BTX for Wrinkle Management

Botulinum toxin (BTX) is used extensively medically and even surgically (see MEDICAL INDICATIONS for Botulinum Toxin)

In fact, the original doses for the use of BTX injections around the eyes and on the forehead were developed by Dr Kate Coleman while she was working in the “BTX CLINIC” of the Royal Victoria Eye and Ear Hospital, in the 1980’s. This clinic provides BTX to treat conditions called Blepharospasm, facial dystonia and, Meigs Syndrome and we continue to run a similar clinic in Suite 22, led by Dr. Kate Coleman, where we offer injections of BTX for medical indications (patients are covered for these treatments by their health insurance plans). Dr Coleman also runs a clinic in Suite 22 for Facial Palsy patients, to offer BTX, fillers and (sometimes) eye lid surgery to ‘balance’ their faces, create symmetry and restore their confidence.

BTX a 150x150 BTX for Wrinkle Management BTX b 150x150 BTX for Wrinkle Management

“I first used BTX for wrinkle removal, in 1988, when I had a young patient with Bells’ Palsy and paralysis of the right side of her face. She was miserable and her condition was exacerbated by a twitching of her eye lid muscles, which we call blepharospasm, and which is common when new nerves grow to different muscles after a stroke/palsy of the face. She had responded well to my injections of BTX to stop the spasm, but the muscles on the normal side of her face had become hyperactive and she was getting extra wrinkles, emphasising her ‘lop sidedness’. I suddenly had a brainwave, and being used to doing my friends make up etc, understood the huge cosmetic importance of symmetry. I asked her to trust me, and suggested injecting BTX in to the normal side of her forehead and around her eyes. My hunch was, based on a medical principal called ‘Hering’s Reflex’, that this should not only even out the normal side, reducing overactivity, but ALSO channel some muscle effort to the paralysed side, even helping recovery.”


How does BTX get rid of my wrinkles?
BTX is injected through a microneedle into the area of your wrinkle. It seeps into the muscle /nerve junction (where the message goes from the body and along the nerve to tell the muscle to move). BTX blocks the release of Acetylcholine, the nerve messenger, from the end of the nerve. Some Acetylcholine is usually floating around in the nerve/muscle gap. This is why your injection of BTX will take 3-5 days to work, because the leftover Acetylcholine, which is floating around, can still stimulate your muscle until it is mopped up. Once the Acetylcholine is depleted, usually 3-5 days later, the muscle cannot turn on a contraction ( as if it were missing the light switch to light it). Meanwhile, the muscle starts to get lazy, from disuse, and diminishes, over the following few weeks. Finally, when new little nerves have sprouted (see photo) and can produce and release Acetylcholine to the muscle (usually 12 weeks later, depending on type of treatment), and the muscle starts to move again, it is actually weaker and lazier than before treatment.

What does this mean? Yes, it means that even with one treatment, you can reduce the wrinkle movements for much longer that the active phase of 12 weeks, because the muscle has been considerably weakened.
This is particularly useful for the frown muscles, because patients often notice that they ”break the habit’ of frowning during their treatment phase. They simply forget to frown.  We happily have never seen a patient who forgets how to smile!

Once Dr Coleman  has recommended BTX as the optimal treatment for your wrinkles, you will be given a micro injection (with an ultrafine needle) of various doses of BTX in various locations around your wrinkles. The BTX brands that we use do not sting (unlike a brand called Myobloc which we avoid). After you feel a small pinch, you will be asked to press your finger over the area and your doctor will move in succession, quickly, until your wrinkles have been surrounded with adequate BTX. It is extremely rare to get a bruise, although if you are taking blood thinners, such as Aspirin, Nurofen or Omega 3 supplements, you might notice more oozing.

The treatment takes a few minutes and you can resume full activity immediately (contrary to many myths about flying, exercise and so on). Since Dr Kate Coleman first gave BTX in 1988, she has never seen exercise or flight induced side effects!!

NB: we do like to avoid anything that could tamper with the concentration of your BTX at the muscle site. For example, another treatment could cause oedema (swelling) and flush your valuable dose away from the desired area. We have seen a patient whose treatment of BTX drifted to her lower face for a few days because it was given under a layer of recently injected filler. Our experts will advice you accordingly.


The appearance of frown lines and other areas treated will be dramatically improved within three to five days of treatment. The skin will appear smoother and unlined while untreated facial muscles work as usual to allow the normal facial expression to be unaffected by the treatment.

It can sometimes take 10-14 days for the nicest effect to take place, because weakening one muscle can affect the way the surrounding muscles will respond. Your doctor, trained by Dr. Kate Coleman, will know this and will plan the treatment locations accordingly. We usually review a new patient at two weeks, as patients may require a ‘top up’ treatment for which there is no charge. In our clinic,  we will listen carefully to your desires, but firmly believe that natural beauty is unbeatable and will strive to keep your face looking normal, as opposed to ‘frozen’, because we know how to.


Some minimal bruising may be experienced following treatment (very rarely) and you may have some red marks at the injection site that will last approx 15-30 minutes. You can apply makeup directly after treatment to the area. Occasionally a mild headache may be experienced, we believe because you often use new muscles for facial expression, especially your scalp muscles. (please tell our doctor if you are a migraine sufferer, BTX can offer long lasting relief).

How Often:

The effects of BTX injections can last three to four months if desired. After several treatments, the effects will begin to last longer and repeat treatments may be required less. Here we tailor the BTX treatments to our clients need. Treatment options include BTX, clinical BTX and BTX LITE. The latter involves finer doses in different locations in order to control the duration of paralysis. This is very effective for occasions, for example a six week result, and because the doses are lighter, it allows a different reduced price plan option for our patients budget .