Botox (Botulinum Toxin): A Complete Guide to Aesthetic and Medical Uses

Botulinum toxin, most commonly known by the brand name Botox, has one of the most fascinating histories in modern medicine. Once feared as a dangerous foodborne toxin, it is now one of the most widely used therapeutic and cosmetic injectables worldwide. What began in the late 1970s as an experimental treatment for eye muscle disorders is today approved in more than 100 countries, with millions of patients receiving injections every year.

Botox was first used to treat eye disorders? Its cosmetic effect was discovered by accident, when patients noticed fewer wrinkles around the eyes after treatment.

Botox is best known for smoothing wrinkles, but its uses go much further. In skilled hands, it can subtly lift brows, refine the jawline, balance a smile, reduce excessive sweating, prevent migraines, and even help patients with neurological disorders. For many, it’s not just about looking younger — it’s about looking fresher, feeling better, and preventing signs of aging before they fully appear.

What Is Botulinum Toxin and How Does It Work?

Botulinum toxin is a purified protein derived from the bacterium Clostridium botulinum. It blocks the release of acetylcholine, the neurotransmitter that triggers muscle contraction. Without this signal, the treated muscle relaxes for several months.

This effect is highly localized. It doesn’t spread through the body or affect overall muscle tone when injected correctly. The result: softened wrinkles, balanced movement, and targeted relief for conditions linked to muscle overactivity.

The Different Toxins: Botox, Dysport, Xeomin, and More

All botulinum toxins used in aesthetics are based on the same core molecule, but they differ in formulation, stability, and diffusion.

• Botox® (onabotulinumtoxinA) – The original and most studied. Approved for multiple medical and cosmetic indications.
• Dysport® (abobotulinumtoxinA) – Spreads more widely than Botox; sometimes preferred for broad forehead treatment.
• Xeomin® / Bocouture® (incobotulinumtoxinA) – “Naked” toxin with no complexing proteins, believed to lower the risk of antibody resistance. Stable at room temperature before reconstitution.
• Jeuveau® (prabotulinumtoxinA) – Marketed as “Newtox,” focused on cosmetic use.
• Innotox® – A liquid, ready-to-use toxin developed in Korea. Does not require refrigeration before injection.
• Coretox® – Protein-free formulation, also from Korea, designed for higher purity and reduced immunogenicity.

These differences are important for doctors more than patients. In practice, injector experience and technique matter far more than the brand.

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Preventive Botox: Starting Before Wrinkles Set In

Preventive Botox is increasingly popular among people in their late 20s and 30s. The idea is not to change appearance, but to slow the development of deep lines.

Every time you frown or squint, the skin creases. Over years, those creases become permanent. Botox relaxes the muscle activity just enough to reduce repetitive folding.

Preventive Botox uses very small doses, often called “Baby Botox,” placed in high-movement areas such as the frown lines, crow’s feet, or forehead. The result is natural — you still look expressive, but your skin ages more slowly.

Treating Deep Wrinkles: What Botox Can and Cannot Do

For wrinkles already etched into the skin, Botox cannot fill or erase them. What it can do is stop the constant movement that makes them worse and allow the skin to gradually smooth out.

In many patients, deep lines soften significantly after a few treatment cycles. For the most stubborn creases, Botox is often combined with fillers, chemical peels, or laser resurfacing to rebuild skin quality.

Advanced Botox Uses: Beyond the Forehead, Frown, and Eyes

While most people know Botox for the “three zones” (forehead, frown, crow’s feet), modern aesthetic practice goes far beyond this.

Brow Lift

By weakening the brow depressor muscles (corrugators and procerus), Botox allows the frontalis muscle to lift the brow tail slightly. This opens the eyes, reduces heaviness, and creates a fresher look. When done correctly, it’s subtle and natural.

The human face has over 40 muscles. Great injection technique is nothing without anatomy knowledge — which is why only doctors can inject Botox safely.

DAO (Depressor Anguli Oris)

The DAO pulls the corners of the mouth downward. Botox here reduces the downward pull, lifting the corners for a friendlier, more balanced smile.

Lip Flip

A few micro-units in the upper lip muscle relax tension, causing the lip to roll outward. The effect makes the upper lip look fuller when smiling. It’s especially useful for gummy smiles, but results last only six to eight weeks.

Cat Eyes / Fox Eyes

By relaxing the muscles that drag the brows downward at the outer corners, Botox can create a mild elongation and lift of the eye. Results are subtle and best suited for patients with naturally good brow position.

