What is botulinum toxin ?
Botulinum toxin is a toxin produced by the bacterium responsible for botulism. It comes as a powder to be reconstituted and temporarily reduces contraction of the targeted muscles.
Initially used for medical indications (neurology, ophthalmology, etc.), botulinum toxin is now widely used in aesthetic medicine and surgery.
It is the most frequently performed aesthetic treatment worldwide.
How botulinum toxin acts on wrinkles
Botulinum toxin type A is an injectable medicine that temporarily reduces transmission of the nerve signal to the treated muscle. The muscle contracts less strongly, reducing skin wrinkles associated with facial expressions. The treatment therefore softens wrinkles whose appearance depends on muscle activity.
These wrinkles, known as dynamic wrinkles, appear particularly when you frown, smile or raise your eyebrows. Over time, some wrinkles may remain visible at rest : the wrinkle has then also become etched into the skin. Injections can soften it, but reducing muscle contraction is not always enough to eliminate it completely.
Botulinum toxin acts differently from hyaluronic acid injections, which are used in particular to restore volume, perform medical lifting techniques or fill hollows. The choice of treatment depends on the cause of the wrinkle and the area concerned. The two techniques can sometimes be combined after assessing their benefits and the risks specific to each area.
What are the benefits of botulinum toxin ?
Botulinum toxin is very popular in Switzerland thanks to its many benefits, both aesthetic and practical.
- A method recognised for its reliability : when administered by an experienced doctor, botulinum toxin injection is considered a safe treatment. Used in medicine for several decades, it benefits from extensive clinical experience and an excellent safety reputation.
- Rapidly visible effects : the first results generally appear a few days after the session and last an average of three to six months.
- A treatment involving little pain.
- No social downtime required.
Areas treated with botulinum toxin
- The forehead lines, which appear when you raise your eyebrows. During treatment, Dr Romano takes into account the role of the frontalis muscle in maintaining their position (to avoid lowering the eyebrows).
- The frown line, located between the eyebrows and accentuated by frowning. Correcting it can soften a stern expression.
- The crow’s feet, visible at the outer corners of the eyes, particularly when smiling. Treatment must take account of smiling movements and the condition of the eyelids (particularly the presence of bags under the eyes).
Areas are not selected solely according to visible wrinkles. The forehead muscles and those that lower the eyebrows act in relation to one another : their balance must be assessed before injections.
Botulinum toxin is also used for primary excessive underarm sweating. This indication requires a separate assessment and protocol. Other medical uses, particularly in neurology or ophthalmology, do not correspond to the aesthetic wrinkle treatment described here.
How is a botulinum toxin injection performed ?
The medical consultation begins with a discussion of your expectations and medical history. Dr Romano analyses the face at rest and in movement.
Before treatment, you must report :
- Your medicines and dietary supplements, including those taken without a prescription. To reduce the risk of bruising after treatment, it is recommended that, in the days before the session, you avoid substances that can thin the blood : anti-inflammatory medicines, aspirin and certain dietary supplements such as turmeric, omega-3 or vitamin C.
- Any previous botulinum toxin injections, their dates, the areas treated and, if known, the product used.
- A neuromuscular disease, difficulty swallowing or breathing, or an eyelid disorder.
- Pregnancy, plans for pregnancy, breastfeeding or a previous reaction to an injectable product.
This information helps the doctor assess the necessary precautions before an injection. Do not stop prescribed treatment, particularly an anticoagulant, without the agreement of the doctor supervising it.
After disinfection, small amounts of product are injected into the targeted muscles using a fine needle. The injections usually take a few minutes, excluding the consultation. The injections may cause tingling or a brief burning sensation ; anaesthesia is not necessary.
Several botulinum toxin preparations are available. Their units are not interchangeable : a number of units stated for one brand cannot be used to compare the dose of another preparation directly.
Contraindications and interactions to check
The main situations that may prevent treatment or require it to be postponed are :
- A known allergy to botulinum toxin or a component of the product (particularly an egg allergy).
- An infection at the planned injection sites.
- Certain diseases affecting neuromuscular transmission, such as myasthenia gravis or Lambert-Eaton syndrome.
- Pregnancy or breastfeeding.
Certain medicines, particularly aminoglycoside antibiotics and treatments that affect neuromuscular transmission, may alter the effects of the toxin. The decision depends on the product chosen and your medical situation. Dr Romano checks contraindications and interactions in the medicine’s official product information.
After-effects and precautions following injections
Minor redness, swelling at the injection sites or bruising may occur.
The recommendations after a botulinum toxin injection aim in particular to avoid pressure on the treated areas. If you are preparing for an event, allow time for the results to develop and for any minor bruising to disappear.
