Procedures - Botulinum toxin injections ("Botox")

Wrinkles are part of the ageing process. They can be attributed to sun damage, effects of gravity and muscle contraction resulting from facial expressions such as frowning and laughing. Wrinkles due to the effects of gravity represent natural sagging of tissue with age and are generally only improved by surgical tightening procedures.

Wrinkles caused by muscle contraction (muscle over-activity or hyperactivity) such as frown lines, forehead lines and crows' feet, can be improved by botulinum toxin (Botox – Allergan; Dysport – Ipsen) treatment. The various wrinkles caused by facial muscle contraction are illustrated in diagram 1. Botox can also be used to treat excessive sweating of the armpits and palms of the hands.

What is Botox?
Botulinum toxin is commercially available as Botox® or Dysport®. However, these injections arecommonly referred to as 'Botox injections' whichever product is actually used.

Botox® and Dysport® are the trade names for Botulinum toxin, a highly purified protein toxin produced by bacteria called Clostridium botulinum. Several types of toxins have been identified, but type A, which is used commercially, is the most potent. Botox acts by blocking acetylcholine, a chemical that is responsible for transmitting electrical impulses that cause muscle contraction. This results in muscle paralysis. The resultant paralysis, however, is temporary, as the new growth of nerves will re-innervate the muscles. By stopping the transmission of nerve impulses to the facial muscles that contract and cause wrinkles, (such as frown-lines between the eyebrows, horizontal forehead lines and crows’ feet around the eyes), patients find that about a week after Botox injections their facial wrinkles smooth out, giving them a more relaxed and youthful look.

Botox was first used in 1978 to weaken over active muscles in the eye, followed by other neurological conditions such as dystonia and hemifacial spasm with good effects and little side effects. Botox was first used cosmetically in 1990, to reduce facial wrinkles arising from muscle contraction.

Botox injections are the most commonly performed cosmetic procedure worldwide with an estimated 3 million injections performed annually (12.2 billion injections in last 25 years) – a testimony to its effectiveness and safety.

What can you expect at the time of your procedure?
Botox is injected directly into the muscles that cause the wrinkles, using a very small needle. Several injections are usually needed at specific sites, depending on the area treated (see diagram 1). Localised discomfort and bruises can occur, but no sedation or local anaethesia is generally required. Normal activities can be resumed immediately. It is however, recommended to avoid strenuous exercise for the first 24 hours.

What are the results?
Botox usually takes effect 24-72 hours after injection, with maximum effect at about 1 to 2 weeks. Its effects generally last for approximately 3-4 months. When injected into the muscles that are responsible for expression wrinkles, it gives the face a more relaxed and smoother appearance. Sometimes longer lasting effects (9-12 months) are seen after treatment of excessive sweating. A gradual fading of treatment effect is noticed after a few months which is then the usual time when most patients come back for a ‘top up’.

What are the limitations?
Whilst Botox can be very effective in reducing wrinkles due to muscle contractions, it has no effect in reducing the fine lines on the face caused by sun damage, and lines due to sagging of facial skin. In those patients with very heavy lines, repeated treatments may be needed for maximum effect. There are a small proportion of patients who have limited or no effect from Botox injections, presumably the result of antibodies to the toxin.


  • Patients who show early signs of aging, as well as those who may not be suitable candidates for more extensive aesthetic facial surgery, may be good candidates for this procedure.
  • No downtime – patients can immediately resume normal activities.
  • Long experience has proven anti-wrinkle injections to be safe. To date, no systemic complications associated with anti-wrinkle injections have been documented.
  • Treatment is reversible within several months.
  • May be beneficial for treatment of migraine headaches and a wide variety of other medical conditions such excess sweating, cerebral palsy, muscle spasm’s etc.

What are the contraindications for treatment?
The use of Botox is contraindicated in people with neuromuscular disorders such as myasthenia gravis, those who are taking certain muscle relaxants and antibodies such as aminoglycosides, pregnant or breast feeding women, those with infection or inflammation at the proposed site of injections and bleeding disorders, including patients who are taking anti-coagulation medications.

What are the risks?
No severe complications after cosmetic use of Botox have been reported in the literature. Very rarely excessive weakening of the target muscles and paresis of adjacent muscles can occur, resulting in facial weakness. This is self-limiting. When injecting above the eyebrows, upper eyelid ptosis or slight drooping may occur but only 1:100. This can be corrected with eyedrops but will also improve as the effects of the Botox wears off.

Procedures by Dr De Aguiar



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Choosing to have plastic surgery requires thorough research and educated decision-making. This website is designed to help guide you get to know a little bit more about my practice and understanding of the procedures and treatments available to you. I look forward to meeting you which will allow you to make a better informed decision around treatments or surgery best suited to you.

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