This article has been translated. For the original please click here.

Actions and side effects you should know before receiving botulinum injection cosmetology



Women who care about wrinkles

Botulinum injection is called not only wrinkle treatment but also small face injection, and it is a beauty treatment that does not require a scalpel and is performed only by injection . While it is a simple treatment, there are many troubles that cause unexpected effects on the facial muscles due to lack of skill of doctors. It is important to have a solid understanding of the effects and side effects before receiving treatment for botulinum injections.

Botulinum injection that suppresses muscle movement and leads to improvement of facial expression wrinkles

Image of facial expression wrinkle treatment by botulinum injection

Botulinum injection is said to suppress the movement of muscles by injecting a drug that relaxes the muscles, leading to improvement of facial wrinkles caused by the habit of facial muscles . In addition, not only facial expression wrinkles but also gills (masseter muscles) and calf muscles developed by muscles are gradually reduced to lead to slender lines.

Botulinum injection has been used worldwide since the 1980s as a highly safe medical preparation because the drug does not accumulate in the body. Due to its characteristics, botulinum drugs are used in the fields of ophthalmology and neurology for the treatment of eyelids and facial spasms, and botulinum injection treatment is an application of this to cosmetic treatment.

Botulinum is a component extracted from botulinum toxin

The drug used for injection of botulinum is called botulinum toxin , which is one of the proteins extracted from Clostridium botulinum, which is also the causative agent of food poisoning . The drug used in the treatment is a toxin that has been decomposed and purified and diluted with physiological saline, and has no toxic effects on the human body.

"Botox" is not the name of a wrinkle treatment

Botulinum injection, which is used to treat wrinkles and small faces, is widely known as the so-called "Botox injection". Botox is the product name "Botox Vista" registered by Allergan, Inc. It is not the name of the treatment.

In 2002, Allergan's product "Botox Vista" was approved by the FDA (US Food and Drug Administration) and began to be used as a treatment for facial expression wrinkles between the eyebrows. In Japan, manufacturing and sales were approved by the Ministry of Health, Labor and Welfare in 2009.

Problems and indications that can be approached by botulinum injection

A woman holding her hand on the armpit

Facial expression wrinkle treatment

The most common treatment for botulinum injections that act on muscles is said to be facial expression wrinkles. The action of botulinum toxin on muscles that move unconsciously prevents the skin from coming close, and prevents the fixation of wrinkles, leading to smooth skin quality.

In addition, it is said that when a botulinum drug is injected, the release of acetylcholine, a neurotransmitter involved in muscle movement, is suppressed and wrinkles themselves are less likely to occur.

Applicable parts and worries

  • Wrinkles on the forehead
  • Vertical wrinkles between the eyebrows
  • Eyebrows rise or fall too much
  • Laughter wrinkles at the corners of the eyes (footprints of crows)
  • Nose laughing wrinkles
  • Wrinkles on the chin (dried plum wrinkles)
  • Vertical wrinkles on the neck
  • Spread of nose (dango nose)

Small face, beautiful legs, stiff shoulders / irritated shoulder treatment (muscle contraction treatment)

By injecting botulinum toxin into the developed ella (masseter muscle) and calf muscle (shoulder leg) other than the facial muscles, it acts on the treatment to adjust to a slender line and the tension of the shoulder muscle, and the shoulder is delicate There are also treatments that lead to the right line.

Applicable parts and worries

  • Gill line due to masseter development
  • I want to make the face line thinner
  • I want to make the calf developed by muscles thinner
  • I want to heal my legs
  • Severe stiff shoulders
  • Shoulder muscles develop

In addition, botulinum injection can be expected to be effective when muscle development is the cause. If there are other possible reasons, you should consider the treatment method. For example, if the cause is subcutaneous fat, there is a procedure by " lipolytic injection " that dissolves excess subcutaneous fat. Lipolysis injection is a method of injecting a drug into a part of the body that has subcutaneous fat, such as under the chin or legs, to expel fat cells from the body.

Treatment of armpit / hyperhidrosis

In the treatment of hyperhidrosis, it is said that the amount of sweat is reduced by injecting botulinum into the armpit. Since the odorous substances in the apocrine glands are excreted with sweat, it is a treatment method that suppresses the secretion of the cause of odor by reducing sweat .

Applicable parts and worries

  • Those who have a lot of sweat
  • Those who are concerned about the smell of sweat
  • Those who want to reduce armpits, hand sweat, and sole sweat

Gummy smile treatment

The condition where the gums are exposed when you laugh is called a gummy smile. By injecting botulinum into the muscles that move the upper lip (levator labii superioris) without surgery, the movement of the muscles is suppressed, the condition where the upper lip rises too much when laughing is weakened, and the gums are made difficult to see.

Applicable parts and worries

  • Those who can see too much gums when laughing

Eye area / sagging eye formation

It is a treatment method that works on gentle eyes by lowering the outer corners of the eyes with botulinum injection without using a scalpel. By injecting botulinum into a part of the orbicularis oculi muscle that suppresses the movement of the lower eyelid, the force to support the eyelid is weakened, and it is said that the eye becomes a line that hangs down to the outer corner of the eye .