Platysma Bands / Nefertiti Lift

The platysma muscle in the neck pulls downward, causing vertical bands and early jowling. Botox weakens this pull, smoothing the neck and sharpening the jawline. When injected along the mandibular border, it is called the Nefertiti Lift.

Masseter Slimming

Large masseter muscles can make the jawline appear heavy. Botox gradually reduces their bulk, slimming the face into a softer V-shape. It also relieves bruxism (teeth grinding).

Nose Tip and Bunny Lines

Botox in the depressor septi nasi lifts a drooping nose tip, especially noticeable when smiling. Injections into the nasalis muscle soften “bunny lines” across the nose bridge.

Nostril Flare Control

‍Some patients naturally flare their nostrils when smiling or speaking, which can make the nose appear wider. Tiny doses of Botox placed into the dilator muscles of the nose can reduce this flare. The result is a more refined nasal contour during expression. Because the area is very delicate, this treatment must be performed conservatively to avoid affecting normal breathing or smile dynamics.

Chin Botox (Menton)

The chin (menton) is often overlooked, but the mentalis muscle can create dimpling, puckering, or an “orange peel” texture. Botox smooths the chin surface and improves lower-face balance, especially when combined with DAO injections. Careful dosing is essential — too much can cause heaviness or difficulty moving the lower lip.

Smoker’s Lines (Perioral Wrinkles)‍

Vertical lines around the mouth, often called “smoker’s lines” or “barcode wrinkles,” appear with age due to repetitive lip movement, sun damage, and collagen loss. Small doses of Botox can soften these lines by relaxing the orbicularis oris muscle.

• Result: a smoother upper lip area, with lipstick bleeding less into lines.
• Best for: mild to moderate lines; deeper creases may also need resurfacing (peels, laser) or fillers.
• Caution: over-treatment may make it difficult to purse the lips, whistle, or drink from a straw — so precise dosing is essential.

Barbie Botox (TrapTox)

Popularized on TikTok as “Barbie Botox,” this trend involves injecting the trapezius muscles at the base of the neck and shoulders. The goal is an elongated neckline and slimmer shoulders, mimicking a “Barbie doll” silhouette. While some patients request it for posture relief or tension, experts warn that purely aesthetic use carries risks — including muscle weakness, pain, or changes in shoulder function. It remains a controversial trend, and should only be considered for genuine medical reasons such as trapezius hypertrophy or chronic tension.

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Before Botox: How to Prepare

Proper preparation can reduce side effects and help your results look their best.

1–2 Weeks Before

• Avoid blood-thinning medication and supplements (unless medically required): aspirin, ibuprofen, vitamin E, fish oil, ginseng, garlic, ginkgo. These increase the risk of bruising.
• Limit alcohol in the days before, since it also raises bruising risk.
• Manage skin health: if you have a rash, active acne, or infection near the injection area, reschedule until your skin has healed.

24 Hours Before

• Avoid alcohol completely.
• Stay hydrated and keep your skin well-moisturized.
• Don’t plan other face treatments (peels, facials, microneedling) on the same day.

On the Day of Botox

• Arrive with a clean, makeup-free face.
• Expect your skin to be cleaned with antiseptic before injections.
• Ice may be applied to reduce discomfort and bruising.

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Post-Botox Protocol: Aftercare That Matters

How you care for your face after injections affects both results and longevity.

First 4 Hours

• Stay upright; don’t lie flat or bend deeply.
• Avoid touching or rubbing treated areas.
• No makeup or skincare around injection sites.
• Gentle movement (frowning, raising brows, smiling) can help the toxin settle.

First 24 Hours

• Avoid strenuous exercise, alcohol, or saunas.
• Sleep on your back if possible.
• Skip facials, masks, or massages.

First Week

• Be patient: full results show after 10–14 days.
• Don’t judge symmetry too early — muscles relax at different speeds.
• Delay other treatments like microneedling or peels.

Skincare and Devices

• SPF: Always recommended and safe the next day.
• Moisturizers/serums: Fine after 12–24 hours. Avoid acids and retinoids the first night.
• Microcurrent devices: Wait 7–10 days.
• Radiofrequency and ultrasound (RF, HIFU): Wait at least 2 weeks.
• LED masks: Safe immediately.

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Complications: Visual and Functional Side Effects of Botox

Bruising is the most common side effect of Botox. It happens in about one in four patients, usually fades within a few days, and can often be prevented by avoiding aspirin or alcohol before treatment.

Botox is considered very safe when performed by a qualified doctor, but no medical treatment is entirely risk-free. Most side effects are temporary and mild, though a few rare complications exist. Knowing what can happen — and how to prevent or correct it — helps patients feel informed and reassured.

