Botulinum Toxin (Botox)

How it works

Botulinum toxin temporarily blocks the signal between a nerve and the muscle it controls. A relaxed muscle moves less, so lines caused by repeated expression, such as those between the brows or across the forehead, may soften. The same principle is used in the sweat glands to reduce excessive sweating, and in the chewing muscle to reduce its bulk, which can narrow a square lower face for some people. The effect usually builds over several days and wears off gradually over months as the nerve recovers. Nothing is added to the skin, so it does not fill hollows or lift tissue.

Who it may suit

• Lines that appear mainly when you frown, squint or raise the brows
• Excessive underarm or palm sweating, when discussed by the doctor
• A prominent chewing muscle that makes the lower face look wide
• Early lines that have not yet become deep folds at rest

The treatment day

1. Facial movement review. The doctor watches how you move your face and decides which muscles are responsible for the lines.
2. Mapping and cleansing. Injection points are planned and the skin is cleansed; ice or numbing cream may be used.
3. Small injections. Tiny amounts are placed into targeted muscles using a fine needle.
4. Post-injection guidance. You receive instructions on activity and are usually advised to return if you want a review of the result.

Aftercare

• Avoid rubbing or pressing on treated areas for the first day
• Stay upright for several hours and avoid intense exercise for the rest of the day, if the doctor advises it
• Skip saunas and heavy facials for a day or two
• Expect the full effect to appear gradually over about a week or more

Things to know first

• Bruising, small bumps, headache and temporary heaviness are possible
• Spread to nearby muscles can cause a drooping eyelid or brow, or an uneven expression; these effects are temporary but can last weeks
• Pregnancy, breastfeeding and certain nerve or muscle conditions are reasons not to proceed
• Some antibiotics and muscle-affecting medicines can interact, so share a full medication list
• Over-treating the chewing muscle can affect chewing comfort and, with repeated use, change the contour of the lower face

How botulinum toxin compares with nearby options

The simplest way to separate it from fillers is to ask what is causing the line. If a crease appears only when you make an expression, relaxing the muscle may help. If a fold is visible at rest because tissue has thinned or descended, a filler or a collagen stimulator is more relevant, since toxin cannot restore volume. Many faces have both, and doctors commonly discuss a combination.

Skin Botox, or microbotox, uses far smaller amounts placed just under the skin and aims at oil, pores and fine surface texture rather than at strong expression lines. It is not a substitute for standard muscle-targeted dosing.

For skin that looks crepey or dry, a skin booster is closer to the mark. For a heavy lower face caused by fat rather than muscle, an injection that reduces fat or an energy-based device is more suitable than toxin, and a doctor can help work out which tissue is responsible.