Botulinum toxin. Trade names include Botox®, Vistabel®, Dysport® and Neurobloc®


To reduce the appearance of wrinkles on the forehead, between the brows and around the eyes. Experienced doctors and nurses also sometimes use botulinum toxin on wrinkles on the lower part of the face and neck, often in combination with dermal fillers.

The treatment:

Botulinum toxin is a prescription-only medicine which can only be prescribed by a doctor or dentist, and from 1 May 2006, Nurse Independent Prescribers are also able to prescribe Botox® and Vistabel® independently for a named patient during a face to face consultation. Prescribers may delegate the administration to a suitably qualified and competent other person.

Some brands of botulinum toxin - namely Botox®, Dysport® and Neurobloc® - are not licensed for cosmetic use. Medical, dental and nursing practitioners have a responsibility to explain that these medicines are not licensed for cosmetic use and ensuring that the patient understands this. One brand of botulinum toxin - Vistabel® - has been licensed for cosmetic use on glabellar lines. Glabellar lines are the vertical lines between the eyebrows. Vistabel® is produced by the same manufacturer and to the same formulation as Botox® and patients previously treated with Botox® may be offered future treatments with Vistabel®.

When you smile or frown, this is a result of a nerve signal from your brain to your muscles causing them to move. Botulinum toxin is a purified protein that blocks this signal from brain to the nerve endings. This means that when you laugh or frown, the overlying skin becomes smoother and unwrinkled while the untreated facial muscles work normally, and facial expressions are not affected.

Your skin will be cleaned and then small amounts of botulinum toxin will be injected into the area to be treated. You will be advised not to massage or rub the treated area and to treat it gently for 24 hours following treatment.

The results:

The area treated should appear smoother and with less wrinkles. Results are often visible by around 8 days, although it may take between 2- 3 weeks after the treatment for the full effects to be seen. The effects of botulinum toxin injections generally last for about three to four months, although the results can last longer with repeated treatments. Botulinum toxin may be less effective for people aged 60 and over because the muscles underlying the skin are not as firm.

The risks:

It is very hard to predict exactly how botulinum toxin injections will affect your muscles. You may therefore find that the results are not what you intended. Very occasionally patients who receive botulinum toxin injections in the forehead experience a drooping of the eyelids or eyebrows, although this is temporary and will resolve itself when the effects of botulinum toxin wear off. Rarely double vision or blurred vision can occur and you should seek medical attention if this happens to you. The risk of side effects following treatment is reduced by going to an experienced practitioner.

Before you start:

The effects of botulinum toxin injections are temporary. If you are looking for longer lasting solution, you may want to talk to your doctor, dentist or surgeon about alternative techniques. Botulinum toxin treatments should not be advertised to the general public - you should report any advertisements you see for Botox®, Vistabel® or Dysport® to the Medicines and Healthcare products Regulatory Agency (MHRA). MHRA contact details can be found on the useful links page.

Cosmetic surgery useful links

Also see:

Brow lift
Suture facelift
Upper and lower eyelid surgery
Dermal fillers

Procedure information is copyright Department of Health ( Reproduced under the terms of the Click-Use Licence.