Botulinum toxin is one of the most requested treatments for expression lines. These are the three questions I hear most often about it.
At what age should treatment begin?
There is no fixed age. I recommend the first treatment when fine lines start to appear on the forehead, between the eyebrows or around the eyes — crow's feet.
At first, these lines appear only with facial movements — they are called dynamic wrinkles. Botulinum toxin targets them to help prevent them from deepening into lines visible even when your face is at rest, known as static wrinkles. They often begin between ages 25 and 30, though this varies with how you use your facial muscles, as explained below.
How long does the effect last?
You've probably read it lasts three to six months. It's true in general terms, but the duration depends a lot on how each person's muscles work. One useful way to understand this is to distinguish three types of patients according to their muscle tone:
Kinetic patients. Their facial movements reflect what they are feeling: they frown when angry and raise their eyebrows when surprised, with no wrinkles visible at rest. They are ideal candidates. In my experience, treatment lasts six to seven months for them, sometimes longer.
Hyperkinetic patients. Their facial muscles move even when they are not expressing an emotion — for example, they may raise their eyebrows or frown while talking, without being surprised or angry. Lines therefore appear earlier. Results usually last four to six months, sometimes less. This is the group that most often seeks treatment.
Hypertonic patients. They find it difficult to relax their facial expression and are often asked whether they are angry. Botulinum toxin alone does not completely remove their wrinkles, so it is often combined with a filler. Its effect is shorter, and treatments need to be more frequent.
An assessment before treatment helps determine the appropriate dose and frequency for your pattern of facial muscle activity.
Who should not receive it?
People with neuromuscular transmission diseases, such as myasthenia gravis, Lambert-Eaton syndrome or amyotrophic lateral sclerosis.
People allergic to any ingredient in the product. Some formulations may contain traces of cow's milk protein, so it is essential to mention this allergy beforehand.
During pregnancy and breastfeeding. There is insufficient information about safety at these stages, so treatment is avoided as a precaution. This is why we always ask for the date of your last menstrual period.
People with clotting disorders or taking anticoagulants or antiplatelet drugs, such as aspirin, clopidogrel or warfarin. This is a relative contraindication: the main risk is easier bruising.