Botox in Berlin with Botulinum Toxin – AS Clinic

How does botulinum toxin work on lines?

Botulinum toxin mainly treats lines caused by repeated muscle movement. If the activity of the muscle responsible is reduced, the skin above it is folded less strongly and the line can appear softer. The frown line is a typical example: muscles between the brows work when you draw your eyebrows together, and if that movement repeats over many years a line can become increasingly visible. That does not mean every line has to disappear completely. How much a line improves depends among other things on:

• How strongly the muscle works
• How deep the line already is
• Whether it is visible only in movement or also at rest
• The condition of the skin
• Your individual anatomy
• The area treated
• The dose used

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Dynamic and static lines – what is the difference?

Dynamic lines are mainly created by muscle movement and are therefore particularly relevant for treatment with botulinum toxin. They appear when you frown, raise or draw together your eyebrows, or smile and squint; typical examples are forehead lines, frown lines and crow's feet. Static lines, by contrast, remain visible even when the facial muscles are relaxed: if an expression line has been folded over and over for many years, it can become permanently etched into the skin. Botulinum toxin can reduce the muscle movement that causes it — but a line already etched deeply into the skin does not have to disappear completely. Depending on your starting point, other or additional treatment options may therefore make sense.

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Botox for forehead lines

Horizontal forehead lines are mainly caused by the muscle that raises the eyebrows. Botulinum toxin can reduce its activity in a targeted way and so soften the lines forming across the forehead. The forehead should not be considered in isolation: the forehead muscle also has an important role in the position of the eyebrows, and reducing its activity too strongly can have unwanted effects on your expression or on how the forehead feels. Before treatment we therefore look at, among other things:

• The natural eyebrow position
• The strength of the forehead muscle
• The height of the forehead
• Existing asymmetries
• Movement when raising the eyebrows
• The interplay with the frown line

Botox for the frown line

The frown line – medically the glabellar line – is created by repeatedly drawing the eyebrows together. Treating the muscles involved in a targeted way can make the line between the eyebrows appear considerably softer. A pronounced frown line can make an expression look stern, tense or intensely focused, even when the person does not feel that way. Planning starts by observing how strongly the muscles work when you draw your eyebrows together, and whether there are differences between the two sides.

Botox for crow's feet

Crow's feet are expression lines at the outer corners of the eyes that become particularly visible when you smile. Botulinum toxin can reduce the activity of selected parts of the muscle ring around the eye and so soften those lines. A natural smile should remain possible. That is why we do not simply inject to a fixed pattern of points, but take the individual movement of the eye area into account.

Will my face look frozen after Botox?

A treatment with botulinum toxin does not have to leave the face immobile. How strongly muscle movement is reduced depends on the area, the anatomy, the dose and the treatment goal. The aim of a conservatively planned aesthetic treatment is normally not to switch off facial expression entirely. Some people want only a slight relaxation, others a considerably stronger reduction of particular expression lines — either way, it should be discussed before treatment. A natural result takes into account:

• Individual muscle strength
• Your existing range of expression
• Eyebrow position
• Symmetry
• Age and skin condition
• The strength of effect you want

Why does an expression analysis matter before Botox?

A face can look symmetrical at rest and behave quite differently in movement. Before treatment we therefore look at a range of movements — frowning, raising the eyebrows, drawing the eyebrows together, smiling and squinting. The number of injection points or units should therefore not be set by a standard template alone. This shows:

• Which muscles work particularly strongly
• Where natural asymmetries exist
• Which muscles work together
• Where treatment could be sensible
• Which areas are better left untreated

When does Botox start working?

Botulinum toxin does not take effect immediately. First changes can often be noticed within a few days; the effect is usually assessed after about two weeks. Straight after the injection, therefore, no reliable judgement about the final result is possible. This clearly distinguishes botulinum toxin from a hyaluronic acid filler, where added volume is visible immediately after treatment.

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Why is Botox only reviewed after about two weeks?

Botulinum toxin needs time to develop its full effect on the treated muscle, so a review after only a few days is often too early. In addition, the effect on different muscles or on the two sides of the face can set in at slightly different speeds. A review after about two weeks therefore allows a more meaningful assessment than a very early appointment.

How long does Botox last?

The effect of botulinum toxin is temporary. With aesthetic treatments it often lasts several months; for many people the period is roughly three to four months, though individually it can be shorter or longer. A repeat treatment should therefore not automatically follow a fixed date — it makes more sense to reassess when muscle activity increases again. How long the effect lasts depends among other things on:

• The muscle treated
• Muscle strength
• Your individual response
• The dose
• The product used
• Previous treatments

How many units of Botox do I need?

The dose required cannot be set in a blanket way. It depends on the botulinum toxin product used, the muscle treated, the muscle strength, the anatomy and the treatment goal. Important: the units of different botulinum toxin products are not generally interchangeable. A seemingly simple statement such as "X units per zone" therefore says little without knowing the specific medicine and the individual situation. The specific dose is determined as part of the treatment.