Treatment with botulinum toxin in the medical field includes blepharospasm, hemifacial spasm, and hemiplegia after stroke, which causes limb tension and deformity on the paralyzed side.

Applicable parts and worries

  • Those who want to have a hanging eye
  • Those who want to bring the eye line closer to the almond line

Pore sagging treatment

Treatment of pore sagging with botulinum toxin

As for the injection method of botulinum toxin, in addition to the treatment method of injecting into the muscle like the usual treatment of facial expression wrinkles, there is a treatment method of injecting a very small amount into the dermis in a shallow, fine and wide range.

This treatment is called botulinum lift, and it acts only on the surface fibers of the muscles to tighten the skin, leading to a firm skin with less noticeable sagging pores and fine wrinkles on the cheeks. The effect of botulinum lift is said to last for 4 to 6 months.

Botulinum lift adaptation site

  • amount
  • Outer corner of the eye
  • cheek
  • Around the mouth
  • Neck etc.

Differences depending on the type of botulinum toxin preparation

There are seven different types of botulinum toxin from A to G, of which the ones used for medical and cosmetic treatment are botulinum toxin types A and B.

Type A botulinum toxin preparation

Formulation name Country of manufacture
Botox America
Dysport England
Xeomin Germany
Neuronox Korea
Regenox Korea
Medytox Korea
Btx-A China

Type B botulinum toxin preparation

Formulation name Country of manufacture
Narblock Japan

While the duration of action of botulinum toxin type A is said to be about 4 months, type B has a short effect of about 1 month and it takes time to act, so type A is used for cosmetological treatment. It is said that botulinum toxin is often used.

Among type A botulinum toxin, Allergan's Botox (Botox Vista) is the only medical drug approved for manufacture and sale in Japan.

Benefits of drugs approved for manufacturing and marketing

Drugs that have been approved for manufacture and sale by the Ministry of Health, Labor and Welfare are manufactured, stored, and transported under strict control, and health hazards due to side effects are covered by the public system called the Drug Side Effect Relief System .

* Side effect relief benefits do not cover all health hazards.

Risks and side effects of botulinum injection

Woman looking in the mirror

Side effects of botulinum injection

Internal bleeding at the injection site, ptosis, ptosis, redness, swelling, pain, twitching, heat, numbness, malaise, headache, muscle pain, urticaria, itching, swelling, fever, cough, cold sweat, chest pain, anaphylactic shock , Eye abnormalities, inflammation, etc.

Risks from repeated treatments with botulinum injections

Repeated use of botulinum toxin may produce neutralizing antibodies in the body and diminish the effects of botulinum injection . In addition, it is said that the risk of antibodies increases with age by repeating the treatment of botulinum injection from young people. However, recently, some drugs are less resistant to antibody production, and repeated treatment in a short period of time has become possible.

Although there are individual differences, the cumulative dose of botulinum toxin, which produces neutralizing antibodies, is about 2000 to 4000 units.

Those who need consultation with a doctor

  • Those with muscle disease
  • Those who are allergic to botulinum toxin
  • People with respiratory diseases and glaucoma
  • Botulinum injection is contraindicated for those who are pregnant, pregnant or breastfeeding

What you need to know before botulinum injection


Gradually realize the effect over 1 to 2 weeks

Facial expression wrinkle treatment with botulinum injection is different from hyaluronic acid injection, and the effect does not appear immediately afterwards. It starts to work about 2 to 3 days after injection, is most stable in about 2 weeks, and is said to have a duration of about 3 to 4 months . After that, the drug action gradually disappears over several weeks.

Continued treatment is required to maintain the effect of the botulinum injection. However, it will take about 3 months or more before the next treatment.

In addition, even if the treatment with botulinum injection is stopped, it is said that the symptoms such as wrinkles will not worsen only by returning to the original state.

Has little effect on fine wrinkles and crepe wrinkles

Since botulinum injection acts only on muscles, it cannot be expected to improve wrinkles such as fine wrinkles other than facial expression wrinkles and crepe wrinkles even when there is no expression.

Left-right difference may occur due to habit of muscle movement

Even if a certified doctor performs an appropriate procedure for botulinum injection , there is a possibility that there will be a difference between left and right after treatment because there are individual differences in muscle movement . In addition, when the facial expression becomes unnatural after botulinum injection treatment, it is possible to improve by injecting "acetylcholine chloride" that corrects the botulinum action.

Use only one botulinum toxin drug

There are various botulinum toxin drugs from each manufacturer, but the safety and efficacy of simultaneous infusion treatment have not been established. Therefore, be careful as it may cause serious side effects . Be sure to tell your doctor the name of the botulinum toxin you used earlier for additional treatment at another hospital.

