Now Botulinum toxin is called as either Onabotulinum A(Botox), Incobotulinum A(Xeomin) or Abobotulinum A(Dysport), the Onabotulinum A(Botox) being the most commonly used. It is a safe, precise, potent and almost always effective drug which can be injected in very precise amounts at precise locations and depth to relax facial muscles in a desired manner to improve the appearance of the face.
Initially used as a standalone treatment, now it is almost always part of a composite rejuvenation procedure of the face.
Upper 1/3 of the face: It is the injectable of choice where it is used to smoothen the forehead wrinkles, the vertical frown lines and the dynamic crow’s feet. Also, it can be judiciously used to elevate the eyebrows which have descended due to ageing, or enhance/ modify the shape of the eyebrows.
Middle 1/3 of the face: It is used to treat scrunch lines and treat a gummy smile
Lower 1/3 of the face: It helps improve the upward riding of an ageing chin, helps shape the jawline by relaxing the platysma. Also, prominent square jaws in women because of a strong masseter, can be improved significantly by reducing the bulk of the muscle, leading to a more oval and longer face. Also, the nature of the smile can be changed to a pleasant and happy look.
Facial asymmetry can be balanced significantly by carefully assessing and planning injections of the toxin in the muscles of the unaffected side .
Mesobotox( described by Dr Woffles Wu) is now an established concept involving injection of small amounts of diluted Botox superficially in the skin. It is effective in giving a smooth appearance to the skin of the forehead , midface,chin and especially the neck by relaxing only the skin attachments of superficial muscles.
It also improves open pores by relaxing the erector pili muscles.
Botulinum toxin is very effective in the treatment of hyperhidrosis of the palms, underarms and soles of the feet.
The effect of the toxin starts appearing on the 3rd to 4th day the first time, and lasts for about 3-5 months, after which it has to be repeated.
Adverse effects are usually mild and reverse themselves by about 2 weeks to 2 months.

Dr Kuldeep Singh

Past President IAAPS

Senior Consultant

Dept of Aesthetic , Plastic & Reconstructive Surgery

Indraprastha Apollo Hospital , New Delhi and

Hony Senior Clinical Fellow

Postgraduate Institute , Faculty of Medicine

Anglia Ruskin University, UK