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Procedure guide · Skin and non-surgical
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Botulinum toxin (Botox)Botulinum toxin injections relax the small muscles that create frown lines, forehead lines and crow's feet, smoothing the skin above them for three to four months. A treatment takes ten to twenty minutes with no anaesthesia and no downtime; the effect starts after three to five days and peaks at two weeks. It is a prescription medicine that should be injected by a doctor or registered nurse prescriber, and results wear off gradually rather than reversing suddenly.
Botulinum toxin type A blocks the signal between nerve and muscle at the injection site, so the treated muscle relaxes and the skin over it stops folding. Frown lines between the brows, horizontal forehead lines and crow's feet respond best because they are caused by muscle movement. Small doses also lift the brow tail, soften a gummy smile, slim the masseter muscles and reduce neck bands. Dosing is measured in units and adjusted to your muscle strength and the look you want, from a light softening to full smoothing. The effect wears off gradually as new nerve endings form; regular treatment can weaken the muscles so that lines fade over time.
Patients researching treatment abroad will come across several approved botulinum toxin type A products beyond the original Botox: Dysport (sold in some markets as Azzalure), Xeomin (Bocouture), and in some countries newer entrants. All work the same way, blocking the same nerve signal, but they are formulated and tested differently, so a unit of one is not equivalent to a unit of another. Dysport is typically dosed at roughly two to three times the unit count used for an equivalent Botox result, reflecting a different manufacturing concentration, while Xeomin's "naked" formulation, stripped of the accessory proteins that surround the toxin in Botox and Dysport, is usually dosed close to a one-to-one ratio with Botox. Diffusion, how far the product spreads from the injection point, also varies slightly by brand and dilution, which matters more for fine, superficial areas like crow's feet than for stronger muscles like the glabella. In practice, which brand a clinic stocks matters far less than whether the injector understands these differences, dilutes and doses accordingly, and places the product in the right muscle plane for your anatomy.
Botulinum toxin's effect on appearance tends to change over years of repeated treatment, not just within a single three- to four-month cycle. Muscles that are regularly prevented from contracting at full force gradually lose some of their bulk and habitual pull, a mild, reversible form of disuse weakening sometimes called a training effect. Many long-term patients notice that lines take longer to reappear between sessions, that a lighter dose produces the same smoothing they once needed more units for, or that they can stretch the interval between appointments from three months to four or five. Stop entirely, and the muscle regains its normal strength over the following months as nerve endings regenerate; the lines return to whatever they would have been without treatment, simply back to baseline on the timeline the muscle needs to recover full function.
Surgeons look for these points at the consultation.
Adults with dynamic lines caused by muscle movement, realistic expectations of a temporary softening, and no neuromuscular disease.
Reasons a good surgeon will ask you to wait or choose something else.
Pregnancy and breastfeeding, neuromuscular disorders such as myasthenia gravis, allergy to toxin components, active infection at injection sites.
Ask your surgeon which technique they recommend for you and why.
Standard points across the glabella, forehead and crow's feet.
Smaller doses spread more widely to soften rather than freeze movement.
Toxin into the chewing muscles reduces a square jaw and teeth grinding.
Step by step, from arrival to discharge.
The injector watches your expressions and marks the muscles to treat.
Small volumes are injected with a fine needle at several points; it takes minutes.
Stay upright for four hours and avoid rubbing, exercise and alcohol that day.
A check at two weeks allows small top-ups.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
Botulinum toxin is one of the lowest-risk procedures in aesthetic medicine: it involves no incision, no anaesthesia and no permanent change, and the great majority of patients experience nothing worse than a small bruise or a mild, short-lived headache. The rare outcomes that do concern people, a drooping eyelid or an asymmetric brow, are almost never caused by the toxin itself but by how it was used: an inexperienced injector placing it too close to the levator muscle or orbital rim, dosing without accounting for a patient's muscle strength, or product that has been diluted incorrectly or is not genuine. A doctor or registered nurse prescriber working from licensed stock, with a clear understanding of facial anatomy and a conservative starting dose, reduces these risks to a very low baseline.
At injection points; fade within a week.
Mild, in the first days.
If toxin spreads to the wrong muscle; wears off in weeks.
From uneven dosing; temporary.
There is no recovery period after botulinum toxin in the surgical sense, only a short list of sensible precautions for the rest of the treatment day. Most clinics advise staying upright and avoiding lying flat, strenuous exercise, facials, saunas or vigorous head massage for several hours, so the product settles in the intended muscle rather than spreading. Make-up can usually go back on once the injection marks have settled, often within an hour. The effect is never visible immediately: the toxin needs several days to bind to nerve endings and block the signal to the muscle, which is why nothing changes for the first three to five days and the result is still settling at the two-week mark.