Choosing a Doctor for Botulinum Injection Treatment and What to Do If You Fail

Botulinum injection is a treatment that suppresses the work of muscles and peripheral nerves. Depending on the injection site and the amount of drug, the facial expression may look unnatural. Therefore, it is important to choose a doctor who is familiar with anatomy such as muscles and nerves .

In the unlikely event that botulinum injection causes problems such as undesired effects, injections that suppress the effects of botulinum toxin (acetylcholine chloride) can be used to improve it. After that, it is possible to treat with botulinum injection again after a certain period of time.

Botulinum injection dosage guideline and price quote

Smile woman

The dose of botulinum toxin used to treat wrinkles and small faces varies from person to person, such as the injection site, so it is important to receive appropriate treatment based on the doctor's diagnosis.

Regarding the cost of treatment, botulinum injection treatment in the medical field such as blepharospasm and spasmodic torticollis is covered by insurance. Also, according to the doctor's diagnosis, severe hyperhidrosis is covered by insurance, but other wrinkle treatment and small face treatment are in the beauty area, so all medical treatment is free. Initial / re-examination fees and drug prices vary depending on each clinic.

Part Estimated injection dose Price quote
amount 10 units ~ From 20,000 yen
Between the eyebrows 10 units ~ From 20,000 yen
Outer eyes (both eyes) 20 credits ~ From 20,000 yen
Chin (pickled plum) 10 units ~ From 30,000 yen
neck 40 units ~ From 30,000 yen
Small face (both ella) 40 units ~ From 50,000 yen
Calf (both legs) 200 units ~ From 100,000 yen
Shoulders (both shoulders) 100 units ~ From 50,000 yen
Gummy smile 10 units ~ From 40,000 yen
Hyperhidrosis (both sides) 50-100 units From 80,000 yen

* For botulinum injection, the amount of drug is expressed in "units" instead of cc or ml.
* Depending on each clinic, the treatment fee, anesthesia fee, needle fee, etc. may be charged separately.

Flow of botulinum injection treatment

Treatment with botulinum injections works on the muscles. It is important to convey to the doctor in charge the image you want to aim for, such as the face line and the part you want to treat.

Basic treatment flow

(1) Examination / preparation for injection

After the examination, remove makeup only from the face wash or injection site, and apply anesthetic cream and cooling if desired.

(2) Injection

Using an extra-fine needle, inject botulinum injection into the muscle area desired for treatment. If you do not use anesthesia, the treatment time is about 10 to 15 minutes. It is said that there are almost no needle marks left after injection.

(3) End of treatment

It is said that make-up after treatment is possible, but avoid touching or irritating the injection site.

Pain during botulinum injection is suppressed by anesthesia

The needle used to inject botulinum is so thin that it is said to be less painful . You can also use an anesthetic cream, so if you are not good at pain, consult your doctor in advance.

Precautions after botulinum injection treatment

Botulinum injection, including botulinum lift, can be applied immediately afterwards. However, avoid touching or stimulating the injection site.

You can take a bath on the day, but refrain from drinking alcohol, strenuous exercise or sauna. Esthetic treatments and massages are possible after about 2 weeks, but it is important to consult with your doctor during treatment.

Injecting botulinum into the calf may cause the legs to become tangled or difficult to walk for about 2 to 3 days after injection. Avoid high-heeled shoes and refrain from riding a bicycle or car.

Cosmetological treatment that can be used with botulinum injection

Women undergoing high frequency treatment

Botulinum injection that can treat wrinkles and small faces by acting on muscles. It is said that you can aim for more youthful skin by combining a laser that approaches the skin and injection of a drug such as hyaluronic acid .

When using botulinum injection with other cosmetological treatments, be sure to consult with your doctor in advance about whether treatment is possible on the same day and when to start other treatments.

Combined cosmetological treatment that works for lift-up and wrinkle treatment

Combined cosmetology that works to treat hyperhidrosis and armpits

How to find a botulinum injection expert

Woman with a syringe

Find a doctor with a certified doctor or instructor system

The effect of botulinum injection cannot be confirmed immediately after injection. It is important to inject the appropriate amount of botulinum toxin into the appropriate site to prevent problems such as the drug not working or the facial expression becoming unnatural.

Each pharmaceutical company has a certified doctor and instructor system in which a certificate is awarded after attending the prescribed training and practical seminars. An instructor is a doctor who teaches a doctor a procedure, and can be said to have a wealth of experience and knowledge. If you are worried about botulinum injection treatment, one way is to look for a doctor based on a certified doctor or instructor .

It is important to take proper treatment

Botulinum injection, which can treat facial expression wrinkles and small faces with a single injection, is easy, so it is possible that repeated injections will produce antibodies and diminish the action. Another characteristic of botulinum injection is that it takes some time to realize the effect.

Do n't panic if you don't feel the effect right away, wait about two weeks for additional injections or corrections before consulting your doctor . The movement of the facial muscles is delicate and many nerves are gathered. It is important to aim for natural beauty with botulinum injection treatment with appropriate drugs by a doctor who is familiar with anatomy.