Toxin Applications

Botulinum toxin, also known as Botox, is a procedure used to soften movement-related (dynamic) wrinkles by temporarily relaxing targeted expression muscles. Since the upper face — forehead, between the brows and around the eyes — is where facial expressions are most intense, it is the area where botulinum toxin is most commonly applied for aesthetic purposes. The goal is not to freeze expressions completely, but to soften lines while preserving a natural, rested look.

Botox, Dysport, Nabota and Bocouture are different brand products that essentially contain the same active ingredient (botulinum toxin type A). The physician decides which product to use, in which area, at what dose and with what plan, after evaluating facial anatomy, muscle strength and expectations.

What is it used for?

• Forehead lines: Softening the horizontal lines that form when raising the brows
• Between the brows (glabella): The vertical "frown" lines between the brows
• Around the eyes (crow's feet): Lines that appear at the corners of the eyes when smiling
• Brow shaping and a subtle brow lift: Balancing brow position and a slight upward look at the outer brow
• Nose bridge lines (bunny lines): Fine lines on the nose that form with expression

How is it performed?

Before the procedure, facial expressions are evaluated and injection points are planned. It is performed by a specialist physician using fine needles to inject very small amounts into the targeted muscles; the procedure takes a few minutes and usually requires no anesthesia. The effect does not appear immediately but begins gradually within a few days.

Results and duration

The effect usually begins to appear within 3-7 days and settles fully in about two weeks. Results are temporary; they last 3-6 months on average and the procedure can be repeated as the effect fades. It is fully reversible over time; with regular applications, lines may become less pronounced.

For a natural look

The aim is a balanced, natural result, not an expressionless face. Personalized dose and injection-point selection is important both for softening lines and for preserving expressions. For first-time patients, a more conservative start with a check-up two weeks later may be preferred.

Who is it not suitable for / precautions

It may not be suitable in cases such as certain neuromuscular diseases, active infection at the treatment site or a known allergy to the product. In the first hours after the procedure, it is advised not to massage the area and to avoid bending forward or lying down. For this reason, a specialist evaluation is always required before the procedure.

Important note

Botulinum toxin is a prescription medical product and should only be administered by a qualified physician under appropriate clinical conditions.

When does the effect start and how long does it last?

The effect usually begins a few days after the procedure and settles fully in about 10–14 days. Duration varies from person to person but is mostly in the 4–6 month range; with regular applications the effect may last longer. When the effect wears off, the muscles gradually return to their previous movement.

Before and after the procedure

• Blood-thinning medications and supplements used before the procedure should be reported to the physician
• For a few hours after the procedure, avoid bending forward and lying down
• Do not massage the area on the same day; avoid heavy exercise, sauna and Turkish bath

Why should planning be personalized?

In upper face toxin treatment, not only the points where lines are located but also brow height, eyelid structure, how much the forehead muscle supports the brow and right-left differences in expression are evaluated together. Applying the same dose to everyone can cause heaviness in the brows, excessive lifting or unnecessary stiffness in facial expression. Therefore, injection points, dose distribution and check-up timing are planned according to a dynamic examination of the face. For deepened lines that are also visible at rest, toxin alone may not always be sufficient; other procedures that support skin quality may be considered separately.

Treatment during breastfeeding

Botulinum toxin treatment during breastfeeding may be planned for some patients; however, the decision must be made on an individual basis. The drug is expected to act locally within the injected muscle, with limited passage into the systemic circulation. Nevertheless, for aesthetic procedures, the product's package insert, total dose, the mother's health status, the baby's age and concomitant medications should be evaluated together by the physician. Stopping breastfeeding, pumping or discarding milk should not be regarded as a routine rule; if such a need exists, it should be determined by the treating physician and, when necessary, a pediatrician. Further evaluation is required in the presence of infection at the injection site, a history of serious allergy to the product used, or certain neuromuscular diseases.

What is assessed at the follow-up visit?

