It relaxes muscle; it does not fill. Botulinum toxin type A temporarily blocks the nerve signal reaching the muscle, and in doing so softens the dynamic lines of the forehead, the frown area and the crow’s feet.
It appears between the third and the seventh day, peaks at 10–14 days and lasts 4 to 5 months, up to 6 in some patients. Repeating it before the muscle has fully recovered softens the lines progressively.
It has uses that are not cosmetic: relaxing the masseter in bruxism — it reduces the force of the bite without compromising chewing — and treating hyperhidrosis of the armpits, palms and soles.
It does not replace a facelift and it does not remove laxity, and lines that are marked at rest do not disappear completely: they soften with repeated sessions.
It is not used in pregnancy or breastfeeding, in neuromuscular diseases such as myasthenia gravis, with an active infection in the area, or with a known allergy to the toxin.
At the Instituto de Cirugía Plástica del Mediterráneo (ICPM) in Valencia we are specialists in the medical and aesthetic use of botulinum toxin, a treatment that has transformed the prevention and correction of expression lines. Over the years its efficacy, safety and versatility have made it one of the most powerful tools in non-surgical aesthetic medicine. Obtaining natural, harmonious and lasting results, however, depends largely on the experience and the precision of the practitioner applying it.
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Botulinum toxin type A, better known as Botox after its most widely used brand name, is a purified protein that works by temporarily blocking the nerve signal reaching the muscle. This produces a controlled relaxation of certain facial muscles whose repeated contraction is associated with dynamic lines, such as those of the forehead, the frown area and the familiar crow’s feet.
Applied correctly, the toxin visibly reduces these lines without altering the expressiveness of the face. Indeed, when used to rigorous clinical criteria, the treatment does not freeze the face: it relaxes it strategically, to restore a rested, youthful and natural appearance.
These are two treatments that are often confused and that work on different things. Botulinum toxin acts on the muscle: it temporarily blocks the nerve signal reaching it and relaxes the repeated contraction that gradually marks the dynamic lines — forehead, frown area and crow’s feet. Hyaluronic acid acts on volume: it is placed beneath the fold and lifts it from within, which is what is wanted in the cheekbones, the tear troughs, the nasolabial fold, the lips, the chin or the jawline. That is why they are not in competition: in many cases they are combined, each on its own ground. Diagram by the Instituto de Cirugía Plástica del Mediterráneo, simplified for explanatory purposes.
Which lines Botox treats
The areas most commonly treated with neuromodulators include:
Horizontal lines on the forehead
Vertical lines between the eyebrows (the glabella)
Periocular lines, or crow’s feet
Besides these classic applications, at ICPM we use botulinum toxin very effectively in other situations:
Relaxing the masseter muscle for bruxism and facial slimming
Defining the facial oval and lifting the eyebrows
Correcting a gummy smile
Treating hyperhidrosis (excessive sweating) of the armpits, palms and soles
Each treatment is planned individually, taking into account the patient’s facial anatomy, muscle strength and the aesthetic and functional goals sought.
Medical and functional indications
Although the cosmetic use is the best known, botulinum toxin also has significant medical indications. One of the most important is the treatment of bruxism, a functional disorder in which the patient clenches or grinds their teeth, particularly during sleep. Partially relaxing the masseter muscle by infiltrating toxin reduces the force of the bite without compromising chewing, easing the jaw pain and preventing dental wear.
Another medical indication is hyperhidrosis, which is abnormally heavy sweating in certain areas of the body. By infiltrating small doses of toxin into areas such as the armpits, the palms of the hands or the soles of the feet, the nerve signal responsible for activating the sweat glands is blocked. This treatment is effective for several months and improves the patient’s quality of life.
How long it lasts, and maintenance
The effects of treatment with botulinum toxin begin to be seen between 3 and 7 days after infiltration, reaching their maximum at 10–14 days. The result usually lasts between 4 and 5 months, although some patients keep visible effects for up to 6 months.
