Wrinkles and botulinum toxin

Botulinum toxin type A (Botox) is used to eliminate or reduce wrinkles in women and men so as to improve their appearance. The application of botulinum toxin is indicated when the wrinkles have a serious psychological impact on a patient. In the face we distinguish forehead lines in the brow and the glabellar lines in the area of the bridge of the nose which stand out in a frown and then crow’s feet around the eyes which are visible in a wide smile. Botulinum toxin therapy is very effective in the treatment of wrinkles and has been proven in the highest class clinical trials.


Botulinum toxin type A (Botox) is a drug that has a high safety profile and in the Czech Republic has been used for decades in a number of indications in neurology, physiotherapy, urology, surgery and cosmetics. For example, in neurology, which is the most important area, we use this drug in patients with spasticity after a stroke, patients with cervical dystonia, blepharospasm, facial hemispasm, other focal dystonias, and also, for example, for over 20 years in children with cerebral palsy.

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The application of botulinum toxin in the treatment of wrinkles occurs approximately once every four months, we use very thin needles and in the standard situation 44 units of Botox are administered. Each single injection usually consists of 4 units of Botox and a total of 11 injections are applied to the areas of the bridge of the nose, the eyebrows, the forehead and around the eyes. Be aware that botulinum toxin application must take place individually after a thorough medical examination and consultation between physician and patient from which the number of units, the target area on the face, and the number of application areas is decided.

Places most often applied in patients with wrinkles.

vrasky 1 vrasky 1a
vrasky 2 vrasky 2a

Before the first application the physician examines the patient, considers carefully his/her case history and if botulinum toxin is therapeutically indicated, the physician provides the patient with basic information about the medicine – how this therapy works and what the potential side effects are. The consultation mentioned above may take up a separate appointment with the physician. Subsequently, if the patient agrees to the treatment he/she signs the informed consent and the botulinum toxin may be applied. A clinical visit with botulinum toxin application lasts approximately 30 minutes or longer. The effect of botulinum toxin appears within 7 days and the check-up visit is performed approximately 1 month after the injection/s. At that time we anticipate the maximum effect of the botulinum toxin. If the botulinum toxin is efficient it could be applied repeatedly once every three months or less frequently without any limit to the number of applications in the future.

Important and useful information about the medication is mentioned below.

What to expect after the application of botulinum toxin:

The effect of botulinum toxin should appear on average 7 days after injection. The maximum effect, when botulinum toxin should be acting at full strength, is approximately one month after injection. The duration of the effect is from 3 to 4 months. However, each patient reacts individually which means that the effect’s onset might come anywhere from three to ten days after the injection/s and the duration of the effect may vary from two to six months. It also depends on the number of units applied. The more units applied the stronger the expected effect. On the other hand if the patient is ill (cold, flu or similar acute illness) at the time of application, the botulinum toxin might completely fail and there even exists the possibility that the ineffectiveness will develop. If botulinum toxin is properly indicated the majority of patients respond to the therapy very well. Patients satisfied with the treatment come for application repeatedly which is from approximately 2 to 4 times per year. If the first application does not work it is advisable to try one more treatment session. The reason is that the physician is initially very careful with the number of units and tends to administer the lowest possible dose. Thus it may happen that the second application will be successful. For the long-term indication of Botox therapy it must be of clear benefit to the patient in the treatment of his/her wrinkles.

Who may apply botulinum toxin:

It is highly advisable that the physician who applies botulinum toxin has had long-term experience with this substance. It is a very specific drug that requires a special approach and knowledge of both its application and the potential side effects. The physician who applies the botulinum toxin at our department has worked with this medication for over 10 years in various indications and in the therapy of a spectrum of diseases.

Informed consent:

The patient will have signed the informed consent before the first application of botulinum toxin. This is not mandatory in the health care system of the Czech Republic, but in our department it is the assurance that you have been properly educated about the medication and no relevant information has been omitted. Informed consent is focused on the basic information about botulinum toxin treatment and its side effects. An original copy of the informed consent remains in our medical documentation and a copy is given to the patient. Informed consent to botulinum toxin application >>>

Side effects of botulinum toxin:

Like any other drug botulinum toxin might sometimes show side effects (adverse events). Although the side effects of Botox develop very rarely and are often mild or negligible, it is however useful to keep them in mind. They are listed in the leaflet which is obligatory for each distributed drug in the Czech Republic. For Botox you can download this information from the website of SÚKL (Státní ústav pro kontrolu léčiv = State Institute for Drug Control) database (information is in Czech) or here on our website under the link SPC – botulinum toxin. At the same time we have the side effects of botulinum toxin listed in our Informed Consent here (information in English).

How can I obtain the application of botulinum toxin:

Make an appointment with us for a consultation. You can even make an appointment if you are not sure, and we will try to advise you as to whether to try its application or not.  (Email: neuro.km@gmail.com, Telephone number: 00 420 730 415 109)

How the botulinum toxin applications are covered :

Currently, applications of botulinum toxin are not covered by public health insurance and are fully paid for by the client. Application of a standard dose of botulinum toxin costs approximately 6200 CZK. For any further information please contact us by e-mail or telephone.  (Email: neuro.km@gmail.com, Telephone number: 00 420 730 415 109)