After botulinum toxin injections, everyday activities can be resumed immediately. However, a few precautions are usually advised :
- Avoid rubbing or massaging the injected areas during the first 24 hours. In particular, postpone facial massages and treatments that put significant pressure on these areas.
- Cleanse your face gently. If you wear make-up, apply products without rubbing or pressing firmly.
- Avoid washing your hair on the day of the injections. Wait two days before colouring your hair or having eyebrow treatments.
- Avoid saunas, steam rooms and exposure to intense heat for one week
- Postpone sport and physical exertion for two days.
- As a precaution, avoid lying down during the first two to four hours if your doctor recommends it. This advice remains common, but its usefulness is not firmly established.
- Do not schedule another treatment on the treated area immediately, particularly a laser treatment or peel, without discussing it with your doctor. The interval depends on the treatment planned and the condition of the skin.
Restrictions on air travel or normal facial movements are not supported by strong evidence. Nor is it necessary to repeat facial expressions to “fix” the product. Instructions should be adapted to the areas injected and any associated treatments.
Side effects of botulinum toxin
Side effects are generally temporary. Their duration varies according to their nature : reactions at the injection sites usually disappear within a few days, whereas unwanted muscle weakness may persist for several weeks. Reactions at the injection sites : redness, swelling, tenderness, pain or minor bruising.
- Headaches : these may occur after the session and are generally temporary.
- Dry eyes, watering or eye discomfort : these symptoms may occur particularly after treatment of crow’s feet. Persistent discomfort requires medical advice.
- Drooping of the eyebrow or upper eyelid, known as ptosis : an eyebrow may droop when the frontalis muscle is weakened too much ; an eyelid may droop when the toxin reaches the muscle that lifts it. Anatomy, dose and injection sites influence this risk. This complication does not, on its own, prove a technical error or failure to follow instructions. It is generally reversible, but may last several weeks, sometimes longer.
- Asymmetry or an unwanted change in expression : treatment may reveal, accentuate or create a difference between the two sides of the face. Pre-existing asymmetry can sometimes be softened, without any guarantee of complete correction.
- More rarely, dizziness, fatigue or flu-like symptoms may be reported.
Difficulty swallowing, speaking or breathing, or generalised muscle weakness requires immediate medical attention. These symptoms may indicate spread of the toxin’s effect to distant areas, which has very rarely been reported.
Possible effects after repeated injections
- Reduced muscle volume : repeated injections may cause the treated muscle to become thinner. This effect must be taken into account when adjusting doses and preserving the balance of facial expressions. Muscle weakening is therefore not always beneficial.
- A weaker or shorter-lasting response : this does not automatically mean that “tolerance” has developed. The doctor must first reassess the dose, targeted muscles and injection technique before considering an increase in dose.
- Resistance associated with neutralising antibodies : this phenomenon is rare in aesthetic use. High doses and injections given too close together can promote the formation of these antibodies and reduce the effectiveness of subsequent treatments.
Possible results and limitations of treatment
Botulinum toxin injections soften expression lines and can give the upper third of the face a more relaxed appearance. The aim is to reduce the contractions responsible for wrinkles while preserving a natural expression. The desired mobility is discussed before the session. Doses and injection sites are then adapted to muscle activity, eyebrow position and facial asymmetries.
The result also depends on the condition of the skin and the cause of the signs to be corrected :
- Deep wrinkles that are already visible at rest may soften without disappearing completely.
- Excess eyelid skin cannot be removed with botulinum toxin.
- Volume loss, pigmentation spots or irregular skin texture are not corrected by its action on the muscles.
- Pre-existing asymmetry may sometimes be improved, but a difference between the two sides of the face persists in most cases.
An excessive reduction in muscle activity may freeze certain expressions or lower the eyebrows, giving the eyes a heavier appearance. Achieving a natural result therefore relies onadapting injections to facial anatomy and movements.
Onset of results and duration of effects
The first effects of botulinum toxin generally appear between three and seven days after the injections : discover why botulinum toxin takes time to work.
Expression lines gradually soften as the treated muscles contract less strongly. The result is usually assessed at around two weeks.
The effect most often lasts four to six months. Its duration depends in particular on the preparation, dose injected, area treated and individual response. These time frames remain indicative : they cannot predict precisely how long the result will last for each patient.
As the toxin’s action diminishes, muscle contractions gradually resume and wrinkles become more visible again. A further session may be considered according to this progression and your wish to continue treatment. The interval between sessions must comply with the recommendations for the medicine used, generally with a minimum of three months.
