Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum. In a purified form, as is the case with many drugs/medications such as Penicillin, Botulinum toxin is a very safe, effective treatment not only used in cosmetic clinics, but also for several medical conditions, including migraine, cerebral palsy and excessive sweating.

All botulinum toxins are prescription only medicines (POM) and can only be prescribed by doctors, dentists and nurses or prescribing pharmacists with the prescribing qualification, following a face to face assessment and consultation with the qualified prescriber.

The toxin blocks the transition of chemical messages sent from the nerve to cause the muscle to contract. Without these messages, the muscle stays in a resting state until the ‘messengers’ recover. This recovery takes approximately 8 to 12 weeks on average.

The aim of this treatment is to significantly reduce the movement of the muscles causing expression lines (dynamic lines). It may not cause the expression lines themselves to disappear completely, this will depend upon the quality of your skin and may take time over a course of treatments. It may not ‘completely freeze’ the expression, particularly if extreme effort is exerted to make an expression.

Botulinum toxin is not suitable for lines present without expression (static lines), your practitioner will advise you. There may be only a partial reduction in movement this very much depends on the amount administered and location of product placement – This is not a one size fits all treatment and may be tailored to suit your individual requirements and expected treatment outcomes – discuss this with your clinician at the time of consultation.

A very fine needle is used and generally this treatment is not painful and can be well tolerated with no anaesthetic. Ice may be helpful in numbing the skin for nervous patients as well as reducing the risk of a bruise.

All treatments carry a degree of risk. All risks and complications will be discussed with you at consultation and prior to any treatment being agreed.

Botulinum Toxin should be administered by a healthcare professional with specialist training. Adverse events are uncommon, usually occur within a few days of treatment and are expected to be temporary, usually resolving spontaneously within weeks.

Your practitioner will provide aftercare advice designed to minimise risk and promote speedy recovery from any expected side effects.

Side effects include, but are not limited to:

• Bruising
• Swelling at injection sites
• Redness at injection sites
• Asymmetry of expression
• Drooping of the brow, or eyelid
• Headache or a sensation of ‘tightness’ or ‘heaviness’

Your practitioner will take a detailed medical history and an assessment of your needs and expectations to ensure this is an appropriate treatment for you. This must be a nurse, doctor, dentist or prescribing pharmacist with specialised training, qualified to prescribe.

Except in exceptional circumstances this is not a treatment recommended for those under 25 or over 65.

For best results skin should be in good condition and the target lines not too furrowed. Your practitioner will assess your suitability and advise.

• Botulinum toxin cannot be given to pregnant or breast-feeding women.
• Not suitable for patients with certain neurological disorders.
• Not suitable if you are currently taking certain medicines.
• If you have previously experienced adverse reactions to any botulinum toxin treatment.
• Treatment is not recommended if you are suffering from any skin infection in or near the treatment area or are unwell in any way (even a cold).
• If you are taking any medicines which affect bleeding, such as aspirin or warfarin.
• If you are currently or have recently completed a course of Roaccutane (acne treatment) in the last 18 months.

Please contact your practitioner if redness, tenderness or swelling worsens after 3 days, rather than settling. Though some tenderness is to be expected, pain is not and should be reported.

If you suffer any of the following symptoms, which may indicate a serious allergic reaction, seek immediate medical attention:

• Itching
• Rash
• Red itchy welts
• Wheezing
• Difficulty swallowing
• Asthma symptoms
• Dizziness
• Feeling faint

If you are at all concerned about symptoms you were not expecting or any that concern you, you should contact the practitioner who treated you and make an appointment to be seen.

If you wish to see someone else, contact your practitioner and ask for a copy of your treatment record and or a referral letter. This detailed information will be important if another practitioner is going to safely help or advise you.

If you suffer any adverse reactions or a poor cosmetic result, it may be that correction is not possible and you will be advised to wait until the muscle recovers and the toxin wears off. All side effects are temporary and reversible as the effects wear off.

If you have suffered a serious side effect, related to the medicine or product used (rather than the technique of the practitioner), you may report to The Medicines and Healthcare Regulatory Authority (MHRA) using The Yellow Card Scheme