Botox(botulinum toxin)

  • It’s a proteases exotoxin produced by a bacteria called clostridium botulinum
  • It consists of seven type of neurotoxins but only type A and B are used
  • It works by blocking the release of acetylcholine from cholinergic nerve endings
  • These causes inactivity of muscles or glands (both sweat and sebaceous) innervated by these nerves
  • Its effects are not permanent, seen within 1-4 days, with maximum effect at 1-4 weeks
  • Usually the effects lasts for 3-4 months

Uses in dermatology

  • Mostly it’s used to treat facial wrinkles:

glabellar frown lines,

crow’s feet or side of the eyes,

horizontal forehead crease,

wrinkles around the mouth,

nasolabial folds,

smoothing out the neck and chest/cleavage wrinkles

  • To elevate the eyebrows
  • Treat hyperhidrosis
  • To treat lichen simplex, dyshidrotic eczema and acne vulgaris
  • Can also be used to prevent other signs of aging like:

dry skin

pigmentation disorders

vascular abnormalities

dull and rough texture

Side effects:

  • Injection side reactions such as pain, swelling, erythema and bleeding
  • Headaches, expected to resolve within 2-4 weeks
  • Malaise, nausea and flu-like symptoms
  • Ptosis, ectropion and strabismus can occur
  • None of the side effects are permanent


  • Microbotox technique was developed by Dr Woffles Wu
  • With the aim to deliver tiny blobs of Botox as superficial as possible in the skin
  • These is to create an intradermal effect and superficial muscle weakness avoiding paralyzing the entire muscle
  • Also used on the T-zone to decrease oiliness
  • On the lower face and neck injections are given for a face lift effect by relaxing the muscles which tend to pull the face down
  • Other known effects are decreasing sebum production, pore size and reduce hyperhidrosis
  • Additional effects are seen in adult acne and fine crinkly skin of face and neck
  • It also leads to increased collagen production leading to anti aging effect


  • Primary disorder of excessive sweating, mainly affects the maxilla, the palms, the sole of the feet and the face
  • Botox acts by blocking acetylcholine release by overactive sudomotor nerves that innervate exocrine sweat glands leading to reduction in sweating
  • Sweating is often relieved for 3 to 14 months
  • The sweating area is defined by iodine starch test
  • Intradermal injections are given evenly in the area that sweats a lot

Other uses:

  • Facial contouring
  • Facial asymmetry correction
  • Even rejuvenation-facial elasticity, texture, pore size or sebum production


  • Neuromuscular disorders eg myasthenia gravis
  • Taking certain medications that can interfere with neuromuscular transmission eg aminoglycosides penicillamine, quinine and calcium channel blockers
  • Pregnancy, infection at side of injection
  • Allergy to botox


After injection no lying down,  exercise, massage of treated area during the first 4 hrs


  1. Clinical,Cosmetic and investigative Dermatology 2019:12
  2. J Cutan Aesthet Surgey.2018 April-Jun;12(2):47-50
  3. J Clin Aesthet Dermatol.2019;12 (11): 32-34
  4. Dermatol Ther (Heidelb) (2020) 10:779-789
  5. J Clin Aesthet Dermatol. 2017;10(2):34-44.

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