What Botox® can do and what it can't

Botox® can smooth out expression lines

Botox® can make certain muscles stay relaxed. For example, the facial muscles responsible for expression lines. For instance, the "frown line" that is formed when the eyebrows are drawn together. If these muscles remain relaxed, this line smooths out instead of becoming even deeper.

So if the movement of muscles creates and deepens lines, Botox® can provide relief. This makes it the treatment of choice for expression lines.

Botox® can also alleviate chronic migraine and excessive sweating

Botox® is also used to treat chronic migraine and excessive sweating (hyperhidrosis). In the case of chronic migraine, Botox® can reduce the number of days when headaches occur each month. With hyperhidrosis, Botox® brings about significant improvements.

What Botox® can’t do

Botox® cannot fill out or plump up wrinkles. If wrinkles are not caused by muscle movements but by loss of skin tone, for example, Botox® treatment will not be effective. During our consultation prior to each Botox® treatment session, our doctors will precisely clarify this with you. If necessary, they will then recommend and expand upon alternative forms of treatment to Botox®.

Botox® against wrinkles

Botox® is extremely well suited to treating expression lines. These are lines that are formed and intensified by muscle movements in the face:

• Furrows (""worry lines")
• Lines between the eyebrows ("frown lines")
• Laughter lines around the eyes ("crow's feet")
• Wrinkles on both sides of the nose ("bunny lines")
• Certain wrinkles on the chin ("cobblestone lines" or "chin bossing")

By relaxing the specific muscles that cause the wrinkles, existing wrinkles are smoothed out. It also prevents them from deepening.

Botox® is also of particular interest for treating wrinkles caused by unconscious muscle movements. For example, when people frequently raise their brow or draw their eyebrows together while concentrating. Botox® treatment can minimize these unconscious, wrinkle-forming movements.

Not quite sure whether the wrinkles you would like to have treated are actually expression lines? Don't worry. At the practice of Dr. Timm Golüke, every Botox® treatment session is preceded by a detailed consultation. Here, one of our doctors clarifies with you which form of treatment is suitable for your skin and the result you desire.

Botox® against sweating

Specific Botox® treatment reduces excessive sweating, also known as hyperhidrosis. This works because the sweat glands are activated by small muscles. Botulinum toxin prevents these muscles from contracting. As a result, fewer sweat glands are activated, which means that less sweat is secreted.

How Botox® is used against hyperhidrosis
During hyperhidrosis treatment, Botox® is injected into the area where the sweat glands are located. The effect lasts for up to nine months and can be repeated as often as desired.

Important: before Botox® treatment, a doctor needs to have clarified that a case of primary hyperhidrosis is concerned – i.e. not the symptom of another disease.
We will discuss this with you and answer any questions you may have in a personal consultation.

Botox® against migraine

Botox® has been approved in Germany since 2011 for the preventive treatment of chronic migraine. Studies show that treatment with botulinum toxin can reduce the number of days on which headaches occur and the intensity of the pain. Under certain conditions, therefore, health insurance providers will cover the cost of treatment.

Why Botox® helps relieve chronic migraine
Unfortunately, the exact causes of migraine have not yet been conclusively established. What is known, however, is that during a migraine attack, muscles in the head, neck and shoulder area become very tense. This tension can lead to additional pain. Botox® helps in this case because it prevents or restricts the tightening of these muscles.

How Botox® is used to treat chronic migraine
Botulinum toxin is injected into the muscles in the forehead, head and neck. The effect lasts for about three months and can be repeated as often as desired.

In view of the intense level of discomfort and the many supposed miracle cures for migraine, we would like to emphasize one thing: Botox® unfortunately cannot cure chronic migraine. Nevertheless, it can help to alleviate the symptoms. We would be happy to explain this to you in more detail in a personal consultation and answer any questions you may have.

If you would like to read up on the subject in advance, we recommend reading the expert recommendation by the German migraine and headache society (Deutsche Migräne- und Kopfschmerzgesellschaft), "Therapy of chronic migraine with botulinum neurotoxin A" (in German only).

The side effects of Botox®

Botulinum toxins such as Botox® are among the most researched active agents in the world. When used responsibly, their side-effects profile is highly favorable. This is because the potential side effects are largely mild.
Since the human body produces botulinum toxin, they are also temporary. Long-term side effects of Botox® are unknown. However, botulinum toxin has been used in neurology for decades to treat muscle spasms in children and babies – in higher doses than for aesthetic use.

