Antiwrinkle Top-Ups: Some ‘Top’-up tips from Dr Michael Aicken

Question: If someone has an antiwrinkle treatment and 2 weeks later wants a top-up, as a few lines are still showing, what is your method for assessing and managing this situation?

Crow’s Feet


  • First look at their before photos with them and let them simultaneously see themselves in a hand-held mirror.
  • Together, decide if they have had a little, a lot or no improvement.
  • Assess each area separately. Some may have worked better than others.
  • Sometimes this is enough for patients to see that they have a better result than they realised- because antiwrinkle toxins works gradually over the course of 2-14 days, so some people won’t notice as it kicks in.
  • Then decide what proportion (if any) of the original dose to give. On the forehead, you may decide to give another 1, 2 or 3 graduations of your insulin (or similar) syringe per injection site for example.
  • Air on the side of caution.
  • Don’t suggest that you are aiming for perfection but instead a significant improvement. You can always give them a higher dose next time but if you overshoot with the dose now, you will have a very unhappy customer.
  • Don’t top-up an area if the side effects of that area have already started to set in.
  • Don’t top-up until 2 weeks have passed since the previous treatment – or you are much more likely to overdose someone and get side effects.
  • Remember that wrinkles that were always present at rest are not going to shift with antiwrinkle treatments, unless you use dermal filler (for deeper lines) or a skin-resurfacing technology such as Profhilo for finer lines.