Botulinum Toxin (Botox)
The stress of daily life, genetic factors, sun exposure, and most importantly, the facial expressions we have repeated over the years, leave permanent marks on our faces over time. The facial muscles that contract when we smile, show surprise, or get angry constantly fold the overlying skin tissue, leading to wrinkles that initially only appear in motion (dynamic) and eventually maintain their presence even when the face is resting (static). Botulinum Toxin (widely known among the public as Botox) applications, which are the most preferred, most reliable, and fastest-acting procedures in aesthetic and medical dermatology, are the gold standard treatment method for preventing the formation of these wrinkles and softening existing lines.
The perception of a “frozen, expressionless, and startled-looking” face, which was often formed with the influence of the media in past years, has completely changed thanks to modern medical approaches and advanced injection techniques (Baby Botox, Minimalist Approach). Today, our fundamental philosophy in the clinic is not to completely eliminate your facial expressions, but simply to soften excessive contractions to give you a rested, energetic, positive, and fresh appearance. Applied in the correct dosage and to the right anatomical points, botulinum toxin creates a smooth and bright skin texture where it is not externally obvious that a procedure has been performed.
What is Botulinum Toxin and How Does it Work?
Contrary to a common and false urban legend, botulinum toxin is absolutely not a snake venom. It is a natural protein complex obtained in a laboratory environment from a bacterium called Clostridium botulinum and purified with high technology. This molecule, which has been used safely for over 40 years in the fields of neurology, strabismus, and muscle diseases in medicine, has been the indispensable core of aesthetic medicine for the last 20 years.
Mechanism of Action: Botulinum toxin safely and temporarily blocks the release of a substance called “acetylcholine,” which provides communication between the muscles and nerve endings in the applied area. Due to this blockage, the target muscle’s ability to contract excessively is weakened. The skin over the muscle that does not contract—or contracts less—does not fold; thus, wrinkles are smoothed out, the skin becomes flawless, and the formation of new wrinkles (creasing of the skin) is prevented.
To Which Areas is Botulinum Toxin Applied? (Areas of Use)
In our clinic, botulinum toxin is used in a wide range not only for removing wrinkles due to aesthetic concerns but also for facial contouring and the treatment of certain functional disorders:
1. Upper Face Wrinkles (Classic Aesthetic Applications)
- Glabella (Frown) Lines: The treatment of vertical grooves, also known as “11 lines,” which cause you to have a frowning, angry, and tense appearance.
- Forehead Lines: The smoothing of horizontal lines that develop due to the expressions of surprise and raising eyebrows, making a person look older than they are.
- Crow’s Feet (Eye Contour): The erasure of radiating lines formed at the outer corners of the eyes when smiling, which appear at an early age due to the thinness of the skin.
- Brow Lift: By altering the balance of the muscles around the eyes, the outer part of the eyebrows is lifted by 1-2 millimeters; thus, the gaze becomes more open and attractive.
2. Lower Face and Neck Contouring
- Masseter (Jaw) Botox: Used in the treatment of patients with nighttime teeth grinding (bruxism) problems and in transforming a square/wide facial shape due to excessive chewing muscle enlargement into a “V” (Oval) form. It yields excellent results both medically and aesthetically.
- Nefertiti Lift (Neck and Jawline): The softening of vertical neck lines and the defining of the jaw contour by relaxing the platysma muscle that pulls the jawline downward.
- Gummy Smile: Transforming a condition where the upper gums show more than normal when smiling into an aesthetic smile by weakening the muscles that lift the upper lip.
- Bunny Lines: The treatment of wrinkles forming on the bridge of the nose during smiling or sniffing expressions.
3. Functional (Medical) Treatments
Hyperhidrosis (Excessive Sweating) Treatment: The process of completely stopping excessive sweating and unwanted odors for 6-8 months by blocking the nerves that stimulate the sweat glands in the armpits, palms, and soles of the feet.
Migraine Treatment: Greatly reducing the frequency and severity of pain in patients experiencing chronic migraine attacks with injections applied to specific trigger points in the head, neck, and shoulder regions.
Who is the Ideal Candidate? What is Preventative Botox?
In the past, it was believed that botulinum toxin applications should be done after the 40s, when wrinkles had deepened significantly. Today, the medical world has adopted the principle of the “Preventative Approach.”
Botulinum toxin applications started in micro-doses when lines are only visible while making facial expressions (late 20s, early 30s) prevent the skin from permanently “creasing” and static lines from forming. Once the lines deepen and leave a permanent mark on the skin (penetrating the tissue memory like a scar), toxin treatment alone is not enough; the underlying skin needs to be supported with dermal fillers. Therefore, any adult over the age of 18 who is in good general health, is not pregnant or breastfeeding, does not have a neuro-muscular disease, and wants to delay the signs of aging can safely undergo this procedure.
Comparative Table: The Difference Between Botulinum Toxin and Dermal Fillers
The two procedures most confused by patients applying to an aesthetic clinic are toxin and filler applications. To understand which procedure is suitable for you, you can examine the table below:
| Feature | Botulinum Toxin (Botox) | Dermal Fillers (Hyaluronic Acid) |
| Primary Function | Relaxes overactive muscles, prevents wrinkling | Fills volume losses, erases hollows, shapes |
| Type of Wrinkle Affected | Wrinkles formed by expressions (Dynamic) | Deep lines and hollows existing while stationary (Static) |
| Application Areas | Frown lines, forehead, crow’s feet, masseter, sweating | Lip augmentation, chin tip, cheeks, nose, under-eye light filler |
| Duration of Effect | Average 4 – 6 Months | 9 – 18 Months depending on the area used |
| Onset of Effect | Starts between the 3rd and 7th day, settles fully by the 14th day | Effect is seen instantly (Immediately) at the time of procedure |
Step-by-Step Treatment and Application Process
Botulinum toxin is known in aesthetic surgery as a “lunch-time procedure.” It is an extremely fast, practical process that does not interrupt the patient’s daily life.
