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Ask the Doctor: What should I expect when getting botox?

ExpertsPost Category - ExpertsExperts

As women age, we’re all prone to getting wrinkles and crow’s feet, no matter how diligently we stick to our beauty maintenance routines. As these ageing effects take place, many women are apt to look for different types of procedures that can reduce wrinkles and lift sagging skin. Botox is a well-known injectable product that softens wrinkles and ‘slims’ down wide faces. It’s one of the most popular aesthetic procedures worldwide, but is it for you?

The Basics of Botox

First, some technical background: Botox is actually a brand of boulinum toxin (BT), which is a neurotoxin produced by a bacteria and is responsible for botulism. In different countries, there are different forms and brands of botulinum toxin that are approved for human use. In Hong Kong, current approved ‘on-label’ indications for use of botox include the following:

  • Blepharospasm – excessive blinking
  • Strabismus – squints, ‘cross-eyes’
  • Cervical dystonia – spasmodic torticollis
  • Spasticity due to cerebral palsy
  • Upper limb spasticity associated with stroke
  • Axillary hyperhidrosis – excessive underarm sweating
  • Chronic migraine
  • Bladder over activity
  • Glabellar lines aka ‘frown lines’
  • Crow’s Feet or ‘laugh lines’ at the outer corners of the eyes
  • Forehead lines aka ‘railroad tracks’

The last three are the cosmetic categories, and probably the ones you’re most interested in! BT is often used for ‘facial slimming’ to achieve the coveted V-shaped facial contour that is very popular with Asians. When injected into the masseter muscle, it reduces in size, thus leading to a narrowing of the facial contour. Other cosmetic conditions treated with BT include the gummy smile, lip asymmetry, chin dimpling, jawline tightening (the ‘Nefertiti Lift’) and leg slimming. BT can also be blended with hyaluronic acids and other compounds to improve skin’s texture, pigmentation and hydration. New methods and technologies are constantly evolving.

As with all medications, there are warnings associated with the use of BT. For one, it can spread to other parts of the body, which can lead to muscle weakness, swallowing difficulties, pneumonia, speech disorders and breathing problems. BT is not recommended for anyone with hypersensitivity to any ingredient in the formulation of the product, patients with Myasthenia Gravis or Eaton Lambert Syndrome or patients with infection at injection sites. The duration of adverse reactions may last for several months or longer. BT should also be avoided during pregnancy and breastfeeding.


Botox Treatment

With all the formal medical information out of the way, let’s talk about what you would expect when receiving BT as a cosmetic facial treatment. Initially, you must consult with a medical doctor for the reasons stated above to rule out any related risks. After the initial consultation, a consent form summarising the relevant information will require your review and signature. Photos may or may not be taken for reference (You can refuse photography if you wish.) Check the consent form regarding the confidentiality of the photos unless you want to be surprised with your before and after photos ending up on the side of a bus, in a magazine or all over the internet!

Next, some practices will apply a numbing cream over the areas to be injected. Depending on the medication, the numbing effect starts in 10-25 minutes. Ice is an alternative used for numbing the skin, which is quick and readily available. I prefer individual, disposable ice packs because of hygiene and cross infection issues. There are nifty cooling devices available as well, but this varies from practice to practice.

Prior to injection, the skin must be sterilised. I like to use alcohol pads, again individually wrapped, disposable ones. The BT needles are usually small and injections are often multiple because the BT should be distributed to different areas.  As with any injection, there may be localised pain, tenderness and/or bruising. After the injections, ice can be applied for pain relief and to minimise bleeding.


It is recommended after BT to remain upright for at least four hours to minimize the migration of the BT. Do not rub or massage the area. You can move the treated areas to help increase the response of the targeted muscles. The weakening effect of BT gradually begins over the next 3-5 days and is completed over two weeks. During this time, there may be asymmetry or unevenness within the treated areas. Some patients may be less responsive or ‘resistant’ to the effects of BT. In these cases, effects and duration may be less than expected.

As with all beauty treatments, do some research, ask your friends and consider if this is what you want. In Hong Kong, registered medical doctors are forbidden to advertise, so word of mouth is the most dependable source. Find a reputable physician who does this often and well. If you find a doctor that does botox just the way you like it, I suggest keeping their contact information or getting on their private patient list.

See what the practice policy is for follow up and touch ups (in case of asymmetry or insufficient response). Start with less (smaller dosages) because you can always add more BT later, but you cannot remove BT once it has been injected and would have to wait until it gets out of your system after 4-6 months. While aesthetic medicine is not an exact science and results can’t be guaranteed, for some, botox can be the solution for younger, firmer skin!

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