What is Botulinum Toxin?
Botulinum toxin is a purified protein derived from Clostridium botulinum. It is widely used in both cosmetic and medical treatments to relax specific muscles and reduce the appearance of dynamic wrinkles - those caused byfacial movements such as frowning, squinting or raising the eyebrows.
How does BoNT/A work?
Botulinum toxin works by temporarily blocking nerve signals to the muscles. When injected, it prevents the release of acetylcholine (the neurotransmitter responsible for muscle contractions), leading to muscle relaxation.
How does BoNT/A improve wrinkles?
By injecting BoNT/A into specific facial muscles responsible for dynamic wrinkles, the targeted muscles relax, allowing wrinkles to smooth out and helping to prevent the formation of static lines over time.
Common BoNT/A Brands in Singapore
- Botox®
- Manufacturer: Allergan (AbbVie)
- Origin: USA
- Most widely used and well-studied brand worldwide
- Dysport®
- Manufacturer: Ipsen
- Origin: UK/France
- Slightly faster onset, spreads more, good for larger muscle groups/ treatment areas
- Xeomin®
- Manufacturer: Merz Pharma
- Origin: Germany
- “Naked” formulation with no immunogenic proteins, potentially reducing the risk of resistance
Common indications of BoNT/A:
- Dynamic wrinkle reduction:
Botulinum toxin softens expression lines caused by repeated facial movements such as:
- Forehead lines – horizontal lines from raising eyebrows
- Glabella lines – vertical “frown” lines between the eyebrows
- Crow’s feet – lines around the outer corners of the eyes when smiling or squinting
- Bunny lines – wrinkles on the sides of the nose when smiling
- Facial slimming & jaw contouring:
Injection into the masseter muscles (chewing muscles):
- To slim a square jawline for a more V-shaped face
- Help with bruxism (teeth grinding) and jaw tension
- Improve facial asymmetry from overactive jaw muscles
- Brow lift
Precise botulinum toxin placement can help to lift the eyebrows, opening the eye area for a more refreshed and younger appearance without surgery
- Chin dimpling improvement (mentalis muscle relaxation)
Used to smooth a dimpled chin, creating a more youthful and relaxed lower face
- Neck rejuvenation (Nefertiti lift)
Botulinum toxin can be injected into the platysma bands to reduce neck banding, and soften and improve the jawline contour
- Excessive sweating (hyperhidrosis)
Botulinum toxin is also used off-label to treat excessive sweating, especially in areas like underarms, palms, soles of feet and scalp
Duration of effect of BoNT/A:
Effects of botulinum toxin A typically start to appear within 3-5 days, while full effect is usually seen in 10-14 days. Results last approximately 3-4 months.
Duration of effect may vary based on the site of treatment, dosage of botulinum toxin, muscle activity and metabolism.
Treatment frequency:
For optimal wrinkle prevention, treatments are recommended every 3-4 months.
With consistent care, some patients may be able to extend the interval to 4-6 months.
Regular sessions can help prevent and delay the development of static lines.
Risks and possible complications:
Botulinum toxin is considered safe when performed by trained professionals. However, like with all medical procedures, it carries some risks:
a) Common temporary side effects
- Mild redness or swelling at injection sites
- Bruising
- Headache
- Facial asymmetry (can often be corrected with additional treatment)
b) Rare complications
- Eyelid or eyebrow drooping
- Dry eyes or excessive tearing
- Flu-like symptoms
- Muscle weakness beyond the targeted area
Contraindications:
- Pregnant or breastfeeding
- History of neuromuscular disorder (eg. myasthenia gravis, amyotrophic lateral sclerosis)
- Active infection or inflammation at the injection site
- Allergic to Botulinum toxin ingredients
Pre-procedure:
- Photo documentation
- Detailed consultation with doctor to determine injection plan
- Face is cleaned and topical numbing cream applied for 20 mins
- Obtain written consent
Post-procedure:
- Apply topical healing cream on the treated area, followed by moisturizer and SPF50 sunscreen
- Post-procedure advice:
- Avoid alcohol for 24hrs
- Avoid strenuous activities for 24hrs
- Avoid hot sauna/ extreme heat exposure for 24hrs
- Avoid massage/ rubbing the injection site for 24hrs
- Avoid makeup on the same day and only light makeup the following day
- Stay upright for at least 4hrs post-injection
- Can apply cold compress over the injection site to reduce swelling, if present
- Inform the clinic immediately if there is any unusual post-injection side effect such as intense pain/ swelling or extensive bruising at the injection site.
Comparison between different Botulinum toxin A brands:
Price: $300 per part, $800 for masseters
