Botox or Botulinum toxin: how it works, who it is suitable for, and what you can realistically expect

Botox or Botulinum toxin is the most commonly mentioned procedure in aesthetic medicine. In practice, however, we still notice many myths and misconceptions: that the face will become “frozen”, that it is toxic, or that once the effect wears off, the wrinkles will become even more pronounced.

At Klinika Višnjar, we use botulinum toxin as one of the main tools for rejuvenating the upper third of the face. With it, we relax overactive facial expression muscles, the skin consequently creases less, and the appearance becomes more rested and smoother. The goal is a natural result, not an expressionless or “frozen” face.

Below, we explain how botulinum toxin works, which wrinkles it is most suitable for, how the procedure is performed with us, and what result you can realistically expect.

What is botox / botulinum toxin and how does it work?

Botulinum toxin or Botox is a purified protein that has been used in medicine for decades, not only in aesthetics, but also in neurology, for migraines, muscle spasms, excessive sweating, and other indications.

It works at the level of the neuromuscular junction. It temporarily blocks the release of the neurotransmitter acetylcholine, so the nerve signal does not reach the muscle. The muscle partially relaxes, and the wrinkle above it becomes smoother or softer. The effect is local and temporary.

Typical course:

• first effects: within a few days
• full effect: approximately 10 to 14 days after treatment
• duration: on average 3 to 4 months, and in some patients longer

After that time, the neuromuscular junction recovers and the muscle starts functioning normally again.

Which wrinkles is botulinum toxin most suitable for?

Botulinum toxin is most effective for dynamic wrinkles, which are caused by muscle movement:

• lines between the brows (glabellar lines, “11s”, an “angry” or “worried” look)
• horizontal forehead lines
• smile lines around the eyes (crow’s feet)

In addition, depending on the indication, we also use it for:

• lifting the outer part of the brow
• reducing a gummy smile (excessive gum show when smiling)
• relaxing the chin muscle (“orange peel” chin)
• relaxing the masseter muscles in people who grind their teeth, bruxism
• a minimal lift of the corners of the upper lip (“lip lift”)
• reducing excessive sweating in the underarms, palms, and soles
• gently softening vertical lines around the mouth, in combination with other methods

For deep static wrinkles, which are present even at complete rest, multiple treatments or a combination with other procedures such as fillers, laser, or biostimulators is often needed. In such cases, botulinum toxin reduces the muscular component, but cannot on its own “erase” all deep lines.

Use in bruxism (clenching and grinding of teeth)

Bruxism is a condition in which we excessively clench or grind our teeth, often during sleep. This can cause:

• pain in the jaw joints
• tension and pain in the chewing muscles (masseters)
• headaches
• tooth wear

In selected patients, botulinum toxin can be injected into the chewing muscles, which:

• reduces excessive muscle tension
• relieves the jaw joint
• often reduces morning facial tension and headaches

The result is not a “paralysed jaw”, but less aggressive clenching. The effect, as elsewhere, is temporary and lasts a few months, after which the treatment can be repeated if needed.

Use in excessive sweating

Botulinum toxin is also used for hyperhidrosis, excessive sweating, most commonly:

• in the underarms
• on the palms
• on the soles of the feet

It works by temporarily blocking the nerve signals that stimulate the sweat glands to work excessively. The result:

• less sweating in the treated area
• fewer wet marks on clothes
• less unpleasant odour associated with sweat breakdown

The effect usually lasts several months, in the underarms often longer than on the face, after which the function of the sweat glands gradually returns and treatment can be repeated if needed. There is no concern that the body would not be able to cool itself, because we have a very large number of sweat glands across the body.

Botulinum toxin or fillers: what is the difference?

At consultations, we often hear the question:

“Do I need Botox or fillers?”

These are two completely different treatments:

Botulinum toxin

• works on the muscle
• reduces excessive movement and therefore the formation of wrinkles
• ideal for the upper third of the face: the forehead, between the brows, and around the eyes

Fillers

• work on volume and shape
• used to fill hollow areas, enhance cheekbones and lips, and correct deep wrinkles
• do not affect muscular activity

In many patients, the most beautiful result is a combination of both: botulinum toxin relaxes expression and smooths wrinkles, while filler restores volume where ageing has taken it away.

Botox is not only for women: treatments for men as well

Botulinum toxin is not a “women’s treatment”. The number of male patients has been steadily increasing in recent years.

