What is botulinum?

Botulinum is a naturally occurring protein (metabolic product) in bacteria (Clostridium botulinum), which is obtained biotechnologically.

How does botulinum work?

Botulinum blocks the nerve signal that is responsible for muscle tension and thus for the formation of wrinkles. The muscles relax. As a result of the muscle relaxation, the mimic wrinkles smooth out or disappear completely. Other nerve functions - such as the skin's sense of touch - are not affected.

What is treated?

Due to its mechanism of action (muscle relaxation), botulinum is effective for wrinkles caused by facial expressions (e.g. forehead wrinkles, frown lines, crow's feet). Under certain circumstances, fine wrinkles on the upper and lower lip are also typical areas of application for treatment with botulinum. Botulinum can also smooth out annoying wrinkles on the sides of the bridge of the nose ("bunny lines") or cobblestone-like dimples on the chin.

How does botulinum work for excessive sweating (hyperhidrosis)?

Botulinum blocks the emptying of the sweat glands in the desired area after injection. As botulinum is approved for the treatment of hyperhidrosis in Germany, the costs can be covered by private health insurance.

How does botulinum work for teeth grinding (bruxism)?

Botulinum blocks night-time teeth grinding after injection into the outer chewing muscle. In rare cases, the costs may be covered by private health insurance.

How does treatment proceed?

First, a joint treatment plan is drawn up to determine which regions are to be treated and how. Before the botulinum treatment, the skin is disinfected. Then a small, precisely calculated amount of botulinum is injected at several points on the respective facial muscle. The injection is carried out using calibrated syringes and very thin needles.

When and for how long does botulinum work?

The first effect occurs approx. 2 - 3 days after treatment. The maximum effect is achieved after approx. 2 weeks. The effect lasts for approx. 3 - 6 months.

Is it possible to socialize again immediately after the treatment?

The only things you may see after a botulinum injection are small puncture marks and, in rare cases, tiny bruises if fine skin vessels have been damaged. These can be covered with make-up if desired and will disappear after a few days at the latest.

What do I need to consider before and after the treatment?

Before treatment with botulinum, blood-thinning medication should be avoided for at least 2 weeks. No sport or alcohol should be consumed for 4 hours after botulinum treatment. In the first few hours after botulinum treatment, the skin should not be touched unnecessarily often and no heavy loads should be carried. The application of light make-up and gentle washing is possible. Sauna, UV radiation from the sun or solarium should be avoided for a few days. After wrinkle treatment with botulinum, it is recommended to use the treated facial muscles repeatedly and frequently for a few hours (e.g. frowning) in order to achieve a good distribution of the botulinum.

What are the risks and possible side effects?

Minor bruising or swelling may occur as a result of the injection. Temporary discomfort, tiredness or headaches have been described in rare cases. However, there are also many cases in which existing headaches improve after treatment. It is extremely rare for allergic reactions, itching or skin rashes to occur. Complications such as temporary drooping of the eyebrow or upper eyelid or short-term visual disturbances are also extremely rare. In general, reactions related to the treatment or the injection technique occur within the first week after the injection and are temporary.

Is there a risk of "poisoning" (botulism) when botulinum is used for cosmetic purposes?

Botulinum is a very effective and potentially dangerous toxin. As very small quantities are injected into circumscribed muscle areas during cosmetic application and bound there on site, no poisoning can occur.

Is there any experience of the long-term effects of botulinum?

Botulinum has been used for almost 30 years and in relatively high doses to treat pathological muscle cramps (spasms). From this experience, it is known that botulinum does not cause any long-term side effects. Microscopic examinations have shown that there are no permanent changes to the nerves or muscles after the botulinum effect has worn off.

Can a treatment be repeated as often as required?

Botulinum only has a temporary effect. After the effect has ended, there is no microscopic evidence of the active ingredient or its effects on the nerves. However, as an immobilized muscle becomes weaker over time, less active ingredient is often required to achieve the same muscle-relaxing effect with regular applications. For cosmetic use, no reduction in the effect of repeated applications has been described to date. However, the therapy interval should not be more frequent than every 3 months and depends on the individual response.

When should treatment not be carried out?

Botulinum must not be used in cases of hypersensitivity to the drug or its individual components, as well as infections and viral diseases (e.g. herpes) at the intended injection site. Likewise, treatment with botulinum must not be carried out in the case of known underlying diseases associated with muscle weakness (e.g. myasthenia gravis). Pregnant women and breastfeeding mothers must not be treated with botulinum as a precaution. If you are taking blood-thinning medication, small bruises are more likely to occur, but treatment can still be carried out in consultation if desired.