Botox / Botulinum




Botulinum toxin injections are a medical cure with numerous application possibilities. This treatment is often referred to with the term botox, from the name of the first botulinum toxin (or botulinum) drug. Currently, there are several formulations of botulinum toxin on the market, which take different names depending on the country of distribution.

Produced by the bacterium clostridium botulinum, the toxin is responsible for a "potentially fatal food poisoning, botulism, caused by the consumption of contaminated food (especially homemade preserves and canned products).

The mechanism of action of botulinum consists in blocking the release of a chemical substance produced by the organism, acetylcholine, which transmits nerve impulses to the muscles, regulating their contraction and, therefore, movement. Without being able to receive the stimuli sent by the nervous system, the muscles stop contracting and relax up to muscle paralysis.

Eating foods that contain high amounts of botulinum toxin can have serious consequences and lead to death from asphyxiation following blockage of the breathing muscles. On the contrary, small doses of the toxin, injected into the muscles in order to temporarily put them at rest, make it possible to treat various ailments linked to excessive or inadequate muscle contraction. The use of botulinum toxin must be targeted and carefully controlled.

From the first use of the toxin for curative purposes, continuous research and experiments are underway to expand its fields of application. Currently, the authorized therapeutic indications mainly concern the ophthalmology and neurological sectors in which the toxin is used for the treatment of disorders such as strabismus, spasticity, involuntary muscle contractions (for example of the eyelids), chronic migraine and the treatment of urinary incontinence due to bladder overactivity, especially if caused by nerve dysfunction.

Use of botulinum toxin for aesthetic purposes

In aesthetic medicine, injections, or infiltrations, of botulinum toxin are used to reduce and attenuate expression lines. These are wrinkles caused by the repeated contraction of the facial muscles that are activated daily, often unconsciously, especially to express emotions. Acting directly on the muscles responsible for their formation, the botulinum toxin allows you to temporarily stretch expression lines, giving the face a relaxed and relaxed appearance without resorting to surgery.

The infiltration of botulinum toxin is not effective, however, on wrinkles caused by the effect of gravity (such as relaxation of the eyelids), nor on wrinkles caused by excessive exposure to the sun or tanning lamps.

The Ministry of Health has authorized the use of Botox for aesthetic purposes, when the severity of facial wrinkles has an important psychological impact in adult patients, for the correction of:

  • vertical wrinkles that form between the eyebrows (glabellar lines)
  • lateral canthal wrinkles (periocular wrinkles, also called "crow's feet") that form in the "eye contour area
  • frontal wrinkles, look at the maximum elevation of the eyebrows

The Ministry also recognized the use of the toxin for aesthetic purposes to counteract excessive sweating (hyperhidrosis) of the face, armpits, hands and feet.

The use of botulinum toxin is not recommended in individuals under the age of 18. There is also limited experience of its use in patients over the age of 65.

What to do before proceeding with the treatment of wrinkles

Before undergoing the infiltration of botulinum toxin for the reduction of wrinkles, it is necessary to carefully evaluate its limits and safety and to know that its use for this purpose is subject to a fee:


      • the effect is not permanent
      • there is no guarantee that you will get the desired results
      • the aging process in untreated areas of the face is not arrested


      • injections of botulinum toxin must be performed by qualified and experienced doctors
      • A perfect knowledge of the anatomy of the face is essential, of the characteristics of the drug and of the operating techniques, to avoid that the toxin affects the wrong muscles or spreads to areas adjacent to those infiltrated (as can occur in the case of excessive dosages)
      • the injection may involve some risks and cause some undesirable effects (side effects)

Preliminary visit

During the visit that precedes the botulinum toxin infiltration, the doctor examines the state of the skin and of the wrinkles to be eliminated, evaluating whether, and how, to proceed on the basis of the desired results and the state of health of the person.

Your doctor should be made aware of any medications you are taking as some medications can interfere with botulinum toxin, altering results or causing unwanted effects.

In turn, the doctor illustrates the methods and risks of administering the toxin, the behavior to be followed in the following days and the results that can realistically be achieved.

How the infiltration is performed

Treatment with botulinum toxin is carried out in an outpatient clinic, by injecting very low doses of the drug into the facial muscles, which you want to induce relaxation. No anesthesia is necessary since the infiltrations, practiced with very thin needles, cause only a slight discomfort, generally well tolerated.

The number of injections depends on the size of the area on which you have to intervene and on the result you want to obtain. In any case, the treatment lasts between 10 and 20 minutes.

At the end of the session, normal activities can be resumed. Just be careful not to massage or rub the treated areas and to avoid intense physical activities in the following 48 hours, to prevent the spread of the toxin to nearby areas.


The effects of botulinum toxin infiltration are not immediate. The first results can be appreciated after 2-5 days, while the full effect occurs approximately after 2 weeks, at which time a control visit is performed to verify the "outcome of the treatment and, if necessary, make small adjustments. The results are not definitive but tend to gradually disappear over a period of 4 or 6 months. The duration depends on various factors, the decisive factor is the reaction to the drug which varies from person to person (subjective response). To maintain the result obtained is, however, it is necessary to periodically undergo further courses of injections.


Botulinum toxin should not be used in cases of:

  • neuromuscular diseases, such as myasthenia gravis and Eaton Lambert syndrome
  • infection or inflammation in the area to be infiltrated
  • allergy ascertained to botulinum toxin or to one of the other substances (excipients) contained in the drug (including "human albumin)

The use of botulinum toxin is not indicated in the following cases:

  • ongoing therapy with some classes of antibiotics (aminoglycosides and spectinomycin) and muscle relaxants, which could amplify the effects of botulinum toxin
  • ongoing therapy with antiplatelet and anticoagulant drugs (such as "aspirin and heparin) which, by thinning the blood, could favor the appearance of bruises at the injection sites

During pregnancy and breastfeeding, the use of botulinum toxin is not recommended because the effects on the baby are not known.

Risks and undesirable effects (side effects)

The most common risks of treatment include:

    • flu-like symptoms and headaches, in the 24 hours following the application
    • appearance of hematomas, or bruising, at the injection sites
    • muscle weakness and sagging of the face, such as the lowering of the upper eyelid, due to the migration of the toxin from the injection sites to the adjacent muscles

In any case, the side effects are generally reversible and subside within a few days or weeks.

One can develop in a small percentage of people resistance to toxin generally caused by its use in excessive or too frequent dosage, which determines the formation of antibodies that neutralize it making it ineffective.

In rare cases, more serious problems may occur, such as blurring or double vision when wrinkles around the eyes are infiltrated, even a few weeks after the injections.

In the presence of these, or other, serious ailments (symptoms) it is necessary to consult your doctor immediately or go to the nearest emergency room.

Any type of unwanted reaction (adverse reaction), even if only presumed, can be communicated to the competent health authorities through the special form of reporting a suspected adverse reaction, following the procedures available by clicking on the following link. Reporting an adverse reaction, subsequently evaluated by a group of experts, it contributes to the collection of information on the safety of botulinum toxin.

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