Common and Short-Term Effects

• Bruising and swelling: Up to one in four patients notice small bruises, especially around the eyes. They usually fade within a few days. In rare cases, a larger hematoma may form if a vessel is hit.
  Prevention: avoid aspirin, ibuprofen, vitamin E, ginkgo, ginseng, or garlic supplements for 10–14 days before injections. Apply ice before and after treatment.
• Pain or stinging: Temporary discomfort at the injection site, minimized by fine needles, slow injection, and using reconstituted solution with preservative saline.
• Headache: Some patients experience mild headaches for a few days, occasionally up to two weeks. Usually relieved with paracetamol.
• Flu-like symptoms or tiredness: Rare but described in the first few days.
• Dry skin: A result of Botox reducing sweat gland activity in the area.

Visual and Aesthetic Complications

These effects are not dangerous but can be frustrating until they wear off:

• Eyelid droop (blepharoptosis): A heavy upper eyelid due to diffusion into the lifting muscle. Happens in 1–5% of patients, usually resolves in 2–4 weeks. Apraclonidine eye drops can help lift the lid temporarily.
• Brow heaviness: Over-relaxing the forehead without balancing the frown area can push brows downward. Usually wears off in 6–8 weeks.
• “Spock brow” (Mephisto sign): Over-arched outer brows caused by under-treating the lateral forehead. Corrected easily with a small touch-up.
• Asymmetric smile or mouth droop: If Botox diffuses into perioral muscles. Resolves naturally in 4–8 weeks but can feel socially uncomfortable.
• Under-eye puffiness: Seen in patients with skin laxity after crow’s feet injections. Usually fades in 4–6 weeks.
• Lip stiffness: After a lip flip, the upper lip may feel heavy, making it harder to whistle or sip from a straw. Lasts around a month.
• Masseter paradox effects: In rare cases, masseter injections can cause paradoxical bulging, hollowing of the cheeks, or difficulty opening the mouth. Prevented with careful mapping and balanced dosing.

Rare Functional Complications

Very rare, but worth mentioning for transparency:

• Double vision (diplopia): If Botox diffuses near the eye muscles. Documented in about 2% of crow’s feet treatments. Temporary but unsettling.
• Ectropion: Eyelid turning outward, mostly in older patients with lax skin.
• Lagophthalmos and dry eyes: Difficulty fully closing the eyelid after over-treatment around the eyes. Rare and usually temporary.
• Difficulty swallowing (dysphagia): Seen when large doses are injected into the neck or platysma. Dose-dependent and temporary.
• Generalized weakness: Extremely rare and usually linked to very high therapeutic doses, not cosmetic ones.
• Allergic reaction or anaphylaxis: Exceptionally rare but theoretically possible.
• Skin reactions: Rare psoriasiform rash has been reported; it resolves on its own.

Long-Term Safety and Resistance

Botox has been used for over 30 years with a strong safety record. However, long-term repeated high-dose use (mostly in neurological patients, not aesthetics) can lead to antibody formation and treatment resistance in up to 5–10% of cases.

Results last longer with regular use! When muscles are trained to relax, many patients notice their Botox lasting longer after repeated treatments.

The risk in cosmetic use is very low because doses are small. Products like Xeomin® and Coretox®, which are free of complexing proteins, may further reduce the chance of resistance developing. If resistance does occur, switching to another toxin type may restore effectiveness.

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Medical and Experimental Uses Beyond Aesthetics

Botox is not just cosmetic. It is approved for multiple medical conditions, including:

• Chronic migraine
• Hyperhidrosis (excessive sweating)
• Spasticity and dystonia
• Strabismus and blepharospasm
• Overactive bladder

Research also explores Botox for depression, joint pain, and inflammatory conditions, though these remain experimental.

Choosing a Qualified Injector

In Belgium and the EU, only licensed medical doctors may inject botulinum toxin. Still, training and experience matter greatly.

In Belgium, only licensed physicians are allowed to administer Botox. You can check if your injector is a medical doctor by verifying their INAMI number here. It’s a reliable way to confirm your injector is fully qualified.

Look for a doctor who:

• Is transparent about product brands and storage
• Has proven training in facial anatomy
• Provides natural-looking before/after results
• Offers clear aftercare and follow-up

Avoid non-medical injectors or suspiciously cheap offers. The skill of your injector is more important than the brand of toxin used.

Botox Prices in Belgium

The cost of Botox depends on the area treated and the amount used. On average, one dose or zone costs around €120.
A typical 3-zone treatment (forehead, frown, crow’s feet) usually ranges from €250 to €350.
Advanced areas like masseter, neck, or underarms may cost more due to higher dose requirements.

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