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Nowadays, the most effective anti-ageing treatment for the face is injecting botox. Botulinum toxin, often called by its brand name, Botox®, reduces muscle contraction by acting at the neuromuscular level.

In 1973, Scott began using botulinum toxin during strabology procedures. Today, that means in case of serious strabismus surgery can be avoided in 80% of cases. The use of botulinum toxin for aesthetic treatments began in Canada in 1987. Jean and Alastair Carruthers, ophthalmologist and dermatologist noticed that patients treated for blepharospasm (permanent spasm of the eyelid) no longer had crow’s feet. And so began the use of botulinum toxin for aesthetic purposes by the reducing the tightness of the facial muscles that are responsible for facial expression. From that moment, millions of injection sessions have been performed to the extent that authorities in many countries have labelled botulinum toxin as safe. After retrospective studies approval has been granted to use botulinum toxin for removing frown wrinkles in: USA, Canada, Switzerland, France, the Netherlands, etc.

How does it work?

When botulinum toxin is injected it blocks the release of acetylcholine, which is important for muscle contraction. Everyone has two eyes, a nose and a mouth, and yet there are endless variations of unique facial expressions and shapes that are specific to each individual. This means that everyone possesses a different anatomical structure at rest and during movement. A doctor must carefully look at his patient to assess the position and dynamics of the muscles. These two factors allow the doctor to administer the botox in the right place. Knowledge of anatomy is, therefore, essential.

It is sometimes said that botox makes the face rigid and unnatural. This only happens when the injections are administered in a standardised way, i.e. each person is treated identically. Determining individual injection treatments to meet each person´s characteristics is technically challenging. Knowledge of anatomical structures and experience is required. Before the treatment, an explanation will be provided about botulinum toxin; the desired result will be discussed, and a follow-up consultation agreed. Sometimes it is necessary to perform a 2nd treatment after a month to even out small imperfections. However, during this time the face will carefully mapped out and future treatments will be easier and should not require a second visit.

What can be treated?

Wrinkles caused by expression. Most wrinkles treated in the face are frown lines, forehead wrinkles and crow’s feet. Harmonisation of the face; balancing muscles, improving the skin’s moisture balance at the epidermal level through anticholinergic action – for example, to reduce excessive armpit sweating. Reducing the tightness in resting muscles – prevention of facial ageing is best achieved when there is symmetry.

Injection method

  •     A thorough assessment of the patient’s anatomical structures is first required.
  •     You must not fast around the time of the injection.
  •     Make-up will be removed before the injections.
  •     EMLA cream may be used to anaesthetise the skin beforehand. This cream must be applied 20 minutes in advance.

Reasons the treatment should not be performed

Botulinum toxin cannot be used in cases where it is known that the patient is hyper sensitive to botulinum A neurotoxin, myasthenia gravis or Lambert Eaton’s syndrome. It is not recommended during pregnancy, lactation or aminoglycosides-based therapy (antibiotics). If you are using blood thinners, you must let the doctor know so he can take this into account when carrying out the injection. It is recommended that botox treatment be repeated between every 3 and 7 months. If the treatment is repeated before 3 months, this can result in a so-called “vaccine effect”.

After the treatment

You must not undertake any intensive sports or other activity for two hours after the procedure. Do not massage your face thoroughly; if you do, the product will begin to migrate. During the 1st three days after the injection you must regularly flex your muscles for 5 seconds at a time to facilitate fixation of the material. After 20 days you can have a touch-up (small, taking into consideration the vaccination effect) as the effect may be noticeable for up to 20 days.

Rare effects after the injection

  •     Ecchymosis: blue marks around the area of the injection.
  •     Oedema: Swelling around the eyes can occur a few days after the injection, but should disappear by itself after 5 to 10 days.
  •     If in doubt, you can always call your treating doctor.


  •     Today, local or regional complications are rare
  •     Local complications
  •     Headache – usually disappears after a few days, it should be noted that migraine patients and patients with muscle tension headaches may benefit from botulinum toxin injections.
  •     Eyebrow ptosis may be caused if an injection to remove the low wrinkles on the forehead is made too close to the eyebrow. After a few weeks, the eyebrow will return to its normal position.
  •     Eyelid ptosis is a rare complication that occurs in less than 1% of the cases and usually disappears by itself after a few weeks
  •     Difficulty swallowing can occur with injections around the neck area – this effect is temporary
  •     General complications
  •     Allergic reactions
  •     Nausea and dizziness, fever and signs of flue


The purpose of cosmetic surgery is to make patients happier. Unfortunately, this may not be the case if there are pre-existing psychological disorders. Patients can also react differently, even if the aesthetic result is comparable. Botulinum toxin ensures rejuvenation takes place at the expense of facial expression. This effect must be considered in order to avoid disappointment. Especially when it concerns an actor or presenter.

The results are generally visible within a few days. There may be varying effects in the face for 2 weeks; there may even be asymmetry. After the first injection, the effects will disappear from between 3 and 6 months. Because the product works on the muscle and on the skin’s hydration, there will be a difference in operation results, not only between patients but also for the same patient after different sessions. Also, there may be a slight variation in the product itself due to manufacturing inconsistencies. The variation in the concentration per jar can amount to 20%. The effect will be better after repeat sessions because the face will have been mapped out, and the effect observed. Good cooperation between doctor and patient is essential.

The patient is expected to:

Adhere to the agreed check-ups. People should not return after 4 months and complain that it has not worked. The doctor will not have been offered the chance to correct the work or to maximise the effect. Do not allow other doctors to carry out injections and break continuity. Accept the difference in the effect due to the intrinsic variability of the product.

The surgeon is expected to:

Be unsatisfied if the result is not as good as it should be. Invite the patient back if the result is not as desired, evaluate the problem, explain and correct any problems, or discuss the problem in order to avoid future disappointment.


Botulinum toxin should be injected by an experienced physician (plastic surgeon), who can clearly explain all the advantages and disadvantages of the product. A physician that guarantees the authenticity of the product and takes into account the differences in anatomy and variations of expression between people. Because injecting botulinum toxin is a highly technical procedure, it is not an exact science that can be reproduced. Perfection cannot be expected, but short term improvement in appearance and anti-ageing effects in the long term can be expected.