What Is Botulinum Toxin?

Botulinum toxin is a bacterium that blocks the release of acetylcholine, the substance responsible for transmitting electrical impulses that elicit muscle contraction. In medicine, botulinum toxin is injected directly into hyperactive muscles.  It has been safely and effectively used for treatment of strabismus (cross-eye) and blepharospasm (lid spasm) since the early eighties.

How Does Botulinum Toxin Work?

Hyperactivity of the facial expression muscles often results in the development of deep frown lines, forehead lines and / or crow’ s feet.  Injecting botulinum toxin into the affected area temporary paralyses the underlining muscles responsible for wrinkling, giving the face a more relaxed and pleasant appearance.  The wrinkles become smoother or disappear altogether. When a small amount of purified botulinum toxin (BOTOX) is injected into a muscle it causes weakness or paresis of that muscle.  This appears in 2-4 days and usually lasts 4 months but can be shorter or longer.  
The botulinum neurotoxin can be used to soften the action of several muscles of facial expression.  Regions that benefit from this treatment include the glabellar frown lines, the horizontal forehead lines, mild brow ptosis, crow’s feet, infraorbital lines, zygomaticus and risorius folds and mouth frown, apple dumpling chin and mental crease.  Both vertical and horizontal neck lines and bands respond well to botulinum treatment.

Post Treatment Instructions

  • Refrain from touching the treated area for 3-4 hours
  • Remain upright for 3-4 hours
  • No exercise on day of treatment
  • No sun beds for 7 days
  • No facials / chemical skin peels or laser resurfacing treatment for 7 days
The patient will not be able to voluntarily use these muscles while the injection is effective but that this will reverse itself after a period of months, at which time re-treatment is appropriate. The patient must maintain up-right posture and that I must not manipulate the area of the injection throughout the 4-hour post-injection period.

When and How Long Does Botulinum Toxin Work?

The initial effects of treatment become visible within 48 hours to 72 hours.  The maximum effect is reached in about 1 to 2 weeks. Your facial expression will become more relaxed but by no means mask-like.  The overall result is very natural. The effect of treatment generally lasts for 4 to 6 months.  Re-treatment is then required. Botulinum toxin injection is generally a safe and effective treatment method. Nevertheless, certain side effects can occur but like the intended treatment effects, they are mostly reversible. At this appointment, you will be informed about the potential side effects of botulinum toxin therapy, risks and complications, contraindications to therapy and potential drug interactions.

Potential Adverse Effects (side effects)

  • Bruising or swelling at the injection site
  • Slight feeling of nausea
  • Tiredness, pain in the arms and legs
  • Temporary drooping of the eyebrow or upper eyelid
  • Brief visual disturbances
  • Dryness of the eyes
  • Skin rash
  • Itching
  • Allergic reactions
  • Dry mouth
  • Muscle atrophy

Risks and Complications:

BOTOX treatment of frown lines can cause minor temporary droop of one eyelid in approximately 1% of injections.  This usually last 2-3 weeks.  Occasional numbness of the forehead lasting 2-3 weeks, bruising or transient headache has occurred.  In perioral injections, the diffusion of the BOTOX may transiently weaken adjacent musculature. In a very small number of individuals, the injection down not work as satisfactorily for as long as usual.


  • Pregnancy
  • Breast feeding
  • Myasthenia gravis
  • Lambert-Eaton syndrome
  • Blood coagulation disorders

Drug Interactions

Drug interactions can occur when botulinum toxin is used concomitantly with other medications. Since these medications can alter the effects of botulinum toxin, you must ensure that your doctor is aware of any current medications you are taking, especially:
  • Aminoglycoside antibiotics
  • Anesthetics
  • Muscle relaxants

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