that are too scared to inject the lateral part of the brow, and they skipped this area - so they miss this area. But, they end up with what we call the Jack Nicholson look where the eyebrow was going all the way up. And that to me is a visible sign that you've had anti-wrinkle injections. The key is not to miss it, but to actually know how much and where they put the product to keep the eyebrow looking the same, only slightly lifted. So, the centre and the outside open up your eyes. And these tricks that people need to learn if they're going to practice these procedures on the regular basis and keep people looking natural.

...And is it fixable?

Dr Joseph Hkeik:In some instances,