Day 1
Stay upright for four hours; no rubbing, exercise or alcohol that day.
Days 3-5
Lines start to soften.
Week 2
Review appointment for any top-up.
Months 3-4
Movement returns gradually; repeat if desired.
Lines begin to soften at three to five days and the full effect shows at two weeks, lasting three to four months. With repeated treatment the muscles weaken and the interval can lengthen. Wearing off is gradual, so there is no sudden change.
Unlike a surgical procedure with a single quoted fee, botulinum toxin is priced per unit or per treatment area, since the dose depends on muscle strength and the result you want. The figures on our dedicated cost page reflect typical per-unit and per-area pricing across verified clinics, not a flat package price.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
For static lines and folds that persist at rest.
For a heavy, low brow that toxin only lifts slightly.
Improves fine static lines and skin texture.
Ask the same questions at every consultation so you can compare answers.
A face-lift or rhinoplasty justifies a trip abroad on cost alone, because the saving on a multi-thousand-euro procedure comfortably covers flights and a hotel. Botulinum toxin is a different calculation: a single session is quick, inexpensive relative to surgery, and widely available at home, so the saving on units rarely offsets the cost of travel unless you are already visiting a destination for another reason. It tends to make the most financial and logistical sense as an add-on booked alongside a surgical procedure, a course of dermal filler, or a skin treatment, rather than as the sole reason for the trip.
Because the treatment itself takes minutes, it is tempting to treat the injector as an afterthought. The opposite is true abroad, where it is harder to fall back on local reputation or a regulator you already trust. Before booking, check that the person injecting is a licensed doctor, dentist or registered nurse prescriber under that country's rules, not a beautician or technician working without medical supervision, and that the clinic itself holds the relevant health authority registration, in Turkey a Ministry of Health health tourism authorisation. A reputable clinic will name the product it uses and the injector's qualification without being asked twice.
Counterfeit and diluted botulinum toxin is a real problem in parts of the world with weak pharmaceutical oversight or a large market in non-medical injectors, and it is the single biggest source of serious complications, far more than the treatment itself. Warning signs include unusually cheap per-unit pricing, a clinic that will not tell you which brand it uses, vials that are not opened in front of you, or treatment offered outside a licensed medical facility. Ask to see the box and batch number; a legitimate clinic sourcing genuine product from the manufacturer has no reason to decline.
One practical detail is timing: because the effect only begins after three to five days and peaks at two weeks, a treatment booked on the last day of a trip will show nothing by the time you fly home. If the result matters for a specific date, book early enough in the trip to see it settle, or treat it as the start of a cycle you continue with a provider at home.
A growing number of clinics market botulinum toxin to patients in their twenties and early thirties as "preventative," on the reasoning that treating a frown or forehead line while it only appears on movement, before it is visible with the face at rest, might stop it from becoming etched in permanently. It is a plausible idea rather than a settled one: repetitive folding of the skin along the same crease does contribute to lines becoming fixed over time, but "preventative" is a marketing framing more than a clinical category, and starting early is a personal choice, not a medical recommendation that applies to a particular age.
What the evidence reasonably supports is narrower than the marketing suggests: that relaxing a muscle reduces the dynamic line it causes for as long as the treatment lasts, and that in patients who treat consistently over years, muscles trained this way do seem to need less product over time. Most published research looks at people who already have visible lines and measures improvement, not people in their twenties followed for decades to see whether early treatment changes how they age.
Botulinum toxin does nothing for the two other processes that drive most facial ageing: loss of volume and fat, and loosening of skin and its supporting ligaments. Starting injections at twenty-five will not slow either of those, and a dynamic line left untreated at that age is not a medical problem, simply a line that appears when you move your face. There is a real cost to weigh: committing to a treatment repeated every three to four months for decades is a significant cumulative expense.
A reasonable way to decide is to pay attention to what your own face does rather than to an age on a chart: if a line only shows when you frown or raise your brows, there is no urgency; if it has started to leave a faint trace when your face is still, that is the point many injectors would discuss treatment. Either way, it remains elective and reversible by simply stopping.
A good consultation is mostly assessment and conversation, and the injection itself is the shortest part of the visit. Expect the injector to begin with your medical history before touching your face: previous botulinum toxin treatments and how you responded, any neurological or muscle condition, allergies, current medicines and supplements, and whether you might be pregnant or are breastfeeding. This is also the point at which an honest injector may decide not to treat, or to postpone, and that decision is a sign of careful practice rather than a sales failure.
The next step is watching your face move. Surgeons and injectors usually ask you to frown, raise your brows, squint and smile, then look at the face at rest, because the same line can have different causes. A crease that appears only on movement is a candidate for toxin. A crease that remains with the face completely still is partly a skin or volume issue, and toxin will soften it only modestly. Brow position, eyelid heaviness, the strength of each side and any natural asymmetry are noted at this stage, since toxin does not create symmetry and can make existing differences more visible.
