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Botulinum toxin injections


Botulinum toxin injections are used for the treatment of dynamic wrinkles of the face (those that appear on movement), such as forehead and frown lines, crows’ feet, and some lines around the lips. Such treatments, using formulations such as Botox™, Dysport™, Azzalure™, and others are one of the most commonly performed aesthetic treatments worldwide. These formulations use purified forms of the toxin, in safe, low doses. I use only the highest-quality, thoroughly-researched products for my patients. It is an exceptionally safe drug, which has been in use since the 1970s for the treatment of conditions such as squints, cerebral palsy, and torticollis (neck spasm). It is also an excellent treatment for excessive underarm sweating (hyperhydrosis), and has replaced invasive surgery as the “gold standard” treatment for this condition. While it is potent at high doses, at the doses used for cosmetic procedures, serious side effects are vanishingly rare.


  • Type of anaesthetic
    Length of procedure
    5-10 minutes
    1 hour

  • Onset of action
    4-10 days
    Duration of effect
    3-4 months

My approach

This is one of the easiest cosmetic procedures to undergo – the downtime is minimal, and the effects (almost) instant. It is not, however, one of the easiest procedures to do – if your goal is to provide an excellent rather than an average or mediocre result. Not every face is the same, and injecting every individual in the same places with the same doses will result in suboptimal results. I carefully analyse your face, looking at the strength and precise location of the tiny facial muscles, the way these muscles work together, any pre-existing imbalances, your skin quality and underlying bone structure. I take into careful consideration your specific treatment goals, bearing in mind that most Irish patients prefer to avoid an obviously “done” look. I will explain to you my preferred treatment plan, and most importantly, make sure you understand why I am taking the approach I suggest. My mantra, particularly on your first treatment, is to always err on the side of caution. A follow-up visit two weeks later is always advised: further small doses may need to be administered at this time.

My training as a plastic surgeon, and in particular my time spent as the DAFPRAS (Dutch Association for Facial Plastic Reconstructive and Aesthetic Surgery) fellow has equipped me well to provide this individualised approach to botulinum toxin injections to the face. I have worked with one of the top facial palsy reconstructive surgeons in the UK, at the Royal Free Hospital in London. There, I was exposed to the use of botulinum toxin injections for the improvement of facial asymmetries and tics in patients with paralysis due to a variety of conditions including Bell’s Palsy, and I am happy to see such patients for this treatment.

The treatment

The areas that can be treated are forehead and frown lines, crows’ feet, “bunny lines” on the nose, lines of the upper lip, an overactive chin muscle, and platysmal bands (vertical lines formed by the thin muscle at the front of the neck). Under-eye lines are not usually suitable for treatment, nor are deep lines on the cheeks, between the nose and mouth, or those coming from the corners of the mouth. These areas may be suitable for treatment with fillers or fat injections.

Following a detailed discussion of your treatment goals, I will perform a number of injections to the area to be treated. This usually takes no more than 5 minutes. I carefully document the precise location of the injections you receive, in order that subsequent treatments can be planned based on the results achieved. I have never encountered a patient who was unable to cope with the injections, which can sting. If you are particularly nervous about having these injections, I suggest that you attend for a preliminary consultation, during which I can go through some options to help you deal with this.

Consequences and limitations

Immediately following the treatment, you may expect to have some redness and bumps at the injection sites. These will fade within an hour. Occasionally, some bruising may occur (most commonly in the crows’ feet area). This will fade over a number of days, and can be covered with make-up. Most people find that they can feel the effects (as a stiff or tight sensation) before they see them: for most people, an effect will start to become apparent from around day four. The full effect will be seen between 10 and 14 days, which is why I schedule a follow-up visit two weeks after the initial treatment. For the same reason, if you are having your treatment for a specific event, I usually recommend that you have your treatment at least three to four weeks before, in order that any bruising will have disappeared, and any fine adjustment/ top-up injections will have had a chance to take effect. If you have had your treatment with me in the past, two weeks should be adequate. The effects usually last for about 4 months, although there will be some individual variation in this.

Side effects of this treatment are rare. Some people feel some ‘flu-like symptoms for a few days, or a little nauseated after the procedure, or develop a headache. Occasionally a temporary drooping of the eyelid can occur. This may last a few weeks, but will always resolve. Special eyedrops can be prescribed during this time to help lift the lid back to the normal position. Drooping of the eyebrow can also occur, but it too will resolve. Again some patients experience some double vision after treatment which resolves with time and is very rare. In extremely rare cases patients have developed an allergy to the treatment, while others have shown resistance, i.e. it causes little or no effect on the treated muscles.

Allergic reactions to the botulinum toxins are exceptionally rare, and if you have had such a reaction in the past, you should not have further treatments. You should not have treatment if you have had previous unsuccessful treatment with botulinum toxin, if you have a skin infection in the area to be treated, if you are pregnant, trying to get pregnant or breastfeeding, if you have any neuromuscular disease (e.g. Myasthenia Gravis, Lambert-Eaton Syndrome, motor neuron disease), if you are taking aminoglycoside antibiotics or other medications which interfere with neuromuscular transmission (ask your pharmacist or the doctor who prescribed the antibiotic or medication if you are unsure), or if you are taking anticoagulants (e.g. Warfarin, Plavix). If you are taking Aspirin, Vitamin E, gingko biloba or St John’s Wort you must stop these medications 10 days prior to treatment.