Question 1

Botulinum Toxin for aesthetic facial treatment

Accepted Answer

Treatment with botulinum toxin (Vistabel®, Bocouture®, Azzalure®) has been considered the gold standard for the treatment of many facial wrinkles for many years.
I personally perform all botulinum toxin treatments. Procedures are carried out in a calm, wellness-oriented atmosphere using high-quality products, micro-needles, and—if desired—a topical numbing cream. Techniques include “Baby Botox”, which involves gradual, subtle dosing for particularly discreet results.
“My goal is a natural and harmonious outcome. I adjust the dosage so that the muscle groups responsible for wrinkles are weakened gently and unobtrusively.”

Question 2

Which wrinkles are best treated with Botulinum Toxin?

Accepted Answer

Wrinkles develop due to various factors, including reduced skin elasticity, excess skin, loss of subcutaneous fat, and the activity of facial muscles. These factors affect different facial regions in different ways, which is why experience and individualized treatment planning are essential.
Wrinkles in the forehead, glabellar region (frown lines), and lateral eye area (crow’s feet) are primarily caused by repetitive muscle activity. These wrinkles are typically best treated with botulinum toxin injections, which reduce the underlying muscle activity.
It is important that muscle movement is not completely eliminated, as this could result in a rigid or mask-like appearance. When applied correctly, weakening the muscles leads to visible smoothing of the overlying skin. This beneficial effect on the skin may persist even after muscle activity gradually returns.
Fillers such as hyaluronic acid are more suitable for areas including the cheeks, nasolabial folds, lips, and jawline. Overfilling must be avoided. When age-related volume shifts lead to slimmer cheeks and fullness along the nasolabial folds or jowls, fillers may no longer be the ideal treatment option.
Peels and laser treatments may be used around the mouth or across the entire face to address fine wrinkles, pigmentation changes, and irregular skin texture. Larger folds caused by excess skin—such as in the neck, cheeks, or jawline—often require surgical approaches, such as a facelift, for effective correction.

Question 3

Treatment of tension headaches and migraine with Botulinum Toxin

Accepted Answer

Tension headaches and migraines may respond positively to targeted weakening of chronically tense muscles in the neck, temples, and forehead. When effective, the therapeutic benefit typically lasts around three months and can be repeated as needed. Injections may be administered to the neck, temples, forehead, or a combination of these areas.

Question 4

Safety of Botulinum Toxin treatment

Accepted Answer

Botulinum toxin is a very safe medication when used appropriately. Its effects reliably wear off after approximately three months, and it does not damage body cells. Therefore, any unwanted effects are temporary. Allergic reactions are infrequent.
Strict safety standards must always be observed:

Treatment must be performed by a licensed physician with appropriate specialist training and experience
The practice must be equipped to manage allergic reactions and other emergencies
Emergency medications (e.g., adrenaline) and advanced emergency equipment must be available
The treating physician must hold professional liability insurance for this specific treatment

Patients are encouraged to verify these quality and safety criteria.

Question 5

Treatment of teeth grinding (bruxism) with Botulinum Toxin

Accepted Answer

Night-time teeth grinding is caused by increased activity of the chewing muscles. Targeted weakening of these muscles with botulinum toxin can significantly reduce bruxism in many cases. The effect typically lasts three months.

Question 6

How does Botulinum Toxin work?

Accepted Answer

Botulinum toxin is a medication marketed under various names, including Botox®, Vistabel®, Azzalure®, Bocouture® and Xeomin®. After injection, the active substance is selectively absorbed by nerve cells and acts within the cell.
Its effect begins once a sufficient amount of a specific transport protein inside the cell is deactivated—usually within 24 to 72 hours. At this point, signal transmission from the nerve to the muscle is interrupted, preventing muscle contraction. Clinically, this is observed as reduced wrinkle formation, for example on the forehead.
Botulinum toxin does not cause cell death. Instead, it acts as an “intelligent enzyme,” temporarily interfering with cellular signal transmission. After approximately three months, normal cellular metabolism resumes, nerve signals are restored, and muscle contraction returns. The protein-based toxin is broken down and metabolized by the body.
The effects of botulinum toxin are always temporary, and therefore any potential side effects are also temporary. Historical cases of botulism were caused by ingestion of extremely large amounts of toxin from spoiled food, leading to respiratory muscle paralysis. The dose required for such toxicity would be equivalent to at least 30 vials, far exceeding any medical use. Such effects have never been reported following facial aesthetic treatments.
In the hands of an experienced physician, botulinum toxin is considered safe and low-risk.

Question 7

How long do the effects on wrinkles last?

Accepted Answer

The muscle-weakening effect of botulinum toxin diminishes after approximately three months. However, the beneficial effect on the overlying skin often lasts longer. Overall duration varies between patients and is typically four to seven months.
Early follow-up treatment after about three months can enhance and significantly prolong the smoothing effect on the skin.

Question 8

Pricing of Botulinum Toxin treatments

Accepted Answer

Treatment of small areas (crow’s feet or glabellar lines): approx. €240 (average dose)
Treatment of the entire forehead, including glabella and crow’s feet: approx. €350
Migraine treatment: approx. €350 per treated side of the head
Bruxism treatment: approx. €420–€530 for both sides of the jaw
Treatment of underarm sweating: approx. €420 for both sides

We use only freshly prepared botulinum toxin and do not freeze the medication.

Question 9

Experience and expertise

Accepted Answer

Over 25 years of experience in aesthetic facial treatment with botulinum toxin
Scientific research on botulinum toxin facial treatments since the late 1990s
Awarded by the American Academy of Facial Plastic and Reconstructive Surgery
Patents acquired worldwide by the Mayo Clinic based on this research
Co-author of the current S1 clinical guidelines on Aesthetic Botulinum Toxin Therapy and Prevention of Complications in Filler Treatments, which are key reference works in German-speaking countries

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