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Botulinum toxin injections are among the most popular non-invasive procedures in aesthetic medicine today. The treatment improves most ageing signs caused by repetitive movement of facial muscles, with no downtime. However, the effects are temporary.

What is botulinum toxin?

Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum. The Gram-positive, rod-shaped, anaerobic bacterium. In aesthetic medicine, botulinum toxin injections treat facial wrinkles and creases.

Well-known brand names for botulinum toxin include Botox, Vistabel, Dysport, Xeomin, and Bocouture.

Indications

Botulinum toxin also has non-aesthetic medical uses. The most important ones include the treatment of:

• Hyperhidrosis (severe sweating)
• Chronic migraine
• Strabismus
• Blepharospasm
• Overactive bladder, and
• Cervical dystonia

However, the aesthetic application is the most popular one. Most primary care providers can perform the procedure with adequate training.

As a non-surgical cosmetic treatment for age-related skin changes, the botulinum toxin relaxes the upper facial muscles responsible for the appearance of fine lines and wrinkles. It successfully improves the following indications:

• Crow’s feet
• Frown lines
• Vertical lip lines
• Horizontal forehead lines
• Gummy smile
• Bunny lines
• Chin dimpling
• Facial asymmetry
• Masseter lines
• Jawline definition

How does botulinum toxin work?

Botulinum toxin is injected into facial muscles while they are in a relaxed position. These are usually the muscles responsible for facial expressions such as frowning. Post-injection, the targeted muscles remain temporarily paralysed. That eliminates the wrinkles, but it also inhibits some emotion-related facial expressions.

Safe application of botulinum toxin

A trained practitioner should have a thorough understanding of facial anatomy and the correct injection techniques.

That allows for a relatively safe practice of botulinum toxin. The procedure takes place in a controlled environment, such as a clinic or a doctor’s office.

In the majority of cases, anaesthesia is not necessary. A patient may feel minor discomfort at the injection site. However, the needles are thin, and that discomfort is tolerable for most patients.

There are also some pre-treatment and post-treatment precautions about which the practitioner should warn the patients.

Pre-treatment precautions include avoiding anything that can increase the risk of bleeding or bruising, such as:

• Aspirin
• Ibuprofen, Advil, and similar pain killers
• Vitamin E
• Fish oil
• Gingko Biloba
• Ginger

Post-treatment, patients should avoid drinking alcohol, exercising, sauna, and rubbing the injection site for at least 24 hours. There are no restrictions on applying makeup immediately after the treatment.

How long do the results last?

The effects of botulinum toxin injections are temporary. They usually last between three and six months. After that, the injected muscles regain their previous function, and wrinkles appear again. However, this reappearance is gradual, and the wrinkles tend to look better than before treatment.

Potential side effects

Some side effects of botulinum toxin injections are common and affect most patients. These include:

• Redness
• Bruising, and
• Mild swelling

Such side effects resolve quickly without treatment, in most cases.

Other side effects are rare. They can present as headache, flu-like symptoms, weakness of nearby muscles, numbness, eyelid drooping, facial asymmetry, eye dryness, etc. These side effects can also resolve on their own in 24 hours to 3 weeks. However, additional medical care is sometimes necessary.

Patients suffering from neurological diseases, pregnant and lactating women should not receive botulinum toxin injections.

Learn more with the Certificate Courses in Aesthetic Medicine

Read more recent research.

References

• Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaén P, Monheit GD, Rzany B, Viel M. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit)–Part II: Wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol. 2010 Nov;24(11):1285-95. doi: 10.1111/j.1468-3083.2010.03728.x. PMID: 20569284.
• Satriyasa BK. Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect. Clin Cosmet Investig Dermatol. 2019 Apr 10;12:223-228. doi: 10.2147/CCID.S202919. PMID: 31114283; PMCID: PMC6489637.
• Cohen JL, Scuderi N. Safety and Patient Satisfaction of AbobotulinumtoxinA for Aesthetic Use: A Systematic Review. Aesthet Surg J. 2017 May 1;37(suppl_1):S32-S44. doi: 10.1093/asj/sjx010. PMID: 28388721; PMCID: PMC5434490.