Possible side effects of Botox® include:

• Redness, swelling and bruising (haematoma) at the injection site
• Slight tightness around the treated areas on the face
• Transient headache after the treatment of worry lines on the forehead
• Hypersensitivity or allergic reaction (very rare)

If you experience other side effects or are unsure whether certain symptoms could be related to your Botox® treatment, simply get in contact with us.

Errors during Botox® treatment

From our perspective, two basic treatment errors can take place when using Botox® for aesthetic purposes: rigid facial expressions as a result of too high a dosage and undesirable effects caused by administering the injection in the wrong muscle. In the following, we will go into more detail and explain how we avoid these treatment errors.

Rigid facial expression and mask-like appearance due to too high a Botox® dosage

Depending on the dosage, botulinum toxin can completely or partially prevent the activation of a muscle. The higher the dose, the stronger the effect – and the more unnatural it looks. Hence, the typical mask-like rigid impression caused by early Botox® treatments due to the higher dosages of the active agent given at that time.
How do we avoid this error: in order to achieve particularly natural results, we at the practice of Dr. Timm Golüke carefully work our way up to the perfect Botox® dosage for you. We purposely use very low dosages during the initial treatment session. When the full effect has been achieved after two weeks, we check the results and inject a little more Botox® if necessary. This way, we achieve natural results which retain the full range of your facial expressions and makes you feel good all round.

Undesirable effects due to imprecise Botox® injections

The anatomy of the human face is complicated. A multitude of muscles are responsible for our facial expressions. It is therefore extremely important to determine precisely which muscle the injection should relax prior to the Botox® procedure. If Botox® gets into the wrong muscle, this can, for example, cause a drooping eyelid or sagging eyebrows for several weeks. These unwanted effects wear off as the Botox® is broken down by the body.
How we avoid this treatment error: as specialists in aesthetic and plastic surgery and dermatology, we have a thorough knowledge of the anatomy of the face and its muscles. Based on this knowledge, we carefully take the time to understand the interaction of the muscles in your individual facial expression. Only then do we determine the respective injection points for treatment with Botox®.
And if something were to go wrong anyway? The adverse effect would abate particularly quickly due to the low Botox® doses we use. Moreover, we would be able to take countermeasures with a balancing after-care treatment at the follow-up appointment.

Botox® or hyaluronan?

Botox® is extremely well suited for treating expression lines. In other words, wrinkles that are formed and made deeper by muscle movements in the face. What Botox® cannot do, however, is fill out wrinkles. In aesthetic medicine, wrinkles are injected with fillers such as hyaluronic acid tor this purpose.

Wrinkles that occur because the skin loses its elasticity – which Botox® can hardly influence – can also be treated with injections, e.g. with hyaluronic acid. These include, for example, drooping corners of the mouth or nasolabial folds.

Good to know: Botox® and hyaluronan can also be combined to treat deeply etched expression lines.

Is Botox® right for me?

Botox® is extremely well suited to people who wish to have the expression lines of their face treated. These are wrinkles that are formed and deepened by muscle movements in the face.

Facial expression lines that can be treated well with Botox® include:

• Furrows ("worry lines")
• Lines between the eyebrows ("frown lines")
• Laughter lines around the eyes ("crow's feet")
• Wrinkles on both sides of the nose ("bunny lines")
• Certain wrinkles on the chin ("cobblestone lines" or "chin bossing")

For whom is Botox® not right?

Used responsibly, botulinum toxin is a substance with very few side effects. Nevertheless, there are some people on whom we do not perform Botox® treatments.

We do not perform Botox® treatments on

• Pregnant and breastfeeding women
• People with a proven hypersensitivity to the components of the injection, e.g. to the protein albinum
• People with certain neurological diseases
• People suffering from facial inflammation
• People who have undergone recent treatment with antibiotics

We will be happy to discuss the reasons in more detail in a consultation and recommend suitable alternative treatments.

What course does my Botox® treatment take?

In order to obtain the best results, Botox® treatment at the practice of Dr. Timm Golüke takes place in three steps. You will be looked after by a specialist at every moment from the initial consultation to the actual Botox® treatment itself to the follow-up appointment.

Step 1: The Consultation

• We calmly explain to you the possibilities and limitations of treatment with Botox®.
• We clarify whether treatment with botulinum toxin is right for you and what results you can expect.
• We answer all your questions about Botox® and the treatment.
• You receive explanatory documents from us in writing.

Step 2: The day of treatment

• We determine exactly which facial muscles need to remain relaxed in the future.
• The corresponding areas are disinfected and injected with a low dose of Botox®.
• Usually the injection is not painful, but we are happy to apply a local anaesthetic cream if you wish.
• After the injection, we cool the treated areas to prevent swelling.
• Depending on the extent of treatment, the procedure takes 10 to 30 minutes.

