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Procedures  →  Injection facial procedures

Botulinum toxin


Using botulinum toxin is known to medicine for decades, as different neurological, ophthalmological and urological conditions are treated with it.

Using botulinum toxin for aesthetic purposes is fairly new, but significantly more popular, because it gives a better appearance and reduced the signs of tiredness and aging of the skin.

By injecting the botulinum toxin in different parts of the face and neckline, a reduction and even elimination of the fine lines and wrinkles is achieved, which is owed to the relaxing effect of the toxin on our frown muscles.

What is the procedure?

The injection is a procedure that technically is not difficult, and in the skin of the face and neckline a strongly diluted botulin toxin is injected.

The procedure is practically painless, as most patients describe the feeling as an insect bite. It is not necessary to use sedatives beforehand, but to improve comfort during the procedure pain numbing cream is applied on the skin 10-15 minutes before the procedure. This makes the injecting completely painless. The patient can go back to their normal daily activities right after the procedure. They can go home with their car or go to work. In some patients marks from the injections are observed, but they can be hidden with makeup.

инжектиране на ботулинов токсин

How does the botulinum toxin work?

The lines and wrinkles that appear with age on the skin of the face and neckline are two types: dynamic and static.

The dynamic wrinkles are also called “frown lines” and are owed to the contraction of the delicate facial muscles when smiling of frowning. The bigger the emotion a person shows, the deeper these lines and wrinkles become. With injecting the botulinum toxin in the area of the facial muscles and the so-called “cosmetic denervation” occurs, i.e. an inability to willfully contract the facial muscles, as a result of reversible blocking of the nerve impulses to the muscles. This leads to smoothing the frown lines and the lines around the eyes, also known as “crow’s feet”, as well as other dynamic wrinkles.

Static wrinkles are known as “permanent”. They appear later as a result of skin loosening with age. Most commonly such wrinkles appear around the lips, around the eyes and on the forehead. Blocking the active movements of the muscles in the respective facial area does not lead to reduction or removal of these wrinkles. Here is why applying a toxin in these cases has no effect.

In which cases is botulinum toxin suitable?

Injecting botulinum toxin is suitable for people who have a heightened activity or heightened muscle tone in the area of the neckline and face, many wrinkles that appear as a result of often and active mimicry. Most often a toxin is applied to remove the fine lines and wrinkles in the cases of:

Using botox

  • An appearance of the lines between the eyebrows which occurs from willful or not willful frowning
  • Wrinkles or lines around the eyes when smiling
  • Cross and/or vertical lines on the forehead
  • Wrinkling of the skin of the nose while smiling
  • Heightened pressure on the neckline
  • Heightened chin muscle tone, which created the so-called “orange skin”

Are there counter indications for applying the botulinum toxin?

Despite the fact that there has been no data of botulinum toxin causing defects in the development of newborns, we think it is undesirable for the product to be injected in pregnant women and breastfeeding mothers.

Botulinum toxin is not applied on patients with neuromuscular conditions like multiple sclerosis and myasthenia gravis or other types of neurological conditions.

Patients who take certain medications could feel a more powerful effect on their muscles with the injection of the toxin. Such medications are: aminoglycoside antibiotics (streptomycin, tobramycin and gentamycin), penicillin and its derivatives, quinine and calcium antagonists, used in treating high blood pressure.

What are the possible side effects of using botulinum toxin?

Botulinum toxin has been safely and efficiently injected for decades in treating many ophthalmological and neurological conditions. Thousands of patients every year go through therapy with this product and it already is popular for removing vising scars and aging of the skin.

It is rare but possible to experience slight side effects:

  • Appearance of visible scars from the injections and a slight bruising is possible.
  • Appearance of a swelling at the place of the injection.
  • A temporary loosening of the surrounding muscles is possible, due to the botulinum toxin going to the surrounding facial areas – in rare cases a drooping of the lid appears or asymmetry of the facial expression.
  • Rarely, but there may be headaches or muscle pains in the day of the procedure or the following couple of days.

The risk of side effects depends on the muscles that have been injected. As the effect of botulinum therapy is reversible, the side effects are temporary and may continue for only a few weeks.

How should one react if there are side effects from the procedure?

The temporary drooping of one or both lids is the most significant complication, which could occur after the procedure, but it is considered that its frequency is less than 1%. This phenomenon occurs as a result of locally spreading the toxin around the place of injection and it could be minimized by proper dosing of the product and keeping the patient in a standing position for 4-5 hours after the procedure.

The condition of drooping of the lid/s is usually minimal and it goes away in the span of two weeks. Special eye drops could temporarily reduce the drooping.

What results can be expected from the procedure?

In the cases when dynamic wrinkles give the face a tense and wrinkled appearance, injecting the botulinum toxin can lead to visible relaxing, freshening and rejuvenation of the skin.

With wrinkles, which are owed to aged or damaged skin from the sun, whose appearance is not connected to heightened facial muscle tone, the procedure would lead to a significant aesthetic effect and rejuvenation. Here is why the preliminary consult with a dermatologist is of dire important for choosing the maximally suitable procedure to achieve the desired aesthetic result.

Are there any additional benefits of injecting botulinum toxin?

Injecting botulinum toxin often leads to reducing or stopping headaches caused by migraines.

What are the disadvantages of the procedure?

Injecting botulinum toxin for aesthetic purposes is a procedure with an efficiency limited in time. The duration of the injection’s effect is from three to six months. The injections should be done not more than 2-3 times a year. It is observed that the duration of the effect becomes longer with every subsequent procedure. This means that with time, the procedure is done less frequently and the desired result is achieved. The duration depends a lot on the individual’s reaction.

Is there a risk of allergy to the botulinum toxin?

There are no reported allergic reactions after injecting the botulinum toxin. People with a proven allergy to botulinum toxin or albumin should not have the product injected, due to the risk of an allergic shock.

Is there a risk of forming antibodies to the botulinum toxin?

It is possible for the organism to form antibodies due to frequent use of the botulinum toxin. They cancel it out and there is no effect from the procedure. By reaching a high enough concentration of antibodies in the person’s blood, the effect from the botulinum toxin significantly decreases.

Although it is rare, it is possible that the organism forms antibodies to the botulinum toxin only after consuming different protein foods. In those cases there is no effect from the botulinum toxin even after its first use.

Luckily it’s been discovered that antibodies start forming if the amount of injected botulinum toxin is a few hundred units. The amount used for cosmetic purposes is much less. Thus the formation of antibodies would be a problem in treating neurological conditions, where higher quantities are needed to achieve the desired therapeutic effect.

Is special preparation needed for the procedure?

No special preparation is needed.

Is there a need to take special care of the skin after injecting botulinum toxin?

  • Active mimicry in the injected area in the day of the manipulation helps with faster results from the procedure.
  • It is desirable not to lie down or bend down for at least 5-6 hours after the procedure, and this way you would reduce the risk of having side effects.
  • You should not have a massage or go to the gym in the period after the procedure.

You can see the prices for injecting botulinum toxin here.

Procedure price
Botulinum toxin Xeomin
12 BGN
Botulinum toxin Vistabel
12 BGN
Botulinum toxin Dysport

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