By repeating the treatment before muscle activity is fully restored, dynamic lines can soften progressively, since the muscle stays at rest for longer. This controlled repetition prevents the lines from deepening and keeps a rejuvenated appearance without resorting to invasive procedures.
How much is needed and how long it lasts, according to the trials
It is one of the best-studied aesthetic treatments there is, and two findings order almost everything else.
The dose is not a case of «the more the better». A multicentre, double-blind trial in 119 patients compared three doses in the frown area — 25, 50 and 75 units — against placebo. All three worked: they maintained significant efficacy for at least three months. But looking at the whole six-month follow-up, both the clinicians and the patients themselves put the optimum at 50 units. Going up to 75 did not buy any more result.
And the brand matters less than it seems. A network meta-analysis of randomised trials compared the different preparations available: all were far superior to placebo and, between them, there were no significant differences in adverse effects. There are nuances of efficacy between formulations, but none of them justifies paying for a label. What does change the result is where and how much is injected, and that depends on the musculature of each face.
Hence the sensible approach: start with the minimum effective dose, see how that particular movement responds and adjust at the next session. A result that lasts three or four months and looks natural is worth more than a longer one at the cost of an immobile forehead.
Which product is used
At ICPM we use only botulinum toxin type A preparations authorised by the European regulators, with decades of documented clinical use and an approved summary of product characteristics.
The brand names are not published here, and that is not an oversight: botulinum toxin is a prescription medicine, and advertising it to the public is restricted under Spanish and European law. A public page may explain the treatment; it may not advertise the medicine.
What is worth knowing is what lies behind that choice. The various authorised preparations contain the same type A toxin, but they are not interchangeable unit for unit: they differ in their formulation, in the proteins that accompany the toxin and in how they are dosed. Choosing one or another is therefore a medical decision, taken in consultation by weighing the area to be treated, the patient’s history and the response to previous treatments — and it is explained to you before anything else.
Applying botulinum toxin is a medical act that requires precise anatomical knowledge, clinical experience and aesthetic planning based on facial harmony. It is therefore essential to go to a clinic that meets the following criteria:
Medical staff with specific training and proven experience
Exclusive use of botulinum toxin approved by the health authorities
A detailed clinical history before treatment
Treatment tailored to expression, symmetry and age
Post-treatment checks for follow-up and adjustment
At the Instituto de Cirugía Plástica del Mediterráneo, the medical team assesses every case in consultation to decide whether Botox is the best option, or whether it is better combined with other treatments such as hyaluronic acid or collagen biostimulators.
When Botox is not indicated
Although botulinum toxin has a high safety profile, there are situations in which it is not recommended. These include:
Pregnancy or breastfeeding
Neuromuscular diseases such as myasthenia gravis
An active infection in the area to be treated
A known allergy to components of the toxin
The patient must always have a thorough medical assessment before undergoing treatment. The post-treatment instructions must also be followed strictly, to avoid side effects or unwanted results.
Common myths about Botox
There are many mistaken ideas around this treatment. Here we take apart some of the most common ones:
“Botox leaves the face expressionless”: when it is applied by a qualified professional, the toxin is infiltrated in specific doses and at specific points, to preserve the natural movement of the face.
“It is a permanent treatment”: the effect is temporary, which is what allows the doses to be adjusted and the results kept natural.
“All Botox brands are the same”: there are differences in the formulation and the potency of each brand, so the choice has to be made on clinical grounds.
“It is only useful for women”: more and more men are turning to treatment with botulinum toxin to soften lines and improve their appearance.
Results and expectations
The results of Botox treatment can vary according to age, skin type, muscle strength and how marked the lines are. Not every line disappears completely, particularly those that are marked at rest. Their depth can, however, be reduced significantly with repeated sessions.
It is also important to have realistic expectations. Botulinum toxin does not replace a facelift and it does not remove skin laxity. But it is an effective tool for softening the signs of expression and preventing new lines from forming.
