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What does Botox® actually do?

Botox® is actually a brand name, rather like "Hoover" (instead of a vacuum cleaner) or "Pritt-stick" (instead of glue).  The technical term is Botulinum Toxin and I guess the reason we don’t throw that term around too much is because it has “toxin” in it, which may sound a tad scary! But in reality Botulinum Toxin has been used for over 30 years and when prescribed for the right cases, is incredibly safe and has a lot of data behind it to suggest this and how effective it is.  In addition as it is prescription only medication, it is high regulated, which is a great thing! The question is what does it actually do and what are uses and its limitations.  I will attempt to explain this in this article.  For ease I will refer to Botulinum Toxin as “Botox®”.

Botox® is effectively a muscle relaxant and works by stopping nerve signals to muscles that are injected by it.  This is an incredibly important point because Botox® is effective in reducing facial lines that are caused by muscles only and not other lines caused by age related changes to the skin for example.

Facial layers

This is why a careful assessment is required to ensure the correct treatment is provided for the lines of concern. The picture below shows a patient who had her lines to the side of her eyes treated (crows feet).

Before and after Botox

Our face is very expressive and over the years the repetitive movement of the muscles of facial expression lead to them becoming more prominent resulting to both static and more noticeable dynamic lines. Static lines are when facial lines are present when the muscle is not working and dynamic lines are when the muscle is working. 

Common examples of areas that are treated with Botox® are frown lines, forehead line and the eyes by the side of your eyes (crows feet).  In reality there are many other areas that can be treated:

  • Frown lines

  • Forehead lines

  • Crows feet

  • Bunny lines (lines on the side of your nose when you scrunch your nose)

  • Downturned smiles

  • Gummy smiles

  • Chin dimpling

  • Prominent jaw muscles

  • Vertical bands on the neck

On a side note Botox® can, interestingly, be used to reduce sweating very effectively also and is commonly used  for this in areas such as the underarms.

Anywhere there is movement leading to a line becoming more pronounced could technically be treated with Botox®.  This is another important point as Botox® is designed to treat your dynamic lines really well; for example if there is a noticeable line or lines when you frown but it does not necessarily get rid of static lines; for example the frown lines that are present even when you are not moving them.  These static lines will likely soften more with repeated treatment.

As practitioners we have to be very diligent about the amount of Botox® we place and where we place it as if this is done incorrectly it can, although very unlikely in experienced hands, lead to unwanted movements/lack of movements and asymmetries.  You will notice that I, and many other practitioners, drawing dots on your face and taking pictures before the procedure.  These are our planned injection points and once we have done this we note down, in our records, the amount of Botox® we place in each of these dots. 

Injection markings before Botox injections

As Botox® takes approximately 1-2 weeks to become fully effective this gives us a record of what we have done and so we can always compare treatment against outcome and make tweaks to our injection spread/dose for the next treatment as for most individuals the effects lasts 3-4 months but for some others this may be slightly more or less. 

There has been a “top up” culture in the past where patient would re-attend 2 to 3 weeks later for some additional Botox®.  This is not recommended unless there is an issue, such as an asymmetry, as we know that repeated Botox® in less than 3 months intervals is more likely lead to reduced effectiveness the products - which is certainly not you would want!


Botox® treats muscle related lines (mainly dynamic ones), not fine lines due to skin aging and so different treatments would need to be used for these.  The need for Botox® would need to be assessed  carefully by your practitioner and prescribed if appropriate and the difference between the two pointed out to you.

I hope that this was an informative article and if you have any further questions or would like to discuss this further please do not hesitate to contact us

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