Botox works by relaxing your facial muscles, but how does this affect your wrinkles? The reason is that your facial skin is attached to your facial muscles. Except when you are asleep (though some of my patients tell me that they also frown in their sleep!) these muscles are constantly in a state of dynamic tension and activity. This activity wrinkles the skin and can eventually cause quite deep lines, especially as we age and the skin loses its elasticity. Botox works by immobilizing the muscles of facial expression. It does this by blocking the action of the neurotransmitter called acetyl choline at the point where the nerves from your brain meet your facial muscles.
The Botox therefore only acts in your skin, it doesn’t have any systemic effects in the rest of your body at the dosage that is used for cosmetic treatment. The actual injection of the Botox causes some local redness and possibly some bruising if a vein or (unusually) a small artery is accidentally hit by the needles. The redness will subside within a few hours, but bruising can take considerably longer to dissipate, sometime a week or two if it is really deep.
After the injection the Botox binds to the acetyl choline receptors on the muscle end of the neuromuscular junction, thereby blocking the nerve transmission. This binding can take a few days to take effect, and so the full effect of the Botox treatment usually takes seven to ten days to reach its maximum. Thereafter the Botox is gradually metabolized and dissipated.
So what you will notice after the injection of your Botox is that the redness from the injection will fade, usually over a few hours, and after two or three days you will see a softening of your lines and wrinkles. Of course, this is based on the assumption that the treatment has been provided at the correct dosage and injected in the right place. The other assumption is that the wrinkles that you have are amenable to treatment with Botox. Some lines and wrinkles are too deep for Botox alone, and need additional filler treatment to make a really good cosmetic improvement.
Regular treatment with Botox has been shown to have a very beneficial cosmetic effect on treatment. In effect, it puts your skin into hibernation by taking away all the stress caused by the constant activity of the underlying facial muscles. The end result is that after years of treatment, people who have had regular Botox look significantly younger than those who haven’t had the benefit of Botox.
I was trained in London at the Royal Free Hospital School of Medicine. I qualified in 1982. I spent many years working as a consultant in paediatric medicine in Middlesbrough. I retired from the NHS in July 2010 and am now working as an aesthetic doctor. I am married and have two children, who are home educated.