Botulinum Toxin

What botulinum toxin is and how it works

Botulinum toxin type A is applied in very small, purified doses into a targeted muscle. It temporarily blocks the release of acetylcholine at the nerve ending, so the muscle contracts with less force and the line that muscle creates in the overlying skin softens.

One distinction matters more than any other. Dynamic lines — the ones that appear when you move — respond to this mechanism. Static lines, visible when the face is at rest, are a question of skin quality and underlying volume rather than muscle, and are assessed for fillers, biostimulators or resurfacing instead. Setting that expectation correctly is the single biggest predictor of satisfaction.

Where it is considered

• Glabella (between the brows), forehead and the lines around the eyes
• The masseter muscle: clenching complaints and refining the lower facial contour
• Excessive sweating (hyperhidrosis) of the underarms and palms
• Selected indications such as the Nefertiti neck protocol and a gummy smile

Which areas are appropriate is decided after muscle strength and facial symmetry have been assessed in person.

The appointment and what follows

Treatment usually takes 15–20 minutes using very fine needles. The effect begins between the third and seventh day and settles fully at around two weeks. Duration varies with the individual, the dose and the strength of the muscle, but commonly falls between three and six months.

For the first few hours afterwards we ask you not to lie down or rub the treated area, and to avoid strenuous exercise, saunas and sunbeds for the rest of the day.

When it is not appropriate

It is not used during pregnancy or breastfeeding. Disorders of neuromuscular transmission such as myasthenia gravis, an active skin infection at the injection site, and known hypersensitivity to the product's components are contraindications. Aminoglycoside antibiotics can potentiate the effect, so please bring a full list of your current medications to the consultation.

What actually makes it safe

The result is determined not by the brand of product but by choosing the dose and the injection points to suit your anatomy. Too much softens expression into stiffness; a poorly planned point can cause drooping of the eyelid (ptosis). For that reason the treatment belongs with a physician who knows facial muscle and nerve anatomy thoroughly.