In men, we most commonly address:

• pronounced frown lines between the brows, creating a constant “angry” look
• deep forehead lines that make them look tired or older
• strong lines around the eyes
• bruxism, clenching of teeth
• excessive sweating, in the underarms and palms

In men, it is important to preserve masculine features and not create an overly “smooth”, feminised look. The dosage, injection sites, and intensity of effect are adjusted so that:

• pronounced wrinkles are softened, but not completely erased
• characteristic masculine facial expressions remain
• the forehead and brows retain their masculine architecture

In men too, the goal is the same as in women: a more rested, less tired appearance, and in the case of bruxism or sweating, also functional improvement.

How wrinkle smoothing is performed with us?

1. Consultation

Before the first treatment, we always take time for:

• a discussion about what bothers you and what you want to achieve
• an assessment of your facial movement patterns, skin quality, and facial anatomy
• an explanation of whether botulinum toxin is the right choice, or whether combination with other treatments would make more sense
• a review of your medical history and any possible contraindications

At this stage, we also determine whether a gentler, “baby” approach with lower doses or a slightly stronger correction makes more sense for you.

2. Marking and preparation

We mark the injection points on the face both in a standing and seated position. The skin is disinfected, and if needed we use cooling gel.

3. Botulinum toxin injection

The treatment itself usually takes 10 to 20 minutes. We use very fine needles and small amounts of the product. The feeling is comparable to a few quick pinpricks.

4. After the procedure

• there is no need for sick leave
• you can usually continue with your day, work and light errands
• we recommend that for a few hours you do not rub the treated area and avoid intense sport and sauna on the same day
• on the first night, sleep with the head slightly elevated

The first changes usually appear after a few days. At the beginning, there may be a mild headache and a gradual feeling of tightening of the skin. The full effect will be visible after approximately 2 weeks.

Follow-up and “touch-up” after 14 days

Because botulinum toxin gradually “switches on”, we assess the true result after 14 days.

At that point:

• we check the symmetry and intensity of the effect
• we review together whether the wrinkles have softened to the desired degree
• if needed, we add a small amount (touch-up) if:
• undefined

This follow-up is an important part of the process, because it allows us to adapt the result to your face and wishes.

How long does the effect last and how often do we repeat it?

n most patients, the effect of botulinum toxin lasts around 3 to 4 months, sometimes up to 6 months, depending on the product, dose, and your muscle activity.

When the effect begins to decrease, muscle activity gradually returns. The wrinkles do not “bounce back”, but start to become visible again over time. With regular treatments, we often notice that wrinkles remain less pronounced than at the start, because the muscles are no longer constantly maximally active.

Most patients repeat the treatment approximately 2 to 3 times per year, or according to preference, sometimes only once or twice a year if they want just a “boost” at a certain period.

Will I be “frozen” and without expression after Botox?

This is the biggest fear and at the same time the biggest misunderstanding.

Our goal is:

• that the face still moves normally
• that you can raise your brows, smile, and express emotions
• that mainly the “angry”, tired, or worried appearance disappears, not your personality from your face

We achieve a natural result through:

• precise dosing
• targeting the right muscles
• a restrained, conservative approach at the first treatment

We can always add a few more units later if you want further reduction of movement. It is much harder to correct an overly strong, overdone treatment.

Safety, contraindications, and side effects

When used correctly in expert hands, botulinum toxin is very safe, as it has been used for a long time and in many medical specialties.

We do not perform the procedure, or are very cautious, in cases of:

• certain neurological diseases, for example myasthenia gravis
• active inflammation or infection at the injection site
• pregnancy and breastfeeding, mainly as a precaution

Possible side effects:

• redness, mild swelling, or bruising at the injection site
• a feeling of a “heavier” forehead or brows in the first few days
• occasional headache in the initial period

Rarer complications:

• mild drooping of the eyelid or brow (ptosis)
• asymmetry

Because the action of botulinum toxin is temporary, these effects are also time-limited. By using the correct technique and dosage, and with a follow-up after 14 days, we reduce the risk to a minimum.

Where to start if you are considering botulinum toxin?

If you are considering botulinum toxin, you do not need to decide on treatment immediately. The first step is always a consultation, where:

• together we look at which wrinkles bother you
• we assess whether botulinum toxin is the right choice or whether another treatment would make more sense
• we explain possible results, duration of effect, and potential risks
• we agree on the plan, whether you want a very discreet “baby” effect or a more noticeable correction

Basic information about botulinum toxin with us can also be found on the page:

Botulinum toxin or botox – Klinika Višnjar

Botulinum toxin is suitable for both women and men. The key is to tailor the treatment to your face, your muscles, and how you want to look, not to fashion trends or inflated filters.