Botulinum toxin


What is botulinum toxin?

Botulinum toxin, often referred to as "botox", has been used for over 20 years in ophthalmology (strabismus) and neurology (spasmodic torticollis). Its action is located at the nerve-muscle junction where it blocks the transmission of neurotransmitters. As the information between the nerve and the muscle is limited or blocked, muscle contraction is limited or impossible.

What are the indications and what kind of results can be expected?

Wrinkles are secondary to repeated contractions of the facial muscles. The more or less important decrease in the activity of the injected muscles causes them to relax and the wrinkles fade.  This effect is temporary and reversible within a few months. The effect varies from one individual to another, and also according to the dose injected and the technique used.

The effectiveness of botulinum toxin has been demonstrated for the treatment of:

  • forehead wrinkles,
  • frown lines
  • crow's feet" wrinkles
  • elevation of the tail of the eyebrows
  • for other wrinkles of the lower part of the face (marionette, chin, peribuccal,...)
  • gummy smile
  • wrinkles of the neck or décolleté.
  • neck lift ("nefertiti lift")


It is also used for hypersudation of the armpits, palms and soles where it allows a very important reduction of perspiration in these areas for a period of 4 to 6 months. Its mode of action in this area is not yet well understood.

Contraindications to injections: what you should inform us about:

  • Severe muscle weakness (myasthenia, Lambert Eaton syndrome...)
  • Pregnancy (or possible pregnancy) or if you are breastfeeding.


Precautions before injections: what you should inform us about:

  • Medical, surgical (including cosmetic), family, allergic history as well as any current medication (including vitamin supplements, phytotherapy, etc....)
  • Any previous botulinum toxin injections.
  • Allergy to egg or albumin.
  • Coagulation or platelet disorder.
  • Frequent herpes (preventive treatment to be taken).
  • Medications: Quinine, D-penicillamine, Aminosides
  • Aspirin and anti-platelet agents may be responsible for hematoma formation. Anticoagulants are a relative contraindication.

Procedure for the injections:

Before the injections, the dermatologist will make you grimace several times in order to determine the injection points and the tone of the muscles.
He will mark the points to be injected with a pencil.
These injections are not very painful.
It is not advisable to wear a helmet on the way home.

Precautions after the injections:

  • During the six hours following the injections, it is recommended to :
  • Do not engage in intensive or contact sports
  • Keep your head upright, sitting or standing, do not lie down or bend over (do not vacuum clean...)
  • Avoid drinking alcohol
  • Avoid very hot (sauna, hot bath, sunbed...) and very cold temperatures (ice rink...)
  • Avoid any compression on the injection areas (wearing a bicycle/motorcycle helmet, swimming goggles...)
  • Avoid local massages on the face, avoid applying cream or removing make-up.



The effects settle in 3 to 15 days, during which time they may be variable (even asymmetrical) before stabilizing. If necessary, a touch-up can be carried out (between 3 and 5 weeks after the injection). It is important that you do not schedule the injection appointment just before a period of long-term unavailability (travel abroad, etc.) in order to be able to make any corrections. The result varies from one patient to another and may be incomplete. It fades after about 4 months but with each injection (spaced at least 3 months apart), it can last from 6 to 10 months. In case of thick skin or "deep break" complementary techniques can be considered (filling...) to optimize the result.

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