Botulinum toxin (botox) injections to smooth the wrinkles on the face is the most frequently conducted aesthetic procedure in the USA and is one of the first procedures, which specialists start using in their practice.

Procedures with botox are most frequently conducted on the top third part of the face to smooth the glabellar wrinkles (between the eyebrows), which give a grumpy appearance, wrinkles type crow’s feet (around the eyes), as well as the horizontal lines of the forehead. The use of botulinum toxin for aesthetic purposes is a procedure, approved by the Food and Drug Administration in the USA, due to its minimal risks and side effects, together with the high number of happy patients.

Wrinkles appear due to skin atrophy and the constant contractions of face musculature. Botulinum toxin (botox) is a powerful neurotoxin. It blocks the release of acetilholin, which activates the muscle and is a main neurotransmitter in the autonomic nervous system. Botox in small quantities (units), injected in specific points in the hyperactive face muscles causes a local muscle relaxation, which smooths the skin and visibly decreases wrinkles. The necessary time to see the full effect from botulinum toxin (botox) is about 2 weeks, and the achieved effect lasts for around 4 to 6 months.

For dynamic wrinkles, which appear during the contraction of the muscles the results are way better than these in static wrinkles, which are visible in a state of relaxation of the face muscles. Botox is not recommended for patients with keloid scarring, neuromuscular diseases, allergies from any of the ingredients of botulinum toxin, or dysmorphic body disorders. Minimal redness or bruising can appear after injecting botox. Rare side effects include blepharoptosis or ptosis of the eyelid, which is often due to the technique of injecting, and the risks would be minimal if the procedure is conducted by an experienced specialists.

Before using botox, it is recommended that patients avoid using aspirin or other medications or food supplements that expand blood vessels and can increase the chance of forming chematomas.

How does botulinum toxin work?

As mentioned above, wrinkles appear due to skin atrophy and a repeated contraction of the muscles. Injecting botox in small quantities causes the muscles to relax, therefore smoothing the skin and visibly decreasing wrinkles.

Botox shows its effect by releasing acetilholin, which causes a temporary lessened nerve activity.



Botulinum toxin (botox) is used for more than 20 years to treat different conditions such as blepharospasm, strabismus, cervical dystonia, migraine, hyperhydrosis, muscle spasms.

During 2002, the use of botox for aesthetic purposes was initially approved by the Food and Drug Administration (FDA) in the USA for treatment of the wrinkles in glabbelar folds (the wrinkles between the eyebrows), and during 2013 – for treatment of the muscles, which enable the formation of crow’s feet wrinkles. The procedures with botox have become some of the most desired procedures for removal of wrinkles in the upper third part of the face (wrinkles, the horizontal lines on the forehead, glabella and crow’s feet). Botox can also be used in the bottom two thirds of the face, but with special care by an experienced specialist.



The muscles that shows the face’s mimics are unique in the fact that they are connected with soft tissue to the skin by the superficial muscular aponeurotic system. When the face muscles move, the skin also moves, creating dynamic wrinkles, perpendicular to the muscle movements.

Wrinkles of the face

Glabellar wrinkles, or so called anger wrinkles are vertical lines which appear between the eyebrows. For the formation of these wrinkles, you can blame the five depressor muscles between the eyebrows, which cause a grumpy and sad look. To smooth the angry wrinkles, in most cases, botox is enough. In case they are too deep, a few weeks after injecting botox, a dermal filler can be injected to smooth them completely.


The patients with dynamic wrinkles shows the largest improvement after botox is injected and are the ideal candidates for the procedures. Patients with static wrinkles (visible in a state of relaxation) are also good candidates for a procedure with botox, but results for them are slower, and two or three consecutive procedures may be necessary.

Deep static wrinkles may not be completely smoothed after a procedure with botox, and a combined therapy with dermal fillers or another aesthetic procedure may be necessary to achieve optimal results. During the consultation, the experienced specialist will inform you of the result you can expect after a procedure with botulinum toxin.

On the first picture, you can see the ideal candidate for botox, with mimic wrinkles in the zone between the eyebrows. On picture B, you can see a lack of static wrinkles in the same zone, when the muscles are in a state of relaxation.

On the second pciture you can see the glabellar line during a mimic, and in B – the static wrinkle in the same zone in muscle relaxation.

Cases in which botox cannot be used

  • Hypersensitivity;
  • Infection in the zone that is to be treated;
  • Vascular-muscle diseases /miastenia and others/;
  • Recent use of aminoglycosides, cholinesterase inhibitors, succinylcholine, calcium blockers, lincosamides, polymyxin;
  • Pregnancy;
  • Breastfeeding;
  • Inflammatory/autoimmune diseases/;
  • Age > 65 years;
  • Allergies from medications and food /eggs/;
  • Diagnosed psychiatric conditions;
  • Easy bruising, bleeding, slow scabbing of wounds, easy to get large scars;

Consultation with a specialist

It is extremely important that a consultation with a specialist is conducted, during which the problem zones will be evaluated. Asymetries are described, such as an uneven height of the eyebrows, opening of the eyelid and others, after which the problem zones are prioritized and the options for their treatment are discussed. The expected results and possible side effects are also discussed in the consultation. Botox is the only method for treatment and smoothing of mimic wrinkles approved by the Food and Drug Administrations. The recommended ways to treat static wrinkles also include other methods such as laser peeling, hyaluronic fillers, mesotherapies and others. Pictures before and after every procedure are recommended. The pictures of dynamic and static procedures are usually taken before and two weeks after a procedure with botox, when its effect is final.

Before a procedure with botulinum toxin

To minimize the risk of chematomas and bleeding, it is recommended to stop using aspirin or other medications or food supplements that are anticoagullants two weeks before the procedure. It is usually not necessary to apply anaesthetic in the form of anaesthetic cream before a procedure with botox.


Injecting botox

The points to be expected are determined. The procedure takes about 15 minutes. It is done with a very thin needle, and the patient needs to be in a half-lying or seated position.

After a procedure with botox

For 4 hours after the procedure, the patients need to not be in a laying position. For a minimum of 48h after a procedure with botulinum toxin, the zone that was injected need not be massaged or rubbed. Makeup application should be avoided for a minimum of 4 hours after the procedure. In addition, bending over and heavy physical exercises should be stopped, as well as using the sauna for 7 days after a procedure with botulinum toxin.

Results and consequent actions

For 3 days after the procedure with botox, a partial decrease in the function of the muscles in the zone of the glaberal wrinkles is visible, and the end results is visible 2 weeks after the procedure. The return of the muscle functions happens step by step, usually 3-4 months after the procedure. A follow-up procedure with botox is recommended when the contractions of the muscles become visible, but before they return to their initial condition. After a few procedures, the effect of the procedure with botulinum toxin is usually extended, and for some patients the intervals of injecting botox increase by 3-4 months.

On the picture you can see the dynamic wrinkles before and 1 month after conducting a procedure with botulinum toxin (botox).

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