Useful things to bring or prepare:
Photographs matter more than people expect. Memory of how your face looked three months ago is unreliable, and a record of the starting point helps both you and the injector judge what the treatment actually changed.
You should leave the consultation knowing which muscles are to be treated and why, the brand to be used, the approximate number of units for each area, what a sensible first dose looks like, and when the review will take place. Dosing is individual, so a vague answer such as "we will see on the day" is less reassuring than a stated plan with room to adjust.
It is reasonable to expect a written consent form that lists the risks in plain language, including temporary eyelid or brow droop, bruising and an uneven result. Take time to read it. Consent signed in a hurry at the chair, with the syringe already drawn up, is a poor foundation for an elective treatment.
If you are travelling for treatment, ask how the consultation will work. Some patients have a remote conversation before travelling, and a short in-person assessment on arrival still matters, because muscle strength and asymmetry are difficult to judge from a photograph. Ask also who you should contact once you are home if something looks wrong, and in which language that person can speak with you.
Photographs are the most persuasive material a clinic can show, and also the easiest to make misleading. Because botulinum toxin changes how a face moves rather than its structure, the comparison is more sensitive to small differences in how the picture was taken than a surgical result would be. A few habits make you a more critical reader.
Check the expression. The most useful pairs show the same person in two states: relaxed and fully frowning or raising the brows, before and after. A "before" photograph taken while the patient frowns hard and an "after" taken with a neutral face will exaggerate any treatment. Look for the same expression in both frames.
Check the lighting and angle. Overhead light casts shadows into lines and makes them look deeper, while soft frontal light flattens them. A slight tilt of the chin changes the apparent height of the brow. If the two images differ in light, distance or head position, they tell you little.
Check the timing. The effect peaks at around two weeks, so an image taken a few days after treatment will not show the full result, and one taken at three months may show the effect already fading. A responsible set states the interval and the dose, because a photograph without that information cannot be compared with your own situation.
Look for editing. Smoothed skin texture, altered brightness, different make-up and a changed hairstyle are all signs that the pair has been prepared for presentation. Pores and fine skin texture should look natural in both images.
Look at who is shown. A result in a patient with a mild line says little about someone with deep, long-standing creases, and a result in a younger face does not predict an older one. Ask whether the examples resemble your age, skin type and the area you want treated, and whether they are the injector's own patients rather than images supplied by a manufacturer or taken from elsewhere.
Remember what a photograph cannot show. It will not show how natural the movement felt, whether the patient had a top-up at review, or how many patients did not respond as well. A set chosen from many cases is a selection, not an average.
Before-and-after images are best treated as a way to judge an injector's taste and consistency, not as a forecast for your own face. If a clinic cannot show consistent, unedited examples of treatments like yours, or declines to explain how they were taken, that is useful information in itself. Some regulators also restrict how such images may be used in advertising, so a restrained presentation is often a sign of a more careful provider.
Yes when a licensed product is injected by a doctor in a regulated clinic. Ask to see the vial and batch; unlicensed toxin has caused serious harm elsewhere. Combining a treatment with a surgical trip is convenient but not a reason to travel on its own.
Only with over-treatment. Modern dosing aims to soften lines while keeping expression; you can ask for a lighter dose and top up at the two-week review.
Three to four months for most people, sometimes longer with regular treatment as muscles weaken.
No reputable clinic will treat you during pregnancy or while breastfeeding. Botulinum toxin hasn't been studied in pregnant or breastfeeding women for safety reasons, so clinics decline as a precaution rather than because harm has been demonstrated. It's elective, so the standard advice is simply to wait until afterwards.
Yes, combining them in one appointment is routine, for example relaxing frown lines with toxin while adding volume to the cheeks or lips with filler. Many injectors treat the toxin first in areas where both are planned, so the muscle relaxation has started before the filler is shaped. The two are reviewed together at the two-week follow-up since they settle on different timelines.
It depends on the strength of your muscles, the areas treated, and how much softening you want, so there's no single "first-time" dose. Most injectors deliberately start conservatively for a new patient, because it's easier to add a few units at the two-week review if the effect is too light than to correct an overcorrected result.
The usual reason is a dose too light for your muscle strength, which a top-up at the two-week review usually corrects. Another common cause is treating the wrong problem: botulinum toxin only softens lines caused by muscle movement, so a line that's still visible with your face completely still is more likely volume loss or sun-damaged skin, which needs filler or resurfacing instead.