Once the effect of botulinum toxin has fully settled, brow position, right-left symmetry, the degree to which expressions are preserved and the softening of lines are reassessed. If necessary, balancing can be done with very small doses; however, rather than applying unnecessary additional doses early on, the effect is allowed to settle. In subsequent sessions, the response to the previous treatment, its duration and the person's expectation of natural expression guide the new plan.

Frequently asked questions

Will my expressions disappear completely? No; with the right dose at the right points, the aim is not to freeze expressions but to soften excessive contraction. Natural expression is preserved.

Is the treatment addictive? No. When the effect wears off, the muscles return to their previous state; whether to continue is entirely a personal choice.

Hyperhidrosis is sweating far more than the body needs for temperature regulation. With effects such as damp clothing, hands that are hard to keep dry and social anxiety, it can negatively affect daily and working life, so it should not be viewed merely as a cosmetic problem. Botulinum toxin is one of the treatments with known efficacy, significantly reducing sweating by temporarily blocking the nerve signals that stimulate the sweat glands in the targeted area.

The distinction between primary (focal) type , which affects a specific area and usually starts at a young age, and secondary type , which develops due to an underlying condition or medication and may be more widespread, is important. For the right approach, the presence of an underlying cause is evaluated.

Which areas are treated?

• Underarms
• Palms
• Soles of the feet
• In some cases, the forehead and face

How is it performed?

It is applied to the targeted area with many small injections close to the skin surface. In sensitive areas such as the palms and soles, cooling or local numbing methods may be used for comfort. The procedure is brief.

Results and duration

The effect usually begins within a few days and, depending on the area, mostly lasts several months (often longer in the underarms). The procedure can be repeated as the effect fades.

Who is it suitable for / precautions

People with localized excessive sweating may be suitable candidates. In cases suggesting a secondary cause — sudden onset, one-sided, accompanied by night sweats, or generalized (whole-body) sweating — this cause must be investigated first.

Specialist evaluation

A dermatological evaluation is recommended for an accurate diagnosis (primary/secondary distinction) and appropriate area and dose planning. Before the procedure, the impact on daily life and previously tried methods are also reviewed.

When does the effect start and how long does it last?

The reduction in sweating is usually felt within the first week and reaches its best level within a few weeks. The effect mostly lasts 4–6 months; in some people it may last longer.

Impact on daily life

Excessive sweating is a condition that lowers quality of life and can affect daily life, from clothing choices to social settings and work. After treatment, many people report that concerns about clothing stains, handshakes and social situations are noticeably reduced.

How is the treatment plan personalized?

In treating excessive sweating, it is first assessed whether the sweating is truly localized and whether it points to another underlying cause. The injection density in the underarms, palms and soles varies according to the size of the sweating area and the symptom's impact on daily life. Especially in sensitive areas such as the palms and soles, pain control, dose distribution and preservation of muscle function are planned more carefully. The aim is not to eliminate sweating entirely, but to significantly reduce the excessive sweating that affects the person's social and daily life.

Treatment during breastfeeding

Botulinum toxin treatment for hyperhidrosis during breastfeeding may be performed in some cases. Since the treatment is performed with local injections, systemic exposure is expected to be low; nevertheless, the treatment area, the total dose to be used, the mother's concomitant conditions and the baby's age should be evaluated. Especially when treatment is being considered for medical necessity, the dermatologist can perform a benefit-risk assessment. Stopping breastfeeding or pumping and discarding milk should not be initiated on one's own. If unexpected muscle weakness, widespread fatigue or any other systemic symptom occurs after the procedure, a physician should be consulted.

How are follow-up and repeat treatment planned?

Once the reduction in sweating begins, how dry the area remains, comfort in daily life and any unevenly sweating areas are evaluated. In some people, the entire area may not respond equally; sweating that persists in a small area can be readdressed at the follow-up examination. When the effect diminishes over time, repeat treatment is planned according to the duration of the previous session and the level of comfort the person needs; a fixed schedule is not applied to everyone.

Frequently asked questions

Does sweating stop completely? The goal is to significantly reduce excessive and bothersome sweating; the body's temperature regulation and general sweating function are not impaired.