1. Analysis and Design: During the consultation with our specialist physician, your facial muscles are exercised (you are asked to frown, smile, act surprised) to map out your facial expressions. By analyzing muscle strength, asymmetries, and your skin structure, a personalized injection plan and dosing are prepared for you. 2. Preparation: The procedure area is cleaned with antiseptic solutions. For our patients with a phobia of needles or a low pain threshold, local anesthetic creams are applied before the procedure and we wait for 10-15 minutes. 3. Injection Phase: Using special and very fine micro-needles (even thinner than an insulin needle), the toxin is injected into determined specific muscle points. The procedure time takes only 10 to 15 minutes depending on the area to be applied. The pain felt is at the level of a mosquito bite or a slight tingling. 4. Immediate Return After the Procedure: There may be tiny mosquito bite-like redness at the needle entry points after the application, but this completely disappears within 15-20 minutes. Immediately after the procedure, you can return to your work or social life right where you left off.
What Should Be Considered After the Application?
For the success of the procedure and to prevent the toxin from spreading to unwanted muscles, there are simple rules the patient must pay attention to for the first 24 hours:
- The head should not be tilted forward too much, and one should not lie flat on their back for the first 4 hours after the procedure.
- The injected areas should not be massaged, scratched harshly, or rubbed on that day.
- Heavy sports, tasks requiring excessive exertion, hot showers, hammams, and saunas should be avoided on the day of the procedure.
- Care should be taken not to apply makeup to the procedure area on the first day.
Frequently Asked Questions (FAQ)
You can quickly access answers to the most common questions and find detailed information about the treatment process here.
Will my face be expressionless (frozen) after getting Botox?
No. The frozen and expressionless “mask face” appearance occurs as a result of the toxin being applied to the wrong points and in much higher doses than necessary. In the modern (Baby Botox) approaches we apply in our clinic, the dosing is adjusted entirely according to your muscle strength. Your ability to show surprise, smile, and get angry is not lost; only the severe contractions that would wrinkle the skin are prevented. Your natural expression is preserved.
When does the effect of Botox start and how long does it last?
The effect of the procedure does not begin at the moment of injection. It takes a few days for the medication to bind to the nerve endings. The first effects are generally felt on the 3rd or 4th day, and the maximum feeling of tightness and smoothness fully settles on the 14th day. For this reason, your control appointment is scheduled for the 15th day. The duration of the effect varies between an average of 4 to 6 months depending on the person’s metabolism, muscle strength, and lifestyle.
Will my wrinkles be worse than before when the effect of Botox wears off?
This is one of the biggest misconceptions in the aesthetic world. When the duration of the effect (e.g., 5 months) expires, your muscles return completely to their former strength. Your wrinkles will never be worse than before; on the contrary, because your skin has not folded for 5 months, the aging process for that area has been paused, and the skin has been protected. If the procedure is not repeated, you will simply return to your starting point (your pre-procedure state).
Is there a benefit to having it done regularly?
Absolutely. When botulinum toxin applications are repeated regularly, the target muscles begin to “forget” that severe contraction, and the muscle mass shrinks slightly. Because of this, in subsequent applications, the effect duration of the procedure extends (can reach up to 6-8 months), and longer-lasting permanence is achieved with a smaller dose.
Do creams or "topical botox" products create the same effect?
No, they do not. Creams sold on the market as “having a botox effect” only superficially mask fine lines by moisturizing the top layer of the skin (epidermis). No cosmetic cream can penetrate the skin barrier, reach the muscle tissue, and stop the muscle from contracting. Permanent and true muscle relaxation is only possible through medical injection.
Op. Dr. Sena Genç Elden
Otolaryngologist (ENT Specialist)
Op. Dr. Sena Genç Elden, following her medical and residency training, completed Facial Plastic Surgery School and gained experience as a chief physician; she possesses national and international clinical expertise alongside world-renowned surgeons and currently continues her practice at her own private clinic in Serdivan, Sakarya.
Erase the Traces of Time, Reflect Your Natural Expression
Do not let the lines around your sparkling eyes when you smile, on your forehead, or between your eyebrows make you look more tired or stressed than you are. It is in your hands to give your skin that smooth, rested, and energetic touch it needs while preserving your facial expressions and character. To meet a “younger and fresher you” with a comfortable procedure taking just a few minutes, and to determine your personalized dosing plan tailored to your facial anatomy with our specialist physician, you can schedule your consultation appointment right away.
References and Scientific Basis
The transparency of the medical information provided in our clinic and patient safety are our highest priorities. This content has been prepared with reference to the scientific protocols of the most respected international organizations in the field of aesthetic and medical dermatology:
International Clinical Guidelines;
- Mayo Clinic: Botulinum Toxin (Botox) Injections – Purpose, Procedure, and Risks.
- American Society of Plastic Surgeons (ASPS): Botulinum Toxin Procedures and Effectiveness.
- Cleveland Clinic: Botox Injections (Botulinum Toxin Therapy) Overview.
Academic Publications (Surgeon Dr. Sena Genç Elden) ;
- Elden, S. G., et al. (2024). Diagnostic Value of the Video Head Impulse Test in Patients with Vertigo: Can It Be Used as a Screening Tool? ResearchGate
- Elden, S. G., & Güven, E. M. The Effect of Hypericum Perforatum L. (St. John’s Wort) on Prevention of Myringosclerosis After Myringotomy. ResearchGate
- Genç Elden, S., & Demir, D. Investigation of diclofenac sodium’s ototoxic and neurotoxic effects on the rat model. ResearchGate