Yes, botulinum toxin is an approved treatment for chronic migraine, using a standardised pattern of injections across more sites of the head and neck and a higher total dose than cosmetic treatment uses. It's a distinct medical indication, typically overseen by a neurologist rather than an aesthetic injector.
Often yes: men's forehead and frown muscles are typically stronger and bulkier than women's, so achieving the same smoothing frequently takes more units. Injectors also usually adjust placement rather than just the dose, aiming to soften lines while keeping the brow's natural, flatter male shape.
Avoiding alcohol and non-essential blood-thinning supplements such as high-dose fish oil, vitamin E or aspirin for a day or two beforehand reduces the chance of bruising at the injection sites. If you take a prescribed anticoagulant, don't stop it without checking with the doctor who prescribed it.
Confirm they're a licensed doctor, dentist or registered nurse prescriber under that country's rules, not a beautician, and that the clinic holds the relevant health authority registration for aesthetic treatments. Ask which brand of botulinum toxin they use and whether they'll show you the sealed box and batch number before injecting.
Not in the way a filler can be dissolved. Once botulinum toxin has bound to the nerve endings, nothing removes it, and the effect has to wear off as the nerves recover. This is why a conservative first dose is the usual advice.
The effect is temporary, and a heavy or uneven result normally eases over several weeks as movement returns. If the issue is an uneven brow or a small area that seems over-treated, a small adjustment at the two-week review can sometimes balance it. If a drooping eyelid is the problem, tell the clinic promptly, because there are eye drops that can help lift the lid for a short time while the toxin wears off.
Yes, flying does not interfere with the treatment, and there is no known reason to avoid air travel afterwards. The precautions that matter are the ones for the day itself: stay upright for four hours, avoid rubbing the treated areas, and skip strenuous exercise and alcohol.
Practical timing is a separate question. Because the effect builds over several days, you will not see the result on the journey home, and you will be away from the injector at the point a small top-up would normally be assessed. Many people plan treatment early in a stay, or arrange a review with a local provider who knows the product used. Take a note of the brand, the areas treated and the number of units, so any later injector has an accurate record.
Most people describe it as a series of brief pinpricks or stinging, with a mild pressure sensation, rather than real pain. The needles are very fine and the injections are small, so discomfort is usually short. Areas near the brow and the forehead tend to feel a little sharper than others, and some people are more sensitive than others.
Anaesthesia is not normally needed. If you are anxious or needle-sensitive, say so beforehand, because a numbing cream or a cold pack can reduce the sensation, and a calm injector will go at your pace. Aching can be felt in the treated area for a short time, and some people notice a mild tension headache afterwards, which fits with the risks already described on this page.
A small difference is not unusual in the first days, because toxin takes time to work and the muscles on each side may respond at slightly different speeds. Most faces are also naturally asymmetrical, and treatment can reveal a difference that was previously hidden.
Wait until the two-week mark before judging, as this is when the effect has settled and the injector can see the true pattern. If the difference persists, a few extra units on the side that is more active can usually even things out. Contact the clinic rather than seeking correction elsewhere straight away, since the original injector knows the dose and the points used. Heaviness of the brow or lid, double vision or difficulty moving the eye should be reported promptly.
Most injectors advise waiting at least about three months between full treatments, which fits the usual duration of the effect. Treating more often than that, or in higher doses, does not give a stronger result and may raise the chance of the body developing a reduced response. The exception is the small top-up at the two-week review, which is part of a planned first treatment.
If you notice movement returning earlier than expected, tell the injector rather than bringing the appointment forward. The cause may be a dose that was too light, a muscle that is particularly strong, or a change in the areas that you want treated. Lengthening the interval, rather than shortening it, is the more common pattern after years of regular treatment.
Rarely, yes. In a small number of people the immune system forms antibodies against the toxin, and the treatment gradually stops working. The risk is thought to increase with large doses and with treatments given very close together, which is another reason to keep the intervals sensible and the doses no higher than needed.
A reduced response is more often due to other causes: a dose that is too low, a poorly stored or incorrectly diluted product, or an area where the line is no longer caused by muscle movement alone. If the effect seems to be fading from one treatment to the next, discuss this with the injector. Switching to a different licensed brand is sometimes tried, but it is a decision for a doctor to make after reviewing your history.
It is possible, but the timing should be agreed with your surgeon rather than decided independently. After facial surgery the tissues need time to heal, swelling must settle and sensation returns gradually, and injecting too soon can make it harder to judge the result. Many surgeons suggest waiting until the healing is well advanced, which is often several weeks to a few months depending on the operation.
Toxin is sometimes used deliberately alongside surgery, for example to relax the muscles that pull on a scar or to refine the brow. In that case the surgeon or injector plans it as part of the overall treatment. Mention any previous surgery, including eyelid or brow operations, to your injector, because altered anatomy affects where and how much product is placed.
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