When is a sensible time to have it done? It can be performed at any time of year; planning it before summer is the most commonly preferred timing, as it increases comfort.

The masseter is the powerful chewing muscle located at the angle of the jaw. Botulinum toxin applied to this muscle can help reduce complaints caused by teeth clenching and grinding (bruxism). At the same time, by relaxing an overdeveloped masseter muscle, a pronounced jaw angle can be softened to achieve a more balanced and softer facial contour. This can provide a two-fold benefit, both medical (teeth clenching) and aesthetic (facial contour).

What is it used for?

• Muscle fatigue and jaw-face tension due to clenching/grinding
• Jaw stiffness that is more noticeable in the morning and a feeling of tension in the head and face
• Complaints due to overactivity of the chewing muscle
• Softening a pronounced/angular jawline (aesthetic)

How is it performed?

The muscle is assessed by hand while the patient clenches their teeth and injection points are determined. It is applied by a specialist physician at several points into the masseter muscle at the jaw angle; the procedure is brief.

Results and duration

Relief from teeth clenching usually begins to be felt within 1-2 weeks; the slimming of the facial contour becomes gradually noticeable over weeks as muscle volume decreases. The effect lasts 3-6 months on average and can be repeated; with regular applications, the muscle may become less powerful over time.

Who is it not suitable for / precautions

For problems originating from the teeth and the jaw joint (TMJ), joint evaluation with a dentist may be required; approaches such as a night guard may be added. In the first days, there may be a temporary feeling of fatigue when eating hard foods that require a lot of chewing.

Specialist evaluation

Evaluation is recommended to correctly identify the source of the complaint (bruxism, TMJ, stress, etc.) and for personalized dose and injection-point planning.

When does the effect start and how long does it last?

Relaxation of the jaw muscle is usually felt within 1–2 weeks; complaints related to teeth clenching begin to decrease during this period. In people with pronounced muscle volume, the slimming effect on the facial contour appears within 4–8 weeks. The effect mostly lasts 4–6 months.

Signs of teeth clenching (bruxism)

• Pain and fatigue in the jaw and facial muscles in the morning
• Headache in the temple area and tension around the ears
• Tooth wear, chipping and sensitivity
• Nighttime teeth grinding (often noticed by family members)

Jaw structure and teeth clenching are evaluated together

Masseter treatment does not aim solely at making the face look slimmer. Findings such as chewing muscle volume, tooth wear, morning jaw fatigue, jaw joint clicking or pain and night guard use are considered together. Because very high doses can cause an unnecessary reduction in chewing power or more slimming of the lower face than expected, the dose is adjusted according to the thickness of the muscle. In jaw joint disorders, bite problems or dental pain, toxin alone does not resolve the underlying cause; evaluation by a dentist or maxillofacial surgeon may be required.

Treatment during breastfeeding

Masseter botulinum toxin treatment during breastfeeding may be planned for some patients. Although significant passage into breast milk is considered unlikely because the treatment is local, the evaluation should separate aesthetic and functional purposes. If there is severe clenching, pain or jaw joint complaints, the benefit of treatment and possible uncertainties should be discussed by the physician. A standard approach should not be adopted without reviewing the product used, the total dose and concomitant medications. If a decision to pause breastfeeding is needed, it should be made only on the physician's recommendation.

What is monitored during follow-up?

After masseter treatment, not only facial slimming but also chewing comfort, morning jaw tension, changes in clenching complaints and the muscle balance between the two sides are monitored. Since the reduction in muscle volume develops gradually over weeks, very early additional dosing is not preferred. If necessary, small adjustments to preserve symmetry can be made at the next check-up, and a long-term plan can be created together with an accompanying night guard or dental treatments.

Frequently asked questions

Will my chewing function be affected? Daily chewing function is preserved; what is reduced is the muscle's excessive clenching power.

Does everyone get the face-slimming effect? The contouring effect is more visible in people with pronounced muscle volume; the main goal is to reduce teeth-clenching complaints.

