Dynamic lines and wrinkles are caused by contractions of the delicate underlying muscles every time we smile, laugh or frown. The more emotion we show the deeper these lines and wrinkles are likely to be. Over the years however, constant and even sustained contraction of these muscles, may lead to more permanent lines and creases developing. While we may have earned every one of our worry or laughter lines, the prospect of these permanent creases in the skin may not appeal to everyone. With the advent of an approved drug, dynamic lines can be dramatically softened. The procedure, which uses a purified toxin produced by the bacterium Clostridium botulinum (BOTOX®), is also termed cosmetic denervation. Although the toxin is the same as the one that causes a serious form of food poisoning (Botulism), the amount used in cosmetic surgery is so minute that no systemic or general reaction is likely to be seen.


Botulinum toxin has been used very safely and successfully since 1982 by ophthalmologists to treat nervous twitching of the eyelid and lazy eye. In fact, each year thousands of patients receive BOTOX® treatments for a variety of other conditions but over the last 10 years it has become quite a popular treatment for reversing the visible signs of ageing. Although celebrated in the media mainly as a line remover BOTOX® has more recently been used successfully to combat the problem of excessive sweating of the underarms, palms and even soles.

How does BOTOX® work?

When injected into a given area BOTOX®, which is the trade name of Botulinum toxin type A, reversibly blocks the impulses from the nerves to the tiny facial muscles that are related to expression lines. By doing this, the muscles cannot contract and therefore tend to relax. When muscles relax, the overlying skin remains smooth and unwrinkled while the untreated facial muscles continue to contract in a normal fashion, allowing normal facial expression to be unaffected.

What areas can be treated?

BOTOX® is most commonly performed in the upper face. The most common areas requested are the forehead lines, vertical frown lines between the eyebrows, and crows feet or laughter lines radiating away from the eyes. While it would probably work around the mouth and chin, it would almost undoubtedly weaken the smile. Smile lines are usually either treated by laser or by filling with collagen or fat.

How is it done?

The procedure itself is simple and safe. BOTOX® is injected with a very tiny needle into the desired area. Depending on the area treated, between 4 -10 injections are necessary. Because the needle is so fine and only a small amount of liquid is used the pain is usually minor, like a sting for a few seconds. Once the injection is complete there is usually no discomfort. No sedation or local anesthesia is required and as no recovery is required, you can resume normal activities immediately. You can even drive yourself home or back to the office. Very occasionally some patients experience a slight temporary bruising or redness at the injection site. This can be covered with makeup.

How long does BOTOX® last?

The full effects of BOTOX® treatment are not apparent for three to seven days. As mentioned the effects are temporary in that the toxin is slowly metabolized by the body in approximately three to six months.

Are there any side effects?

There are very few side effects to this procedure. While allergy to any medicine is possible, it is rare indeed with BOTOX®. While a very small amount of brow drooping can occur when injected in this area, this can usually be avoided by not treating the 1-cm area just above the eyebrows. Despite precautions however in exceptionally rare circumstances this can still occur. However due to the non-permanent nature of BOTOX® this is always temporary. In these unlikely circumstances if a droop were to occur, it usually lasts about 2-3 weeks(much less than the full dose of BOTOX® lasts).

Am I a suitable candidate for BOTOX®?

Obviously only a consultation will be able to establish this. However, while BOTOX® is well tolerated by most people, patients who are pregnant or have a neurologic disease should not be treated.