Treatment
Botulinum toxin, read muscle by muscle
The injection is the easy part. What decides the result is which muscles are moving, how strongly, and which ones are holding your face up rather than folding it.
- Appointment
- 20 to 30 minutes
- Anaesthetic
- None required; topical on request
- Onset
- Movement softens from day 3, settled by day 14
- Duration
- Typically 3 to 4 months
- Downtime
- None. Small raised bumps settle within an hour
What it is
Botulinum toxin type A is a purified protein that blocks the release of acetylcholine at the neuromuscular junction. The muscle it reaches stops contracting at full strength. Where a line in the skin is being folded by a muscle underneath it, weakening that muscle lets the crease stop deepening and, over months, lets the skin above it recover.
That mechanism has a boundary worth stating plainly. Lines that are present when your face is completely still are not being produced by muscle contraction at that moment; they are set into the dermis. Botulinum toxin softens them slowly and partially, if at all. Lines that appear only when you move are the ones it addresses directly. Part of the consultation is deciding which of yours are which, because it changes what you should expect.
What is assessed
The upper face is not a single sheet of muscle. Frontalis lifts the brow. Corrugator and procerus pull it down and together. Orbicularis oculi closes the eye and pulls the lateral brow down. These groups are in constant opposition, and the resting position of your brow is the score line of that argument.
This matters because frontalis is the only muscle that elevates the brow. Treat it heavily in someone who is already using it to compensate for heavy upper lids, and the brow drops. The forehead is smooth and the eyes look tired. It is the most common way this treatment goes wrong, and it is an assessment failure rather than an injection failure.
- Brow position and lid height at rest — measured before anything is drawn, with the frontalis relaxed.
- Whether frontalis is compensating — if raising the brow is doing the work of opening the eye, dosing changes.
- Strength and vector of each depressor — corrugator and procerus are dosed to what they actually do, not to a template.
- Asymmetry you already have — almost everyone does. It is photographed and mapped, not averaged away.
- Static versus dynamic lines — so the ceiling of what this treatment can achieve is agreed in advance.
Where it applies
- Glabella — the vertical lines between the brows, produced by corrugator supercilii and procerus.
- Forehead — horizontal lines from frontalis, dosed conservatively and in proportion to the glabella.
- Lateral canthal lines — the creases radiating from the outer eye when you smile.
- Brow shaping — small doses to the lateral orbicularis to release the depressor and let the tail of the brow sit higher.
- Bunny lines, gummy smile, chin dimpling, masseter, platysmal bands — assessed case by case rather than offered as a menu.
The appointment
Assessment
You are photographed at rest and through a full range of expression. Muscle groups are palpated while you contract them. Nothing is injected on a first visit if the assessment says a different treatment is the right one.
Mapping
Injection points are marked on your skin against your own anatomy. You see the map before anything happens and can ask why each point is there.
Injection
A very fine needle is used, and the volume at each point is small. Most people describe it as a brief sting. The whole sequence takes a few minutes.
Review
You are seen again at two weeks, once the effect is fully settled. Adjustment at that visit is planned for, not a sign something went wrong.
Before and after
Photographs, unretouched
Each pair below shows the same person, photographed in the same position, under the same lighting and with the same lens. No retouching or filtering has been applied. Drag the handle to compare.
Before
After
/assets/before-after/botulinum-toxin-dubai-case-01-before.jpg
/assets/before-after/botulinum-toxin-dubai-case-01-after.jpg
- Treatment
- Botulinum toxin
- Interval
- Add the interval between the two photographs
- Note
- There is no guarantee that the result will be the same, as it might vary from one individual to another.
Before
After
/assets/before-after/botulinum-toxin-dubai-case-02-before.jpg
/assets/before-after/botulinum-toxin-dubai-case-02-after.jpg
- Treatment
- Botulinum toxin
- Interval
- Add the interval between the two photographs
- Note
- There is no guarantee that the result will be the same, as it might vary from one individual to another.
Before
After
/assets/before-after/botulinum-toxin-dubai-case-03-before.jpg
/assets/before-after/botulinum-toxin-dubai-case-03-after.jpg
- Treatment
- Botulinum toxin
- Interval
- Add the interval between the two photographs
- Note
- There is no guarantee that the result will be the same, as it might vary from one individual to another.
Please read. There is no guarantee that the result will be the same, as it might vary from one individual to another. These photographs record outcomes in specific individuals and are not a prediction of what any treatment will achieve for you. Anatomy, skin type, age, medical history and healing all differ between people.
Every procedure described on this page carries risks, which are set out in full below and are discussed with you in person before consent is taken. No result is guaranteed, and some people are advised at assessment that a treatment is not appropriate for them.
All photographs are published with the written consent of the individual concerned. Consent can be withdrawn at any time by contacting the clinic.
Risks and limits
These are discussed with you individually before consent is taken. The list is not exhaustive, and it is not a substitute for that conversation.
- Bruising at injection points, most likely around the eye, usually resolving within a week.
- Headache in the first 24 to 48 hours.
- Temporary brow or eyelid ptosis (drooping) if the toxin spreads to frontalis or levator palpebrae superioris. Uncommon, and it resolves as the effect wears off.
- Asymmetry, which is usually correctable at the two-week review.
- A blunted or heavy feeling in the forehead if dosing is too generous for your muscle bulk.
- Rarely, an inadequate response. A small proportion of people develop neutralising antibodies with repeated exposure.
When this treatment is not appropriate
- Pregnancy and breastfeeding.
- Neuromuscular disorders including myasthenia gravis, Lambert-Eaton syndrome and motor neurone disease.
- Active infection at the intended injection site.
- Known hypersensitivity to botulinum toxin or to albumin.
- Aminoglycoside antibiotics and other agents affecting neuromuscular transmission, which need to be disclosed.
After treatment
- Stay upright for four hours.
- Do not rub, massage or apply pressure to the treated areas for 24 hours.
- Avoid strenuous exercise, saunas and hammams for 24 hours.
- Normal facial expression is fine and does not need to be avoided.
- Contact the clinic if you develop visual disturbance, difficulty swallowing or weakness beyond the treated area.
Questions
Asked often
Will my face look frozen?
Only if it is dosed to be. The dose is chosen from your muscle bulk and how much movement you want to keep, and it is easier to add at the two-week review than to remove. If you want to retain visible expression, say so at the consultation — it is a legitimate goal and it changes the plan.
How long before I see anything?
Movement begins to soften around day three. The effect continues developing until roughly day fourteen, which is why the review is scheduled then rather than earlier.
How long does it last?
Three to four months for most people. Muscle bulk, metabolic rate and how much you exercise all shift that. Duration varies between individuals and cannot be guaranteed.
Does it thin the muscle over time?
Treated muscles do reduce in bulk with sustained regular treatment, and some people find intervals lengthen after a few years. This is a known effect rather than a promise.
Is it safe to keep having it?
Botulinum toxin has been used in medicine since the 1970s and cosmetically for decades, with a well-characterised safety profile at aesthetic doses. That does not remove the need for individual assessment at each visit.
What if I do not like the result?
The effect is temporary and resolves fully. Asymmetry or under-treatment can often be adjusted at two weeks. Over-treatment cannot be reversed, which is the argument for starting conservatively.
Also relevant
Related treatments
Consultation
Every face is read before it is treated
A consultation establishes whether this treatment is the right one for you. Sometimes the answer is that it is not.