Botulinum Toxin – Botox

Botulinum Toxin Treatment – How Does Botox Work?

Our botulinum toxin treatment is available for residents across the UK including Preston, Bolton, Lancaster, Burnley, Oldham and Bury. Botulinum toxin treatment, also known as Botox, is used to cosmetically remove wrinkles from the skin giving your skin a younger look. Our Botox treatment is one of our most popular treatments we have available and can be booked by contacting us today.

For The Following Treatments

  • Botulinum toxin A – Bocouture 50 units in 1.25ml unpreserved sodium chloride (0.09%) – 4 units per 10 gradations (Merz Aesthetics)
    Klein, Arnold W, Carruthers, Alstaings (2008)
  • Hyaluronic acid (Belotero intense) is isotonic sterile, viscoelastic injectable implant in 1ml glass syringe. It is cross linked sodium Hyaluronate non-animal origin 25.5mg 1ml phosphate buffer PH7

Client R.J.

  • 31 year old female, office manager at Salon
  • Worried regarding her facial ageing. Wrinkles in her glabella, forehead and crows feet area making her look older than her age
  • Requesting augmentation of her nasolabial folds – make up lumping in the nasolabial fold
  • Smoker
  • Uses sunbeds
  • Melatonin injections
  • In good health, on contraceptive pill, no allergy

Facial Assessment of Patient

  • Skin type – Fitzpatrick Phenotype Type IV
  • Glogau classification –
    • Wrinkles in motion type II
    • Soft tissue laxity is ideal for her age
    • Soft tissue active mobility range type III
  • Symmetrical facial lines
  • No Dermatochalasis – lax upper eyelid


Botulinum toxin type A was remarkably safe and effective in reducing glabella lines

Carruthers, Jean D, Lowe, Nicholas J (2003)

Combination therapy with Botulinum toxin A and Hyaluronic acid dermal fillers is superior to either modalities used alone

Carruthers A, Carruthers J, et al (2010)

Medical History Screening Form

Past Medical History

Diabetes, Hypertension, Asthma, Eczema, Epilepsy, myocardial infarction, Stroke, Transient Ischaemic Attack (mini stroke), Keloid formation, easy bruising, bleeding disorders, prolonged bleeding after dental extraction.


Aspirin, Warfarin, Aminoglycoside antibiotics – e.g. Gentamicin, Neomycin. Quinine, Calcium channel blockers – Diltiazem, Nifedipine or Verapamil. Non depolarising muscle relaxants, Contraceptive pill / HRT, Steroids.

Systemic Disorders

Liver (Jaundice) or kidney disease, Rheumatic fever, Heart valve surgery / Pulmonary shunt, Chorea.

Neurological Conditions

Bells palsy, Myasthenia gravis, Motor neurone disease, Multiple sclerosis, Lambert-Eaton syndrome.


Hepatitis B or C, Herpes simplex, Herpes zoster, TB, HIV, CJD.


  • Allergy to Penicillin, Latex, Local anaesthetic or General anaesthetic
  • Known allergy to Botulinum toxin, Fillers, Hyaluronic acid

Recent Exposure to Sunbed

  • In last 48 hours, increased risk of bruising/swelling/bleeding


  • Hypersensitivity/Allergy to the product
  • Autoimmune disease
  • Active Streptococcal infection
  • Active Herpes Simplex/Zoster
  • Predisposition to Keloid scarring
  • Pregnancy and Breast feeding
  • Younger than 18 years of age
  • Specific contraindication for botulinum toxin – Myasthenia Gravis and Dermatochalasis

Full Consultation Prior to Treatment

  • No guarantee of treatment outcomes
  • Cost of treatment
  • Consent
  • Complete client record
  • Photographs taken

Pre-Treatment Instructions

  • No guarantee of the outcome of treatment
  • Results may vary from person to person
  • Multiple treatments may be necessary
  • The treatment will not cure any underlying condition
  • Redness, bruising, blistering, swelling and discolouration may occur
  • Hyper, Hypo-pigmentation may occur
  • Possible infection and permanent scarring of the area may occur
  • Allergic reactions / anaphylaxis are rare but may occur