Botulinum toxin is a treatment option used for preventive (prophylactic) purposes in chronic migraine, aiming to reduce the frequency and severity of attacks. It is applied to specific muscles in the head and neck according to a standard plan; it is thought to help suppress the overstimulation of pain-transmitting pathways. It is not a method that instantly relieves the pain of an attack ; it is a regular preventive treatment aimed at reducing the attack burden over time.

Chronic migraine is defined as headache on 15 or more days per month for at least three months, with a certain proportion of these days having migraine features. It is important that the diagnosis and suitability for treatment are established by a physician, particularly through a neurology evaluation.

Who may be suitable?

• People diagnosed with chronic migraine
• Patients who have not benefited sufficiently from other preventive treatments or who cannot use them
• Cases where attacks significantly affect daily life, work and social life

How is it performed?

It is applied with many small injections to designated areas such as the forehead, temples, back of the head and the neck-shoulder region, according to a standard protocol. The procedure is performed in an outpatient setting, takes a short time and usually requires no special preparation.

Results and duration

The effect is not immediate; a reduction in the number and severity of headache days usually begins to be noticed within weeks. Treatment is generally continued with sessions repeated approximately every 12 weeks, and the benefit is reported to become more pronounced as sessions progress. Response varies from person to person.

Who is it not suitable for / precautions

It may not be suitable in cases such as certain neuromuscular diseases, active infection at the treatment site or allergy to the product. Botulinum toxin is not the acute attack treatment for chronic migraine, nor the solution for every type of headache; therefore, an accurate diagnosis must be made first.

Specialist evaluation

It is recommended that the diagnosis of chronic migraine and suitability be evaluated and, when appropriate, that treatment be planned together with neurology. Botulinum toxin is a prescription medical product; it should only be administered by a qualified physician under appropriate conditions.

When does the effect start and how long does it last?

The preventive effect settles in the weeks following the treatment; the reduction in the frequency and severity of attacks is evaluated over time. The protocol is generally planned as treatments repeated at intervals of about 3 months.

Why is a neurology evaluation important?

This treatment is an option for suitable patients diagnosed with chronic migraine. Treatment is not planned without evaluating the type and frequency of the headache and the medications used; when necessary, it proceeds together with a neurology opinion.

How is treatment success monitored?

In chronic migraine treatment, the effectiveness of botulinum toxin is not judged solely by the relief felt on the day of the procedure. Monthly headache days, the number of migraine attacks, the frequency of painkiller use and daily functioning are monitored over several months. Keeping a regular headache diary helps determine whether the treatment is truly beneficial. The treatment is planned not to stop an acute attack at that moment, but as part of preventive therapy aimed at reducing attack frequency and severity in suitable patients. Reassessment is required if the type of headache changes or new neurological findings develop.

Treatment during breastfeeding

During breastfeeding, botulinum toxin treatment for chronic migraine may be performed with specialist evaluation if there is a clinical need. Here, unlike a purely aesthetic procedure, the decision is made by considering together the mother's pain burden, other migraine medications used, the baby's age and the effect on the mother of remaining untreated. Administering botulinum toxin by local injection limits systemic exposure; nevertheless, joint planning between the neurologist and the treating physician is appropriate. No standard rule should be applied regarding stopping breastfeeding or pumping and discarding milk; the physician's recommendation for the individual situation should be followed.

Which data matter during follow-up?

The benefit of treatment can be measured through a headache diary. Monthly migraine days, attack duration, pain severity, light and sound sensitivity, nausea, ability to continue working and changes in acute medication use are evaluated together. A partial response after the first treatment does not necessarily mean the treatment has failed; the neurologist evaluates the change over several treatment cycles together with its relationship to other preventive treatments.

Frequently asked questions

Will my pain go away completely? The aim is not to eliminate attacks entirely, but to improve quality of life by reducing their frequency, duration and severity.

Is a single treatment enough? More than one treatment cycle is usually recommended so that the effect can be properly evaluated.