Botulinum toxin: the complete data sheet

Botulinum toxin is the best-studied treatment in aesthetic medicine — and simultaneously the one surrounded by the most half-knowledge. This article works through the nine fields by which every treatment on this platform is described. It is deliberately sober and does not replace a medical consultation.

Mechanism of action

Botulinum toxin type A is a protein produced by the bacterium Clostridium botulinum. In medicine it is highly purified and used in very small, precisely measured quantities.

At the junction between nerve and muscle it cleaves a transport protein required for the release of the neurotransmitter acetylcholine. Without acetylcholine the signal does not reach the muscle — the muscle contracts more weakly. The skin above it is therefore folded less strongly.

The effect is time-limited. The body forms new nerve endings, signal transmission is restored, and muscle function returns completely. This is therefore not a permanent paralysis but a temporary weakening.

Indications

In aesthetics, use concerns primarily the upper third of the face:

• Frown lines between the eyebrows
• Horizontal forehead lines
• Crow's feet at the outer corners of the eyes

Alongside this there are numerous purely medical applications for which botulinum toxin holds regulatory approval — including excessive sweating, chronic migraine, muscle spasticity after stroke and teeth grinding.

Worth knowing: not every aesthetic application is covered by the approval. Treatments outside the approved indications are permissible but require explicit disclosure and consent.

Expected results

The effect is not immediate. First changes appear after roughly two to five days, the full result after about two weeks. Anyone disappointed after three days is judging too early.

The distinction between two types of line is decisive:

• Dynamic lines arise from muscle movement and are visible only during expression. These respond well.
• Static lines are visible with the face at rest and are etched into the skin. These improve considerably less — this is where the method reaches its limit.

Duration of effect

Usually three to four months. The range is individual: muscle strength, dose, treatment area, metabolism and physical activity all influence the course. With very strong musculature the effect may be shorter; with repeated treatment over years it is sometimes longer.

Risks

When applied competently the safety profile is considered good. Relevant risks should nevertheless be stated:

• Drooping eyelid or lowered brow — usually the result of diffusion into adjacent muscles; temporary, but it can persist for weeks
• Asymmetry — often correctable, occasionally only once the effect has worn off
• Unintended effect on neighbouring muscles with an altered facial expression
• Very rarely allergic reactions to components of the product

Contraindications include disorders of neuromuscular transmission such as myasthenia gravis or Lambert-Eaton syndrome, infection at the intended injection site, known intolerance, and pregnancy and breastfeeding.

Side effects

Common, harmless and quickly self-limiting: brief redness, small bruises and tenderness at the injection sites, occasionally headache or a feeling of tightness in the first few days.

Scientific evidence

The first description of aesthetic use on the glabellar frown lines dates from 1992 [1]. Numerous randomised, placebo-controlled trials have been conducted since; one of the registration trials for the glabellar region involved several hundred participants and demonstrated clear superiority over placebo [2]. Reviews confirm both efficacy and the generally favourable safety profile when applied appropriately [3][4].

Level of evidence: Strong

Typical costs

In Germany prices typically range from around 200 to 450 euros per treatment area. The range is wide and depends on region, practice, product used and the quantity required. This figure serves only as a rough orientation and is not a price recommendation.

One note for context: strikingly low prices are a warning sign. They may indicate excessive dilution, unsuitable products or insufficiently qualified practitioners.

Suitable — and unsuitable

Generally suitable for adults with movement-related lines, good general health and realistic expectations of the result.

Not suitable in disorders of neuromuscular transmission, during pregnancy and breastfeeding, with known intolerance to components of the product, and with infection in the intended treatment area. The method is likewise unsuitable where only deep static lines or volume loss are present — it does not then address the actual cause.

Assessment

Within aesthetic medicine, botulinum toxin is an unusually well-supported procedure. That says nothing, however, about whether a treatment makes sense in an individual case. That question depends on the findings, on expectations and on the qualification of the practitioner — and can only be resolved in person.

References

1. Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. Journal of Dermatologic Surgery and Oncology, 1992.
2. Carruthers JA, Lowe NJ, Menter MA, et al. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. Journal of the American Academy of Dermatology, 2002.
3. Nigam PK, Nigam A. Botulinum toxin. Indian Journal of Dermatology, 2010.
4. Witmanowski H, Błochowiak K. The whole truth about botulinum toxin — a review. Postępy Dermatologii i Alergologii, 2020.

Last reviewed: August 2026. Price figures are approximate and not guaranteed to be current.