At ICPM Valencia we offer a medical, ethical and individual approach to every botulinum toxin treatment. Our aim is not to change faces but to improve expression and bring freshness back to the face without altering who the patient is. That is why having a team that specialises in Botox is the difference between a correct result and a genuinely excellent one.
Requesting a medical assessment at our clinic is the first step to finding out whether this treatment is right for you. We will help you make informed decisions, always with safety, honesty and professionalism.
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Very fine needles are used and the discomfort is brief: most people describe it as quick pinpricks rather than pain. Anaesthetic is not usually needed; on sensitive skin, cold or an anaesthetic cream can be applied beforehand.
It is common to be left with a small red spot or a little bruise at the injection site, which disappears within a few days and is easily covered with make-up.
Will it show? Am I going to end up with a stiff face?
A stiff face is not an inevitable effect of the treatment: it is the consequence of treating too many areas, or of using more product than that face needs. A well-planned treatment reduces the movement that marks the line and leaves the rest of the expression alone.
Which areas it is worth treating in your case, and how much, is a clinical decision taken by examining the face in movement — asking you to frown, to raise your eyebrows, to smile — not by looking at a photograph at rest. That is why an in-person assessment is not a formality.
As for what has actually been measured: a meta-analysis with GRADE assessment of three randomised trials and 704 participants found that, treating the frown area, the forehead and the crow’s feet at the same time, the proportion of people improving by at least one grade at 30 days was far higher than with placebo, and that adverse effects were no more frequent than with placebo.
Can I carry on as normal afterwards?
Yes. It is an outpatient treatment: you come in and you leave, with no rest and no time off.
What is usually advised is common sense for the first few hours: do not massage or rub the treated area, avoid lying face down, and leave intense exercise, the sauna and strong heat for another day. The specific instructions come from whoever treats you.
And if I stop having it? Will I get more lines?
No. It is one of the most repeated fears and it does not hold up: when the effect wears off, the muscle recovers its movement and the line returns to how it was, not to something worse.
What does happen is an effect of contrast: after months of seeing yourself with the area smoother, the return to your starting point is perceived as a worsening even though it is not. Comparing photographs taken on the same day and in the same light is what clears that impression up.
Can it be done during pregnancy or breastfeeding?
It is not a treatment that is considered during pregnancy or while breastfeeding. It is not that harm has been demonstrated: it is that there are not enough data to accept a risk in a treatment that is not necessary, and faced with that combination the prudent answer is to wait.
If you are trying to conceive, tell your doctor before anything else: it changes the conversation.
Can it be combined with fillers, lasers or other treatments?
A face often needs more than one thing, because the problems are not all the same: the movement that marks a line, the volume that is missing and the quality of the skin are treated with different tools. What can be done in the same session and what is better spaced out depends on the order, the area and the recovery each technique needs.
What should never happen is that a treatment is proposed before deciding what your face needs. The right order is the other way round.
A doctor. Botulinum toxin is a prescription medicine: it requires a prescription, a prior medical assessment and an individual indication, and administering it is not a salon beauty treatment.
Two reasonable questions before you sit on the couch, at any clinic: who is going to treat you and with what qualification, and what happens if an unwanted effect appears. A clinic that answers both well is a clinic where the treatment is a medical act.
Sources
Ascher B, Zakine B, Kestemont P, Baspeyras M, Bougara A, Santini J.A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A in the treatment of glabellar lines. J Am Acad Dermatol. 2004;51(2):223-233. PMID 15280841 — 119 patients: significant efficacy for at least three months with all three doses, and 50 units as the optimum over six months.
Li X, Sui C, Xia X, Chen X.Efficacy and Safety of Botulinum Toxin Type A for Treatment of Glabellar Lines: A Network Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg. 2023;47(1):365-377. PMID 36097079 — all the preparations far superior to placebo, with no significant differences between them in adverse effects.
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