Step 3: The follow-up appointment

• Botox® treatment at the practice of Dr. Timm Golüke includes a follow-up appointment after two weeks, when the full results of your treatment are visible.
• We check how well the low dose of Botox® has worked for you and how satisfied you are with the results.
• If necessary, we inject some more Botox® to achieve a perfect balance of effect and natural facial expression.

Is Botox® treatment painful?

No, because the hypodermic needles used are very thin, similar to those used for vaccination purposes.
You may feel a prick and/or a tiny amount of cool liquid flowing into the area.

If you are still afraid of experiencing pain or the injection, however, just let us know. And don't worry, you won't be the first or the last person to do so. We will then apply a local anaesthetic cream to the treatment area. The needle prick will no longer be a concern for you and you can sit back and enjoy a more relaxed appearance.

How soon will I see the results?

With Botox® against wrinkles

With expression lines, the effect of botulinum toxin sets in one to four days after treatment. The full result is visible after two weeks.
This is why we call you in for a follow-up appointment after the two weeks are up and check the results. If necessary, we intensify the effect with an additional Botox® injection.

With Botox® for chronic migraine

In the case of Botox® treatment for chronic migraine, the effect sets in after two or three days.

For Botox® against hyperhidrosis

Botulinum toxin usually starts to work to alleviate hyperhidrosis after two days. The full effect sets in after two weeks at the latest.

How long does the effect of my Botox® treatment last?

With Botox® against wrinkles

The effect of your Botox® treatment usually lasts for 4 to 6 months. Among other things, the exact duration depends on the dosage used and how quickly your body breaks down the botulinum toxin.
Botox® treatment can be repeated as often as you like. There is no habit forming effect. In fact, on the contrary: with time, leaving larger intervals between treatments often become possible.

With Botox® against chronic migraine

The effect usually lasts about three months and the Botox® treatment can be repeated as often as desired.
In the first year of treatment, 3-month intervals are usually the norm. In the following years, the interval can often be extended to four months.

With Botox® against hyperhidrosis

The effect of botulinum toxin against hyperhidrosis lasts up to 9 months. The procedure can be repeated as often as desired. A longer effect has been observed with repeated applications.

What should I consider before undergoing treatment with Botox®?

Blood-thinning medications such as aspirin promote the formation of haematomas at the injection site. You should therefore stop taking them 2 days before your Botox® treatment appointment.

Important: if you regularly take blood-thinning medication for medical reasons, please discuss this with your attending physician and also with us.

What should I pay attention to after treatment?

You will be immediately "presentable" after your Botox® treatment and will be able to resume your normal daily activities straight away.

Do not have a quick lie down and avoid anything that stimulates your blood circulation

On the day of treatment, the Botox® will still spread slightly under your skin. To stop it spreading incorrectly, we advise you

• Not to lie down for the first 1 to 4 hours after treatment.
• Avoid anything that promotes increased blood flow to the injected areas on the day of treatment: exercise, sauna, steam bath, sunbathing, solarium, lymphatic drainage and massage.

How often can I repeat my Botox® treatment?

Treatment with Botox® can be repeated as often as desired. This is because botulinum toxin is a protein and is broken down by the human organism over time. For this reason, the effect of Botox® wears off after several months – and can be refreshed by administering renewed injections.

By the way, with long-term use of Botox® there is no need to fear a habit-forming effect. On the contrary: the muscle inactivated by Botox® often "learns" to stay relaxed. The intervals between treatment sessions can then be extended.

No long-term negative effects of Botox® have been observed so far – although botulinum toxins are among the best-researched active substances in the world and are used, among other things, to treat muscle spasms in children and babies. The dosages are even higher for these treatments than for aesthetic applications.

Who is allowed to perform Botox® treatment?

Botulinum toxin is a prescription medication, which means that Botox® can only be administered by doctors.
In the practice of Dr. Timm Golüke, only specialists carry out Botox® treatment. We attach great importance to the fact that the success of our treatment is based on a sound scientific basis.

Botox® treatment that draws on specialist knowledge and extensive experience

Our scientific knowledge base primarily includes our detailed specialist knowledge of the anatomy of the face. For example, where blood vessels, nerve tracts and muscle cords are precisely located. Secondly, we believe that professional experience is also extremely important. This is because every face is unique and may well deviate from the textbook face. It takes experience to recognize this and successfully take it into account during treatment.

Please be aware that many decisive movements affecting human facial expressions take place in the millimeter range. It is the smallest changes that tell you whether a smile is friendly, sceptical or courageous. You should therefore choose very carefully who you allow to interfere with your sensitive facial expressions.