What are botulinum toxin injections?

Botulinum toxin injections (commonly known by brand names such as Botox®, Bocouture®, Dysport® and Azzalure®) are injectable treatments used to temporarily relax overactive muscles. In cosmetic dermatology, they are most often used to soften dynamic facial lines caused by repeated muscle movement, such as frown lines, forehead lines, and crow’s feet. Botulinum toxin is a purified protein derived from Clostridium botulinum bacteria. In cosmetic doses, it is safe and has been used in medicine for several decades.

Why might I choose to have this procedure?

You might consider botulinum toxin injections if you want to reduce the appearance of facial lines caused by repeated expressions, such as frowning or squinting. The treatment gives a smoother and often more rested appearance. Some people also use it to reduce excessive underarm sweating (hyperhidrosis) or in certain medical contexts such as migraine or jaw muscle tension, though this leaflet focuses on cosmetic use.

What does the procedure involve?

You will first have a consultation to review your medical history, discuss your goals, and assess whether botulinum toxin is suitable. The treatment itself usually takes 10–20 minutes. The toxin is injected using a very fine needle into selected facial muscles. Most people describe only mild stinging or pinprick sensations. No anaesthetic is usually required. You can normally return to normal daily activities immediately afterwards, though vigorous exercise, alcohol, and rubbing the treated area should be avoided for the rest of the day.

What are the benefits of the procedure?

The main benefit is the temporary softening of expression lines, giving a smoother appearance. Many patients report looking more relaxed and refreshed, without losing their natural ability to express emotions when the treatment is performed carefully. Results are usually visible within 3–7 days, with peak effect at about 2 weeks. Effects last on average 3–4 months, after which repeat treatment may be required to maintain the result. Some newer toxins may have a quicker onset and last longer.

What are the risks and potential side effects?

Most side effects are temporary and mild, such as redness, swelling, or small bruises at injection sites. Headache or a heavy sensation in the forehead can sometimes occur. Less common side effects include temporary asymmetry, drooping of the eyelid or eyebrow, or an unnatural appearance if excessive doses are used. These effects usually wear off as the toxin’s action fades. Rare risks include allergic reaction or unintended spread of the toxin beyond the target muscles. Botulinum toxin should only be administered by trained healthcare professionals who understand facial anatomy and dosing to minimise these risks.

What alternatives are available?

Alternatives depend on your goals. Other options include dermal fillers, chemical peels, laser resurfacing, or topical treatments such as retinoids and prescription creams. Surgical procedures such as a brow lift or blepharoplasty may provide more long-lasting improvements in selected patients. Your dermatologist will discuss what options may best meet your needs.

What should I expect after the procedure?

After treatment you may notice tiny red bumps or pinprick marks that settle within a few hours. Bruising is possible but uncommon. It is important not to rub or massage the area, and to avoid strenuous activity, alcohol, or lying flat for about 4 hours. The treatment takes several days to work, with maximum effect seen around 2 weeks.

How many treatments will I need?

Most people require maintenance treatments every 3–4 months. Some individuals find the effects last longer with repeated sessions. The exact interval will vary depending on your metabolism, the muscles treated, the toxin used, and your cosmetic goals.

Who should not have this procedure?

You should not have botulinum toxin injections if you are pregnant or breastfeeding, if you have an infection at the planned injection site, or if you have a known allergy to any component of the product. People with certain neuromuscular conditions (such as myasthenia gravis or Lambert-Eaton syndrome) should avoid this treatment. Caution is required if you are taking medications that interfere with neuromuscular function, such as aminoglycoside antibiotics. A full medical history will be taken at consultation to ensure treatment is safe for you.

Who can perform this procedure?

In the UK, botulinum toxin injections for cosmetic purposes should only be carried out by qualified, registered healthcare professionals such as doctors, dentists, or nurses with specific training in aesthetic medicine. They should practise within a regulated clinical environment, be able to manage complications, and provide access to follow-up care. Choosing a practitioner with appropriate training and credentials is vital for safe treatment.

Will I need a consultation?

Yes. A face-to-face consultation is essential before any treatment to discuss your expectations, review your medical history, explain the risks and benefits, and decide whether botulinum toxin is right for you. You should also have the opportunity to ask questions.

Where can I get more information?

You can find more information from:

• The British Cosmetic Dermatology Group (BCDG)
• The British Association of Dermatologists (www.bad.org.uk)
• The Joint Council for Cosmetic Practitioners (JCCP)
• NHS guidance on cosmetic procedures

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030