Does a Botox treatment hurt?

Most injections are felt as brief pinpricks. The sensation is individual, but local anaesthesia is often not required for the classic treatment of facial expression lines. The needle used is very fine. Immediately afterwards the injection sites can be briefly tender or slightly red.

Is there downtime after Botox?

Downtime after a botulinum toxin treatment is normally minimal. Many people can carry on with their day immediately afterwards. Small areas of redness, swelling or bruising at individual injection sites are possible, however, so no one should promise that a treatment leaves no visible trace in every person. If you have an important photoshoot, event or business appointment on the same day, take that into account when choosing your appointment.

What should I bear in mind after a Botox treatment?

You will receive individual instructions after treatment. Where regular medication is concerned: prescribed medicines must never be stopped or paused on your own initiative for an aesthetic treatment. For the first period, the following may be recommended:

• Do not rub or massage the treated areas firmly
• Avoid unnecessary pressure on the injection sites
• Avoid intense exercise for a few hours
• Follow the individual instructions given by the person treating you

What are the risks and side effects of Botox?

An aesthetic treatment with botulinum toxin is not free of risk either. Most often these are temporary reactions at the injection sites; depending on the area treated, however, unwanted effects on neighbouring muscles are also possible. Around the forehead and eyes, for example, a temporarily lower eyelid position or a changed eyebrow position can occur. Which side effects and contraindications are relevant also depends on the specific medicine and the region treated, which is why the individual consent discussion takes place before treatment. Possible reactions include:

• Redness
• Slight swelling
• Tenderness
• Small bruises
• Headache
• Temporary asymmetry

Which symptoms after botulinum toxin need immediate attention?

Unusual, severe symptoms such as marked difficulty swallowing, speaking or breathing require immediate medical assessment. Reactions like these are not the typical outcome of an aesthetic treatment and should not be left until a regular review appointment.

Who may a Botox treatment be suitable for?

An aesthetic treatment with botulinum toxin may be an option for adults in whom the activity of the muscles of facial expression causes lines or wrinkles that bother them. Suitability is assessed individually. Factors that play a part include:

• The desired result
• Muscle activity
• The anatomical starting point
• Existing illnesses
• Medication taken regularly
• Previous botulinum toxin treatments
• Possible contraindications of the medicine used

When should Botox not be carried out, or only later?

Whether botulinum toxin can be used has to be assessed individually. With certain illnesses, medication or acute problems in the treatment area, a treatment can be unsuitable or postponed. A complete assessment therefore cannot be made through an online form. Depending on the product and the individual situation, reasons can include:

• Infections or inflammation at the planned injection site
• Certain neuromuscular conditions
• Known hypersensitivity to components of the product
• Pregnancy
• Breastfeeding
• Certain medicines or medical risk factors

Botox in pregnancy and while breastfeeding

Aesthetic treatments with botulinum toxin are not carried out at AS Clinic during pregnancy or breastfeeding. If pregnancy is possible or you are breastfeeding, tell us at the consultation.

Botox or hyaluronic acid – what is the difference?

Botulinum toxin and hyaluronic acid fillers treat different causes. Botulinum toxin reduces muscle activity in a targeted way; hyaluronic acid fillers are used to change volume, contours or particular tissue deficits. Which treatment fits better depends on the cause of what bothers you: for a frown line created mainly by muscle movement, botulinum toxin can make sense; for a volume deficit, botulinum toxin does not address the actual cause.

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Can Botox be dissolved again?

No. Unlike a hyaluronic acid filler, botulinum toxin cannot be dissolved again with an enzyme; the effect decreases on its own over time. That is precisely why an individual dose and careful planning before treatment matter. An effect that turns out stronger than wanted cannot simply be reversed.

Can Botox and hyaluronic acid be combined?

Botulinum toxin and hyaluronic acid can in principle be part of one aesthetic treatment plan, because they address different problems. Whether a combination makes sense, and whether it should happen at the same appointment or separate ones, is assessed individually. Botulinum toxin is used above all for muscle activity, while hyaluronic acid changes volume and contour. A combination should therefore not happen automatically, but only where both steps have a specific goal.

Preventive Botox – at what age does it make sense?

There is no universal age from which an aesthetic botulinum toxin treatment is inherently sensible. What matters is your individual expression, the lines that are there, the treatment goal and medical suitability – not a particular birthday. Starting treatment simply because a certain age has been reached is not a sound medical criterion. There should be a specific indication before any aesthetic application.

Other treatment areas with botulinum toxin

Besides the forehead, frown line and crow's feet, botulinum toxin is used in medicine and aesthetic medicine for a range of other questions. Further areas such as the jaw, neck or excessive sweating are therefore discussed separately and individually at AS Clinic, rather than being treated as one identical treatment. Which applications are actually possible or sensible depends on:

• The specific medicine
• Its marketing authorisation
• The individual indication
• The anatomy
• The possible risks

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