What is botulinum toxin?
Botulinum toxin type A is a prescription medicine that has been used medically for more than three decades – originally in neurology and ophthalmology, and since the 1990s in aesthetic dermatology as well. It temporarily blocks signal transmission between nerve and muscle by inhibiting the release of the messenger substance acetylcholine at the motor end plate. The treated muscle relaxes and the skin above it smooths out. The effect is fully reversible: after a few months the connections are rebuilt.
Worth knowing: botulinum toxin does not fill in wrinkles. It works solely where lines are caused by muscle movement – so-called dynamic lines or expression lines. Static lines, which are visible even when the face is relaxed, we treat with hyaluronic acid or with laser procedures.
Treatment areas on the face
| Region | Effect | Usual units |
|---|---|---|
| Frown lines (glabella) Vertical lines between the eyebrows | Relaxes a stern, tired-looking expression | 16–24 IU |
| Forehead lines Horizontal lines across the forehead | Smooths without letting the brows drop | 6–16 IU |
| Crow's feet Laughter lines at the sides of the eyes | Opens up the eyes, keeps the natural smile | 16–24 IU |
| Bunny lines Fine lines on the bridge of the nose | Fine correction, often alongside the frown lines | 4–8 IU |
| Brow lift Chemical brow lift | Lifts the outer brow by 1–3 mm | 4–8 IU |
| Gummy smile Visible gums when smiling | Lowers the upper lip slightly when you laugh | 2–6 IU |
| Lip flip Border of the upper lip | Rolls the upper lip minimally outwards | 2–6 IU |
Medical applications
Beyond aesthetics, botulinum toxin is an established therapeutic agent. Three applications are covered in detail on their own pages:
- Hyperhidrosis – excessive sweating of the armpits, hands, feet or face. Injected into the armpits, botulinum toxin reduces sweat production by 80 to 90 per cent over six to nine months.
- Chronic migraine – as prophylaxis where there are at least 15 headache days a month.
- Bruxism – teeth grinding and jaw clenching, treated by relaxing the masseter muscle; often with relief of jaw joint symptoms as well.
These medically indicated treatments are usually covered by private health insurers; for patients with statutory health insurance they are self-pay services.
How the treatment works
1. Consultation and analysis. We look at your facial expressions in movement, discuss what you have in mind and decide together which muscle groups are to be treated – and which deliberately are not. Previous illnesses, medication and earlier treatments are recorded, and you receive a medical explanation of the procedure.
2. Injection. Using very fine needles (30–32 G) we place a small number of injections per area. The treatment takes 15 to 30 minutes and is usually easy to tolerate – an anaesthetic is generally not needed, and we can cool the area beforehand if you wish.
3. After the treatment. You are presentable again straight away; small raised bumps disappear within an hour. Stay upright for 4 hours, and for 24 hours avoid sport, sauna and sunbeds, and do not massage the area.
Onset and duration of effect
The effect sets in after three to seven days and reaches its maximum after about two weeks. With aesthetic treatments it lasts three to seven months on average, and with hyperhidrosis six to nine months. The duration is individual: sport, a fast metabolism and strongly developed musculature tend to shorten it. With regular repetition the intervals become longer for many patients, because the treated musculature recedes.
Risks, side effects and contraindications
In the hands of experienced doctors, botulinum toxin is regarded as very safe. Temporary reactions at the injection site are common: slight redness, small bruises, a feeling of pressure, occasionally headaches in the first few days.
We do not treat during pregnancy and breastfeeding, in neuromuscular conditions such as myasthenia gravis or Lambert-Eaton syndrome, where there is known hypersensitivity to the active substance, where there are infections in the injection area, or in certain clotting disorders. The concurrent use of aminoglycoside antibiotics is also relevant – please tell us about all the medication you take.
Fees
| Treatment | Fee |
|---|---|
| One zone (e.g. frown lines, forehead or crow's feet) | from €250 |
| Two zones | from €350 |
| Three zones (complete upper half of the face) | from €430 |
| Fine corrections (bunny lines, brow lift, lip flip) | from €150 |
Where the indication is aesthetic, botulinum toxin is a self-pay service. It is invoiced according to the German scale of medical fees (GOÄ). Where the indication is aesthetic and there is no medical necessity, the services are subject to VAT; all amounts are final prices including 19 % VAT.
Frequently asked questions
What does a botulinum toxin treatment cost in Frankfurt?
How long does botulinum toxin last?
When will I see the result?
Does the treatment hurt?
Will people be able to tell I have had treatment?
Can I go back to work straight afterwards?
From what age does treatment make sense?
Source: Fachinformationen der zugelassenen Botulinumtoxin-Typ-A-Präparate (summaries of product characteristics of the approved botulinum toxin type A products); Empfehlungen der Deutschen Gesellschaft für Ästhetische Botulinumtoxintherapie, DGBT (recommendations of the German Society for Aesthetic Botulinum Toxin Therapy); S1-Leitlinie "Definition und Therapie der primären Hyperhidrose" (German S1 guideline on the definition and treatment of primary hyperhidrosis; DDG)