Preparation for Injection

  • All make up to be removed
  • Lidocaine 2.5% Prilcaine 2.5% (Emla)
  • Cream applied for half an hour to the local area of dermal fillers (naso labial fold)
  • Injected area cleaned with alcohol wipes
  • Aseptic precautions
  • Gloves

Product Dynamics

  • Concentration of Hyaluronic acid in each syringe
  • Degree of modification and cross linking
  • Product is monophasic (cohesive gel) Biphasic (Particulate)
  • The elastic modulus of a gel (G’) is a measure of its firmness and resistance to deformation when a force is applied. (Aesthetic medicine –Prendergast)
  • Do not inject Hyaluronic acid into blood vessels, bones, tendons or muscles
  • Do not inject to the periorbital region
  • Do not use in association with other aesthetic medicine techniques – peeling, dermabrasion, or laser treatment for about 2 weeks
  • Discard the syringe and remaining product

Aftercare Instructions

  • Botulinum toxin effect takes from 3-10 days. Full effect achieved in 2-3 weeks, lasts 3-5 months
  • Frown or tense the area for about 1 hour after treatment
  • Do not rub or touch the area for 3-4 hours
  • Avoid exercise for 3-4 hours
  • Avoid alcohol on the day
  • Avoid makeup for 1 hour. Gentle makeup for 24 hours
  • No facial treatment for 7 days after the Botulinum toxin
  • In care of any concern please ring Dr Motupalli on 07739705711


  • Can be treated with antiviral and antibiotics
  • Steroid cream
  • Surgical excision of granuloma
  • Lisa Christensen (2005) reported degradable gel causing granuloma formation
  • Avoid biofilm formation (bacteria implantation in the filler) by meticulous aseptic non-touch technique
  • Immunodulatory drugs such as Tacrolimus or cyclosporin for granuloma formation


  • Inflammation of the naso labial fold at the injection site
  • Possible Type I hypersensitivity reaction
  • Paul M Friedman (2002)
  • Treated with ice packs and hydrocortisone cream

Injection Techniques

  • Superficial droplet
  • Linear retrograde threading
  • Sandwich technique
  • Perpendicular buttress
  • Fanning
  • Cross hatching
  • Bridge technique
  • Depot
  • Push


  • Carruthers, Jean D. M.D.; Lowe, Nicolas J et al; for the botox glabellar lines II study group. Plastic and reconstructive surgery. Volue 112 – issue 4 – pp 1089-1098
  • Carruthers, A., Carruthers, J., Monheit, G.D., Davis, O.G and Tardie,G. (2010) Dermatological surgery
  • Friedman, P.M., Mafong, E.A.,Kauvar, A.N.B. and Geronemus, R.G. (2002), Safety Data of Injectable Nonanimal Stabilized Hyaluronic Acid Gel for Soft Tissue Augmentation. Dermatologic Surgery, 28: 491-494. doi: 10.1046/j.1524-4725.2002.01251.x
  • Lisa D Grunebaum, MD, Inja Bogdan Alleman, MD, Steven Dayan, MD, Stephen Mandy, MD, and Leslie Baumann, MD. The risk of alar necrosis associated with dermal filler injection. Dermatology surgery 2009; 35:1635-1640..


  • Norton.Neil S (2007). Netter’s head and neck anatomy for dentistry. 2nd ed. China: ELSEVIER. 1-653
  • A. Tosti et al. (2012). Management of complications of cosmetic procedures. London: Springer. 1-125.
  • Lumley.J.S.P (2008). Surface Anatomy. 4th ed. Philadelphia: Elsevier. 1-129.
  • Benedetto.A.V (2006). Botulinum toxins in clinical aesthetic practice. 2nd ed. London: Informa. 1-275.
  • Kumar, Abbas, Fausto, Aster (2010). Robin & Cotran Pathologic basis of disease. 8th ed. India: Elsevier. 1-1447.
  • Prendergast P, Shiffman M (2011). Aesthetic Medicine. London: Springer. 1-629.