According to a survey by the DGBT (German Society for Aesthetic Botulinum Toxin Therapy), many patients are hesitant about treatment with BoNTA because they fear dependency, a rigid facial expression or long-term damage. These concerns are largely based on insufficient information about wrinkle treatment with botulinum toxin A.

It is important that anti-ageing treatment with BoNTA is performed by an experienced physician. At our private practice for dermatology and aesthetics in Munich, Dr Tatjana Pavicic has extensive expertise in wrinkle treatment with botulinum toxin and is an internationally recognised speaker and practitioner in this field. Particular emphasis is placed on natural-looking, individual results.

Botulinum toxin A acts at the junction between nerves and muscles. The active substance reduces the release of the neurotransmitter acetylcholine, which is involved in transmitting the nerve impulse that tells a muscle to contract. Repeated or prolonged muscle contraction, for example when concentrating or squinting, can contribute to the formation of expression lines. BoNTA can reduce this muscle activity and thereby soften the associated wrinkles.

No. This is a common misconception. An injection with BoNTA is intended to relax the treated facial muscles rather than completely paralyse them. As the muscle activity decreases, expression lines can become smoother.

Many patients, particularly those who have never had botulinum treatment before, worry that they may develop an unnatural or expressionless face or lose the ability to move individual areas.

Such an effect is possible in principle if it is deliberately requested or if an unnecessarily high dose is used. This can produce a mask-like appearance.

However, this is not an inevitable consequence of BoNTA treatment. The result depends on a dose that is adapted to the individual anatomy, muscle strength and facial expression, as well as on the skill, anatomical knowledge and aesthetic judgement of the treating physician. With an experienced practitioner such as Dr Tatjana Pavicic, the aim is a relaxed, natural appearance rather than a frozen expression.

The name botulinum toxin derives from the Latin word “botulus” for sausage and the Greek word “toxikon” for poison. The historical term “sausage poison” goes back to the physician Justinus Kerner, who around 1820 identified a link between paralysis-related deaths and the consumption of spoiled food. In nature, botulinum toxin is produced by the bacterium Clostridium botulinum.

Seven types of botulinum toxin are known. In aesthetic medicine, type A is used. It is produced biotechnologically, highly purified and injected only in very small, precisely dosed quantities into selected muscles. The pharmaceutical preparation used for aesthetic treatment is therefore fundamentally different from uncontrolled exposure to naturally occurring bacterial toxin.

Some patients are concerned that botulinum toxin has not been studied for long enough and might cause long-term damage.

Botulinum toxin has been used in medicine since the 1970s. Physicians use it, for example, to treat muscle spasms and spasticity in children and adults, migraine, teeth grinding and other medical conditions. It can also be used to reduce excessive sweating. In aesthetic wrinkle treatment, there is now more than 30 years of clinical experience.

Botulinum toxin has therefore been used for many years in both medical and aesthetic indications. Within this experience, no characteristic pattern of delayed permanent damage from appropriately performed treatment has been established.

Because the word botulinum toxin is sometimes associated with poisons, drugs or medicines, some patients worry that it could be addictive. Botulinum toxin itself does not cause physical dependency.

What may encourage patients to repeat treatment is simply that they like the fresher appearance achieved after a BoNTA treatment.

Wrinkle treatment with BoNTA is generally well tolerated, but there are situations in which treatment should not be performed. These include known intolerance to components of the preparation, pregnancy and breastfeeding. Particular caution is also required in patients taking medication that affects blood clotting, as this can increase the risk of bruising.

We will be happy to advise you individually on whether BoNTA treatment is suitable for you.

The first effects are usually visible around two to four days after the BoNTA injection. The full effect generally develops within approximately two weeks after treatment.

Botulinum toxin is not a permanent wrinkle treatment. Depending on the treated area, the dose and the individual strength of facial movement, the muscle-relaxing effect generally lasts around three to six months. After this, repeat injections can be performed if desired.

In practice, treatment intervals can sometimes become longer over time because patients may unconsciously reduce certain habitual facial movements, such as repeated frowning.

Sweating is a normal bodily function and increases, for example, during hot weather or physical exertion. Some people, however, sweat excessively even without significant exertion. This may indicate hyperhidrosis.

Botulinum toxin can reduce excessive sweating by acting on peripheral nerve endings that use acetylcholine to activate sweat glands. BoNTA blocks this signal transmission at the treated sites and can therefore reduce sweat-gland activity.

The result is a marked reduction in sweating. This approach can be used for excessive sweating of the armpits, palms and soles of the feet.