Wrinkle reduction with botulinum toxin

An experienced general surgeon injects botulinum toxin into the skin using a very fine needle. The procedure is quick – it takes up to 30 minutes – and minimally invasive, so no special recovery period is required. Side effects are rare and temporary. Headache, drooping of the eyelid and nausea may occur temporarily.

The preparations used for aesthetic procedures at Terme Krka are produced under controlled laboratory conditions and administered in very small doses. These thoroughly tested preparations, approved by recognised international institutions, have been used for more than a decade.

What results can I expect?
If you look older because of expression lines or dynamic wrinkles, treatment with botulinum toxin can noticeably rejuvenate your appearance by effectively smoothing these wrinkles. If your skin has been damaged by external factors such as sun exposure and smoking, or if your wrinkles are the result of skin ageing, it is advisable to combine the treatment with other methods, such as a suitable chemical peel and dermal filler injections. Botulinum toxin is not a substitute for a surgical facelift or brow lift, as it cannot correct sagging skin.

How is a botulinum toxin treatment performed?
Botulinum toxin application is a simple and safe procedure. Very small amounts of the preparation are injected with an extremely fine needle into precisely selected areas of the face. The injection points are chosen according to your facial expressions and any asymmetries that we wish to correct or reduce with botulinum toxin.

Is botulinum toxin injection painful?
Some people compare the sensation to a mosquito bite, while others experience only mild discomfort. The preparation is stored in a sterile solution, usually saline without added preservatives. The combination of a pH-neutral preparation and injection with a very fine needle helps minimise discomfort during the procedure.

What kind of preparation is botulinum toxin?
BOTOX® and VISTABEL are preparations based on botulinum toxin type A, obtained from the bacterium Clostridium botulinum. This bacterium produces a protein that inhibits the action of acetylcholine, thereby preventing muscle contraction and relaxing the targeted muscle. Type A is one of seven types of botulinum toxin (A, B, C1, D, E, F and G), each with different characteristics and effects. Botulinum toxin is produced under controlled laboratory conditions and is administered in very small doses for aesthetic procedures.

What are the side effects of botulinum toxin?
In people with cervical dystonia (contractions of the neck and shoulder muscles), the most common side effect is dysphagia (difficulty swallowing, occurring in 19% of cases). Other possible side effects include upper respiratory tract infections (12%), neck pain (11%) and headache (11%). In people with blepharospasm, possible side effects also include drooping of the eyelid (21%), superficial punctate keratitis (inflammation of the cornea, 6%) and dryness of the conjunctiva (6%). With typical doses, systemic reactions such as severe dysphagia or breathing difficulties are more likely to occur in patients with neuromuscular disorders. Botulinum toxin is not used on inflamed areas. Its effects may be increased when used at the same time as aminoglycoside antibiotics or other medicines that act on neuromuscular transmission.

Is botulinum toxin a new medicine?
No. It has been used for more than 20 years and has already helped more than one million people worldwide. Its use has been approved by the relevant health authorities in at least 70 countries around the world – including the American Academy of Neurology and the U.S. National Institutes of Health as early as 1990.

How does botulinum toxin work?
For a muscle to contract and move, it needs a signal from the brain in the form of an electrochemical impulse. These impulses are transmitted to the muscle through nerves with the help of a substance called acetylcholine. When too much acetylcholine is released, muscle tension and spasms can occur. Botulinum toxin prevents acetylcholine from passing from the nerve to the muscle, thereby eliminating or reducing muscle spasms and relieving symptoms of excessive muscle activity.

Is the effect permanent?
No. Approximately 3 months after treatment, the nerve is once again able to release acetylcholine and excessive muscle activity may return. Botulinum toxin injections are therefore recommended again after 3 to 6 months. Repeated treatment is appropriate and possible provided there was no allergic reaction or other side effect following the previous treatment.

What are the most common possible complications?
Complications are rare, but bleeding and bruising may occur. Bacterial infection is also possible – this may be indicated by pain and redness developing within 24 to 72 hours after the procedure. In such cases, the doctor will prescribe an antibiotic based on the results of a swab analysis. Other possible complications include viral infections, including reactivation of the herpes virus, local tissue necrosis caused by secondary closure of small skin arteries, which may be helped by warm compresses, massage and nitroglycerin paste, as well as cystic reactions to the implanted substance and foreign-body abscesses.

Is botulinum toxin really an effective treatment for excessive sweating?
Yes. Clinical studies indicate that botulinum toxin reduces the intensity of sweating in up to 95% of people for 4 to 9 months. Botulinum toxin can therefore also be an effective option for this unpleasant condition, which can sometimes be so disruptive that people avoid normal social interactions because of it.

Where is the preparation injected if I want to reduce sweating?
After a starch test is used to locate the sweat glands, the treatment area is divided into 12 to 15 points. Botulinum toxin is then injected into these points using a very fine microneedle. Physical activity should be avoided for several hours after the treatment.

When does the reduction in sweating become noticeable?
Sweating is reduced by approximately 95% within about 48 hours after the procedure, while the full effect develops within one week.

When should the treatment be repeated to prevent excessive sweating from returning?
When botulinum toxin is injected to reduce sweating, its effect lasts approximately 6 to 9 months. The treatment can then be repeated.

How often should botulinum toxin injections be repeated?
The effects of an individual treatment last from 3 to 6 months. Treatments can be repeated for as long as the symptoms continue to respond and provided no allergic reactions or side effects occur. Treatment is usually repeated three or four times a year. Once certain muscle groups become weaker, repeat treatments are no longer needed as frequently and the desired effect can be achieved with a smaller dose. The effect of the treatment becomes apparent after approximately 14 days, as it takes several days for the preparation to start working after injection. The preparation is effective for most people, although some individuals may gradually develop a reduced response to the treatment over time.

Is long-term use of botulinum toxin safe?
Yes, botulinum toxin is considered safe and well tolerated. This is supported by analyses of studies involving 2,000 patients over a period of 12 years. Its safety is also supported by the fact that botulinum toxin has been used for more than 20 years in the treatment of many neurological and ophthalmological conditions.

When is the use of botulinum toxin not recommended?
During the consultation before the procedure, you must inform the doctor if you are pregnant, breastfeeding or taking any medication. Particular caution is required in people with neurological conditions and in those taking aminoglycoside antibiotics or other medicines that affect neuromuscular transmission. Before the procedure, make sure the doctor is aware of all medicines you are taking, including both prescription and over-the-counter medicines. The procedure will also not be performed if there is an infection or inflammation in the area where the preparation is to be injected.