Botulinum Toxin A (Botox)-

Botulinum toxin therapy is one among the most popular cosmetic treatments


Botox injections are used primarily for the reduction of facial wrinkles. They are also used in treating excessive sweating (hyperhidrosis), neck spasms (cervical dystonia), lazy eye, chronic migraines etc. Botox was the first botulinum toxin used, which is Onobotulinum toxin A. Dysport which is Abobotulinum toxin A and Xeomin which is Incobotulinum toxin A are also popular brands available in the market today. They all have the ability to prevent muscles from moving temporarily, thereby reducing wrinkles on the skin, especially on the face.

This toxin is produced by the microbe Clostridium botulinum, an anaerobic gram positive spore forming bacteria that causes botulism, a type of food poisoning. Seven different strains of botulinum have been identified and are categorized A-G, depending upon the type of botulinum neurotoxin produced. All of this neurotoxin varies themselves in the size, structure and mechanism of action. The most commercially produced and clinically relevant subtypes are A and B. Botulinum toxin A is thought to exert the most powerful neuromuscular blockade and is of longer duration of time.

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Mechanism of action

Botulinum toxin works mainly by the process of inhibiting the release of acetylcholine receptors at the neuromuscular junction, thereby blocking the impulses leading to inactivity / contraction of the muscles in the targeted area. This toxin effect results in localized muscle weakness, that reverses over time and the mechanism by which botulinum toxin-induced muscle weakness is reversed is unknown.

Botulinum toxin once injected will take an average of 3 days to act, for its effect to become clinically apparent. The duration and the effect of the toxin may be in a range of average 3-6 months.

Clinical application of botox injections

We already know that these injections block certain chemical signals from nerves, mostly that causes muscles to contract.
The most common application of this injection is to temporarily relax the facial muscles that causes wrinkles on tho face and neck. They have other clinical uses too, like
  • Lazy Eye
  • Cervical Dystonia
  • Muscle Contractures
  • Hyperhydrosis
  • Chronic Migraines
  • Bladder Dysfunction
  • Eye Twitching

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Some of the major effects of botulinum toxin on the midface and upper face to reduce the wrinkles on skin, due to the ageing process are;
  • Horizontal forehead lines
  • Glabellar frown lines
  • Bunny lines
  • Sagging brow
  • Crow’s feet
  • Perioral lines 
  • Gummy smile
  • Platysmal bands
  •  Horizontal neck lines
  • Prominent square jaw (Hypertropic masseter muscle)
  • Perioral lines

Always select your doctor and clinic

Botox injections are safe when performed by an experienced Maxillofacial surgeon or a Dermatologist. It’s important that the injections be placed precisely to avoid any undesirable effects.


Always tell your doctor if you have had any Botox injections in the last four months . Also inform your doctor if you are taking muscle relaxants, sleeping pills, allergy medicines etc. If you are on any anti-platelets / blood thinners, you may need to stop them 5 days before the procedure, with the consent of your physician.

The only contraindication to the administration of botulinum toxin includes neuromuscular disease such as myasthenia gravis and Eaton-Lambert syndrome or peripheral motor neuropathies, which can similarly potentiate the effects of botulinum toxin.

Botulinum toxin should be avoided in patients with a cutaneous infection at the proposed site of injection. 

No studies have been done so far regarding the effects of botulinum toxin in pregnant woman and breastfeeding mothers, hence use of toxin in these patients are not recommended.

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Usually one may not feel any discomfort during the procedure. Still the doctor may numb your skin beforehand, use topical anaesthesia or freeze your area of injection with ice to make it absolutely painless.

Botox injections are performed in the clinic set up only. The doctor uses the thinnest needle to inject botulinum toxin into your skin and muscles. The number of injections and the dose depends on the area being treated.

 After the procedure donot rub or massage the areas for the next 24 hours. This will prevent the toxin from spreading into different areas, thereby avoiding undesirable results. One can return to the normal activities the next day itself after the procedure.

Botox injections usually start showing results from the same day and may take upto 3-4 days for best results. Depending on the areas treated, the therapeutic effect may last from 3-6 months post injection. To retain the desired effect, one may need follow-up injections at different intervals.

Botulinum toxin, a purified proteinblocks acetylcholine release into the neuromuscular junction resulting in reduced ability of that muscle to form wrinkles. This helps in smoothening  the expression lines that are caused by those muscles.

  • Frown lines between the eyebrows.
  • Crow’s feet.
  • Brow lift
  • Facial contouring like jaw line slimming
  • Improves lines around mouth and neck
  • Excessive sweating over underarms, hands and feet
  • Smile correction
  • Lip lengthening

During the procedure, doctor injects botulinum toxin into targeted muscles on the face or neck which results in temporary relaxation of the targeted muscles, causing fine lines and wrinkles to diminish. One can see the results lasting  forabout 3 to 4 months — and sometimes longer.

We want our patients to look natural. To do this, we inject just enough to weaken and relax the targeted muscles without affecting other muscles. This allows patients to maintain their natural facial expressions.

You can have next treatment session when the excessive sweating or lines and wrinkles return. With repeat treatment for lines and wrinkles, the muscle may thin, leading to longer-lasting results.

There is no downtime for this procedure. You can return to the everyday activities immediately.

To prevent the injected substance from spreading, you need to take a few precautions like:
  • Do not rub or massage the areas where you received the injections for 48 hours.
  • If you apply makeup, be gentle and press or rub it.
  • Avoid strenuous physical activity for 48hrs like lifting heavy weights, working out.

If a patient develops side effects, these tend to be mild and temporary. The injections, rather than the botulinum toxin itself, cause most mild side effects like Swelling, Redness, Soreness, Bruising, headache , Weakness in a neighboring muscle, leading to a temporarily droopy brow or eyelid (rare).