At the practice, a follow-up appointment is scheduled one to three weeks after the session. It allows the result, movement in the treated areas and any asymmetries to be examined. An adjustment may be offered if indicated ; a touch-up is not systematic.
How can the results of botulinum toxin be reversed ?
- Patience : the best way to make the results of botulinum toxin disappear is to wait. The effects are temporary and naturally fade over time, generally within three to six months. The exact duration depends on the dose injected, the area treated and the patient’s metabolism.
- Massage : although controversial and not always recommended, some doctors advise gently massaging the treated areas to try to redistribute the botulinum toxin. However, this must be done by the doctor to avoid possible complications. Dr Romano does not favour this method.
- Muscle stimulation : gentle facial exercises and repeated muscle contractions may help accelerate the breakdown of botulinum toxin by stimulating muscle reactivation. Results vary.
- Medical consultation : if the effects of botulinum toxin are bothersome or cause aesthetic or functional complications, consult your doctor. Although there is no solution for immediately reversing the effects, the doctor can provide personalised advice and manage any side effects.
- Complementary treatments : in some cases, other aesthetic procedures may be considered to soften unwanted results of botulinum toxin. For example, hyaluronic acid injections. Unfortunately, this is not always possible.
The price of botulinum toxin injections in Geneva
For aesthetic treatment of the upper face, the price depends on the number of areas treated. The practice’s prices are as follows :
| Number of areas | Women | Men |
|---|---|---|
| One area | CHF 300 | CHF 350 |
| Two areas | CHF 450 | CHF 500 |
| Three areas | CHF 600 | CHF 650 |
The areas correspond to the forehead, frown line and crow’s feet. Dr Romano specifies which areas are proposed for treatment and the total cost before the injections.
In the USA, the price for the area to be treated is calculated per unit, with an average cost ranging from CHF 10 to CHF 15 per unit ; in Switzerland, the price is calculated more in terms of the area treated.
For primary axillary hyperhidrosis, the price is CHF 600 for the first vial and CHF 350 per additional vial. The amount required is determined after assessing the sweating ; 1 to 3 vials may be indicated.
A Cochrane review bringing together 65 studies and 14,919 participants concludes that botulinum toxin type A reduces frown lines more than a placebo at four weeks. Confidence in this result is moderate to high. Data on the effects of repeated treatments over the long term remain limited.
Source : Camargo et al., Cochrane Database of Systematic Reviews, 2021.
A meta-analysis of seven double-blind randomised trials involving 1,474 participants assessed a dose of 20 units of botulinum toxin type A. It shows greater improvement in frown lines than placebo, including at rest. These results relate to the doses and indications studied.
Source : Guo et al., Plastic and Reconstructive Surgery, 2015.
An analysis of 18 registration studies involving 5,298 participants examined the safety of onabotulinumtoxinA for upper facial lines. It identified no new side effects, but certain reactions, particularly drooping of the eyelid or eyebrow, were more frequent than with placebo.
Source : Brin et al., JAAD International, 2024.
Frequently asked questions
At what age can botulinum toxin injections begin ?
There is no ideal age for adults to start botulinum toxin injections. The indication depends on expression lines, the activity of the muscles concerned and the discomfort experienced. The doctor examines wrinkles during facial movements and at rest to determine whether treatment is suitable.
Injections are therefore not automatically necessary from a given age. They target certain wrinkles associated with muscle contractions and do not prevent all signs of ageing. The doctor also respects the indications and age limits specific to the product used.
Are the injections suitable for men ?
Yes. Botulinum toxin injections can soften expression lines in men. The doctor adapts injection sites and doses to muscle strength, eyebrow position and the desired result. The aim is to soften wrinkles while preserving the expressions and characteristics of the male face.
Can injections be stopped without making wrinkles worse ?
Yes. Stopping botulinum toxin injections does not, in itself, worsen wrinkles. As the effect of treatment diminishes, the muscles regain their activity and expression lines gradually reappear. However, the skin continues to age : after several years, wrinkles are therefore not necessarily identical to those present before treatment began.
Can an unwanted result be reversed immediately ?
The effect of botulinum toxin cannot be reversed immediately. If you are unhappy with the result, consult the doctor to determine whether a correction is possible or whether you need to wait for the effect to fade. Facial massages and exercises cannot eliminate its action.
Why do the effects seem insufficient or short-lived ?
Several causes are possible : a result assessed too early, an insufficient dose relative to muscle strength, or wrinkles already present at rest that reduced contractions cannot fully erase. Resistance to the toxin may be investigated in certain situations, but should not be assumed for every disappointing result.
Can a cream replace botulinum toxin ?
No. A cream can improve hydration, skin texture and certain fine lines, but it does not reduce muscle contractions as botulinum toxin does.
