Botulinum Toxins

What are botulinum toxins?

As a consumer you probably know botulinum toxins through a brand name - Botox®. However, there are a number of brands which are licensed in the UK for cosmetic purposes: historically Azzalure®, Bocouture® and Botox®, and more recently Alluzience®, Letybo® and Nuceiva®. You may see other brands - Dysport® and Xeomin® - but these are licensed for non-cosmetic purposes.

Botulinum toxins are legally classified as prescription only medicines (POM), and this imposes important restrictions.

The procedure

1. 1Consultation and assessmentYour practitioner will explain the full procedure, take a medical history and perform a full assessment. Cosmetic procedures should take place in clinically safe environments, suitable for this type of treatment.
2. 2Targeting the musclesThey will identify the muscles causing the offending lines, or otherwise required to achieve the desired effects, and target these with a prescribed dose (determined by the prescriber, based on the licence listing of the Summary of Product Characteristics issued by the manufacturer), using multiple injections with a very fine needle. The injection points may not be where you would imagine, since your practitioner is targeting the muscles, not the lines.
3. 3Results developBotulinum toxins take several days to begin working, and up to 2 weeks to be fully effective.
4. 4Review and aftercareYour practitioner may wish to see you after 2 weeks to assess results and modify where necessary. Aftercare requirements will be fully explained to you.

Effects and benefits

Botulinum toxins are used to treat lines caused by the movement of muscles - expression lines, when the severity of the facial lines has an important psychological impact on you. Lines present only on expression will improve by limiting that expression; lines that remain when expression is relaxed may soften but may not resolve completely. Careful targeting of muscles can also achieve lifting, most commonly of the eyebrows.

Judicious use can achieve a softening of lines, gentle lifting and moderation (but not inhibition) of expression to achieve natural results, and patients report a ‘fresher’ more ‘awake’ look. Results typically last 3 to 4 months but may last less or more (up to six months), depending on the individual and toxin formulation used.

Risks and side-effects

This list is not exhaustive - consult your practitioner for full details of risks as they relate to you and the intended treatment. There are also contraindications to treatment (such as known hypersensitivity to botulinum toxin type A and myasthenia gravis, amongst others), so not all individuals may be suitable for it.

Weighing up risks and benefits

Tip: don’t consider the risks simply as a list - your practitioner should explain what they can do, and what you can do, to minimise these risks. Don’t consider the risks (or benefits) in isolation - your practitioner should work with you to weigh the risks against the benefits, and the decision should be an agreement between you.

Advertising

It is illegal to advertise a POM to members of the public. This includes all references to brand or generic names, in all forms of media (including social media), directly or indirectly i.e. by inference. As a patient you may choose a practitioner on the basis of a register like the JCCP’s and you may also be influenced by their advertising. Illegal advertising may limit your choice.

Consultation and the prescriber

It is a legal requirement that a POM is provided, subject to a prescription, by or as directed by a prescriber. For botulinum toxins, the prescriber is a doctor, dentist, nurse prescriber, allied health professional or pharmacist prescriber. The prescriber is responsible for:

Information sheet and standards

What training does a practitioner need?