Upper Face Anti-Wrinkle Injections
Doctor-led treatment for forehead lines, frown lines and crow's feet
What are anti-wrinkle injections?
Anti-wrinkle injections use a prescription medicine called botulinum toxin type A to temporarily relax the small facial muscles that create expression lines. When a muscle contracts repeatedly over many years, the skin above it creases in the same place again and again. Eventually those creases begin to linger even when the muscle is relaxed.
By softening the activity of a carefully chosen muscle, anti-wrinkle injections allow the overlying skin to smooth out. The medicine works at the junction between nerve and muscle, reducing the signal that tells the muscle to contract. The effect is temporary, developing over the first two weeks and gradually wearing off over the following months as the nerve endings naturally recover.
The products we use
Because botulinum toxin is a prescription-only medicine, the product itself is chosen by Dr Karwal on prescription, after your consultation. For transparency, our clinic stocks two licensed botulinum toxin type A products.
The first is Botox, made by Allergan, the original licensed product with the longest clinical track record of any botulinum toxin. The second is Relfydess by Galderma, the first botulinum toxin created with Galderma's PEARL technology and supplied as a ready-to-use liquid rather than a powder that requires reconstitution, which means no dilution step and consistent dosing from vial to vial.
The three upper face areas
The upper face is where expression lines usually appear first, and it is where anti-wrinkle treatment is most established. Three areas are commonly treated, on their own or together.
Frown lines (glabellar lines)
These are the vertical creases between the eyebrows, often called "11 lines". They are formed by the muscles you use to frown and concentrate, and they tend to be the lines patients dislike most because they can read as anger or stress. Relaxing these muscles softens the creases and takes away that unintentionally stern look, without affecting the rest of your face.
Horizontal forehead lines
These run across the forehead and come from raising the eyebrows. They are often among the earliest lines to appear, sometimes from the late twenties onwards. Treating the forehead needs particular care and judgement, because the same muscle that creates the lines also holds the brows up. Dosing that is too heavy, or placed poorly, can leave the brow feeling flat. Dr Karwal doses this area conservatively and precisely so that the lines soften while your brow position and natural expressiveness are preserved.
Crow's feet
These are the fine lines fanning out from the outer corners of the eyes, created by smiling and squinting. Treatment relaxes the outer part of the muscle that circles the eye, smoothing the lines while leaving your smile completely untouched. Many patients find this is the change people notice without being able to say why.
During your consultation Dr Karwal will assess how these areas work together in your face. Treating them in combination often gives the most balanced, natural result, but the right plan is always individual and sometimes less is more.
When will I see results, and how long will they last?
Anti-wrinkle injections do not work instantly, and how quickly they take effect depends partly on which product is used for your treatment. With Botox, most patients notice the first changes within three to five days, with the full effect visible at around two weeks, and results typically last three to four months. Relfydess behaves differently. As a ready-to-use liquid formulation, its onset tends to be faster, with some patients in clinical trials noticing changes within the first day or two, and its results have been shown to last longer, up to six months in some patients.
Anti-wrinkle treatment for men
A growing share of our patients are men, and male treatment is not simply the same treatment with a different price. Men typically have stronger, bulkier facial muscles, which means higher doses are usually needed to achieve the same softening. Male brows also sit differently, flatter and lower than female brows, and treatment must respect that to avoid a feminised or surprised look. Dr Karwal plans male treatment around male anatomy, which is also why our prices for men are slightly higher: the difference reflects the additional product required.
Upper face anti-wrinkle prices:
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1 area — Women £300 | Men £350
2 areas — Women £400 | Men £450
3 areas — Women £450 | Men £500
Using Allergan Aesthetics BOTOX®
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1 area — Women £500 | Men £550
2 areas — Women £550 | Men £600
3 areas — Women £600 | Men £650
Using Relfydess™ Toxin (RelabotulinumtoxinA) by Galderma
A full brand-named breakdown of every treatment is on our price list.
FAQs
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No. A frozen look is the result of heavy or poorly placed dosing, not of the treatment itself. Dr Karwal uses precise, conservative dosing designed to soften lines while preserving your natural movement. If you prefer an especially subtle result, tell us and we will plan for it.
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It depends on the product. Botox results typically last three to four months, while Relfydess has been shown to last up to six months in some patients. Duration also varies between individuals depending on muscle strength, metabolism and the areas treated.
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No. Treatment relaxes only the outer part of the muscle around the eye, so your smile stays warm and expressive while the lines beside your eyes appear softer.
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With Botox, most patients notice the first changes within three to five days, with the full result visible at around two weeks. Relfydess tends to work faster, with some patients in clinical trials noticing changes within the first day or two.
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Treatment tends to give the most satisfying results when lines are visible during expression, or in their early stages at rest. Deeper lines that are firmly etched into the skin at rest may improve but not disappear completely, and Dr Karwal may suggest combining treatments to address them properly rather than overpromising what one approach can do. Suitability is always confirmed through a medical assessment at your consultation, and certain conditions, including some neuromuscular disorders, mean treatment is not appropriate. We treat adults only. If you have an important event coming up, book at least two to three weeks ahead so your results have fully settled.
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Yes. Treating the frown lines, forehead and crow's feet together is known as a three-area treatment and is one of our most popular options. The appointment takes around 15 to 30 minutes.
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It depends on the product. With Botox, discomfort is minimal. The needles are very fine and most patients describe each injection as a quick, mild pinch. Relfydess can sting a little more on injection, so we can apply numbing cream beforehand to keep you comfortable. Either way, the appointment is quick and you can return to your day immediately.
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Not at all, but do tell us. Knowing what you have had, when, and how you responded helps Dr Karwal plan your dosing accurately. If you were unhappy with a previous result, bring photographs if you have them and we will plan around it.
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No. Anti-wrinkle injections are not offered during pregnancy or while breastfeeding. We are happy to see you for a consultation in the meantime so you have a plan ready for when the time is right.
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No. The effect is temporary and movement returns gradually as the medicine wears off, over three to six months depending on the product used. Many patients choose regular treatment to maintain their results, and with consistent treatment some find their lines soften further because the skin spends less time being creased.
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You will find us at 2nd Floor, 15 Dover Street, London W1S 4LP, in the heart of Mayfair with excellent transport links from across London. Please note the clinic is on the second floor with stair access only.