Wrinkle-relaxing injections

Wrinkle-relaxing injections use a neuromodulator: a prescription medicine, made from a purified protein, that temporarily relaxes the muscles it is injected into. Clinics use them for lines that form with facial expressions, such as forehead lines, the frown lines between the brows and lines at the outer corners of the eyes.

Several neuromodulator products are authorized in Canada. They are measured in units, and units aren’t interchangeable between products, so a dose of one product can’t be compared directly with a dose of another.

Injecting a neuromodulator involves controlled acts under Ontario’s Regulated Health Professions Act, and the product is a prescription drug. That means a prescriber must be part of your care: a physician registered with the CPSO, or a nurse practitioner registered with the CNO.

Registered nurses (RN) and registered practical nurses (RPN) can give these injections only when a physician or nurse practitioner has authorized it. From 1 March 2027, the College of Nurses of Ontario requires a client-specific order for each patient, issued after the authorizing provider has assessed you in person or by video and set a plan of care. Read what changes in 2027.

• Physicians and nurse practitioners can assess you, prescribe and inject.
• RN and RPN injectors need an authorizing physician or nurse practitioner, who should be named.
• Dentists in Ontario can’t give cosmetic injections outside the mouth (RCDSO position).
• Estheticians and laser technicians can’t give these injections.

Ask for the injector’s full name and registration number, and look them up yourself on the public register: the CPSO register (opens in a new tab) for physicians and the CNO register (opens in a new tab) for nurses and nurse practitioners.

The injection appointment itself is usually short. The effect typically appears gradually over several days and wears off over a few months, so people who continue tend to return a few times a year.

How long it lasts varies from person to person and by area. Ask your provider what to expect for you, and whether a review visit is included.

Your provider should explain the risks that apply to you before you consent. Commonly reported effects include:

• Redness, swelling, tenderness or bruising where the needle went in.
• Headache.
• A drooping eyelid or brow, or an uneven look, which can last until the product wears off.

Rarely, the effect can spread beyond the injected area and cause trouble swallowing, speaking or breathing. That needs medical attention right away. Ask the clinic how to reach them after your treatment, including after hours.