Quick and Simple Wrinkle Treatment with Botox

Relaxed Appearance Thanks to Botox

Overview of Botox Treatment


Indications for SurgeryDynamic wrinkles, i.e. wrinkles caused by muscle activity
Treatment Period A few minutes
AnaestheticAnaesthetic Cream
Patient Stay Out-patient
Inactive PeriodNone
Costs€ 150 – € 450, depending on the required quantity

The use of Botox (botulinum toxin) against Wrinkles and Neurological Diseases

Botox is a substance which reduces or completely suppresses muscular activity. It can be used for aesthetic reasons and on medical indication. Medical indications include, for example, migraine and muscle cramps in the case of spasticity.

In the aesthetic field, it serves for wrinkle treatment and helps counteract, in particular, wrinkles on the upper half of the face: Frown lines, forehead wrinkles and creases around the eyes. Use of this substance at other points requires great caution and consideration.
Another important general remark: Botox is a wonderful simple medicine and not a “poison”! Like other medicines, it comes from nature; its preparation for medical purposes began a good 30 years ago when its suitability for this was discovered.

The substance is produced by the bacterium Clostridium botulinum, as a defence mechanism for survival. The produced substance is called botulinum toxin A. If present in spoiled food, the substance can lead to a dreaded poisoning in human beings, the outcome here being potentially dramatic. In this case, the substance enters the body uncontrolled and then wreaks havoc.

In medical applications, Botox is used very precisely and selectively, i.e. prepared in the most elaborate manner, highly purified and dosed extremely carefully. In this respect, medical applications and poisoning have nothing to do with each other. Botox is a poison only when incorrectly used. It’s exactly the same with other medicines: Anyone who takes 100 aspirin tablets at once will feel quite nauseous.

Worldwide there are three companies which produce botulinum toxin A from bacterial strains. They themselves offer the prepared product. In addition, there is an opaque grey market which must be avoided! We use the original Botox or Vistabel product.

Our manufacturer has developed a process which allows statutory annual function tests in the laboratory. This eliminates the need for the previously necessary animal tests.

Causes and Mechanisms of Botox

Botox reduces or blocks muscular activity. This is done by inhibiting the transmission of stimuli from nerve to muscle: The nerve no longer stimulates the muscle, which then stops contracting and relaxes.

Botox originally had pure medical applications, particularly for patients suffering from spasticity: It calms their overactive muscles which tense up the limbs, and makes the arms and legs normally movable again. For such people, Botox is a blessing and a liberation.

Later, the substance was also discovered to be of help in the aesthetic field, namely, to reduce wrinkles.

To use Botox correctly, one needs to know that there are three types of facial wrinkles: Dynamic wrinkles, static wrinkles, and wrinkles due to loss of volume.

Dynamic wrinkles are caused by facial muscle activity, i.e. the act of contracting and thereby moving the overlying skin. This results in a wrinkle. When the muscle relaxes, the skin smoothens. Botox is the right substance. Wrinkles which are static or due to loss of volume arise via a different mechanism: Subsiding / receding tissue; hyaluronic acid or fat is used for treatment here. This is discussed below. Botox and hyaluronic acid are different classes of substance with very different fields of application.

Botox Injection as a Weapon Against Wrinkles in Face and Neck

Such wrinkles occur mainly in the upper half of the face: As frown lines between the eyebrows, on the forehead and around the eyes. Static wrinkles are formed by the effects of ubiquitous gravity. The tissue sags, resulting in a formation of nasolabial folds or jowls.

Wrinkles due to loss of volume arise as subcutaneous adipose tissue declines in the process of ageing. The padding underneath the skin shrinks. This results in hollow cheeks, as well as naso-labial folds and jowls.

These different types of wrinkles recurrently arise in combination. This also means a need for combined treatment.

Aim of Botox Treatment

Dynamic wrinkles are formed mostly in the upper half of the face:

Between the eyebrows: This causes frown lines.

On the forehead: Folds in the skin develop.

Around the eyes: These are known as crow’s feet.

Dynamic wrinkles can also occur in the lower half of the face. On the chin: The result is a cobblestone relief. On the neck: Platysma strips form.

As described, Botox reduces or blocks muscular activity leading to dynamic wrinkles. Once numerous such folds have formed over the years, the skin’s collagen begins to suffer: Its structure changes, and breaks occur, giving rise to permanent wrinkles. These cannot be influenced by Botox. Other procedures are then needed.

The substance needs up to two weeks to take full effect. This means that nothing happens in the first three days, after which the effect slowly begins to occur and increase.

Botox lasts approximately four months, after which it must be replenished. It degrades more quickly in people who have a very active metabolism, such as those who exercise a great deal or have an overactive thyroid gland. If the substance is used for a long time, the treated muscles become weaker and the time intervals between injections must increase.

Botox cream does not help because it does not penetrate as far as the muscles.

Aim of Treatment

Botox treatment aims to curb or deactivate hyperactive muscles in the face, in order to achieve skin which is smooth and free of wrinkles / folds. The substance also helps alleviate a certain form of migraine, various forms of spasticity, excessive sweating, especially in the armpits, gnashing of teeth (bruxism) and other disorders.

Course of Treatment

The patient comes to us. They tell us which anti-wrinkle injection treatment they want, and we make a proposal. If Botox (trade name: Vistabel) is the right solution, then treatment can begin at once. We first inject a medium dose. Then we ask to observe the effect, because everyone responds a little differently to the substance. If (too many) wrinkles are still visible after two weeks, we inject some more.

It is possible to start receiving Botox treatment as a young adult. This achieves early blockage of the muscles which in later years would cause the collagen in these places to break down and result in permanent wrinkles which are very difficult to treat.


Post-treatment is not required. Up to some years ago, all kinds of activities were discouraged in an attempt to exercise caution. This has turned out to be unnecessary. As mentioned earlier, re-injection might be required after two weeks.


What can happen? Infection at the injection sites is theoretical, and does not occur under normal circumstances.

The doctor might inject too little, in which case more is added.

The doctor might inject too much, in which case one waits for the effect to subside. The passage of time solves the problem.

The doctor might inject at the wrong point. An example of this is injection too close to the eyebrows. The eyebrows then droop temporarily.

The substance has no, or hardly any, effect. Possible causes are: Hyperactive metabolism, antibody formation (extremely rare).
Literature describes the following conditions in the case of aesthetic application: Dry mouth, dysphagia, dry eye, squinting, headaches. I have never seen such side effects. Possible systemic effects have not been sufficiently researched.

When is Treatment not Recommended?

Allergies which can occur with each medicine are published. The substance must not be injected in such cases.

It is necessary to warn against Botox flat rates: Treatment here is provided only with costs in mind. That is not permissible!

Reimbursement of Costs by Health Insurances

Costs of aesthetic applications range between € 150 and € 450, depending on the required quantities, and must be borne personally.

If there is a medical indication, a request for reimbursement can be submitted to the health insurance company. Whether or not costs are reimbursed remains open because health insurances are very reluctant about Botox: They still think that Botox is a substance with purely aesthetic applications.

Further Information

The following authors have dealt in detail with this topic:

J. Carruthers, A. Carruthers, B. Sommer, G. Sattler