Not if it is dosed properly. A frozen result is a dosing decision, not an inevitable property of the drug — and it is not our house style.
Overview
For movement, not for loss
For lines your face makes when it moves. Used well, nobody can tell; used badly, everybody can.
Botulinum toxin temporarily reduces the contraction of the small muscles that fold the skin above them. Where a line is created by movement — frown lines, forehead lines, crow’s feet — softening that movement lets the skin above it settle and, over time, stop etching.
It does nothing for a line caused by volume loss or sun damage, which is why an honest assessment matters more than the injection itself. A great deal of disappointing treatment is toxin used on lines that were never going to respond to it.
Our house style is conservative. We would rather treat lightly, review at two weeks and add a little than produce a forehead that cannot move. Expression is not a side effect to be eliminated; it is most of what makes a face look like a person.
At a glance
- Treatment time15–20 minutes
- AnaestheticNone required
- DowntimeNone; small raised points settle within an hour
- SessionsRepeated every 3–4 months
- ResultsBegin at 3–5 days, full effect at 2 weeks
- Combines withFillers, bio-stimulation, resurfacing
How it works
Reduce the fold, let the skin settle
The toxin blocks the release of acetylcholine at the neuromuscular junction of the treated muscle, reducing its contraction until new nerve endings form. The duration is better established than almost anything else in aesthetic medicine: pooled across four trials and more than six hundred patients, the median was 120 days measured at full contraction and 131 days at rest — among those who had responded at one month, which was about five patients in six. Three to four months is the honest figure; “up to six months” is not.
The skin above stops being folded with every expression. Fine lines soften quickly; lines etched over decades improve across several cycles rather than one, and the data on this is unusually good — in a study following three consecutive treatments, 76 per cent of patients achieved complete resolution of their resting frown lines at some point, and 45 per cent held it through all three cycles. A quarter to a half of those who did not respond to the first treatment responded to the second or third. Response was best in patients with milder resting lines and declined with age.
Dose and placement are chosen for your anatomy, not a diagram. Muscle strength, brow position and the way you actually use your face all change where and how much is placed.
Indications
Suited to
- Frown lines between the brows
- Horizontal forehead lines
- Crow’s feet at the outer eye
- Bunny lines on the nose
- A downturned mouth or dimpled chin
- Platysmal bands in the neck
- Excessive underarm sweating
- A line that is present when the face is completely still and has no movement component
- Brow heaviness or hooding, where weakening the forehead makes it worse rather than better
- Myasthenia gravis and other disorders of neuromuscular transmission
- Pregnancy and breastfeeding
- A patient who wants expression removed rather than softened
In the clinic
Step by step
Assessment in movement
Your face is assessed at rest and through a full range of expression. What moves, and how much, determines the plan.
Injection
A series of small injections with a very fine needle. It takes minutes and needs no anaesthetic.
Immediately after
Small raised points settle within an hour. Avoid lying flat, heavy exercise and heat for the rest of the day.
Days three to five
The effect begins to appear.
Review at two weeks
Full effect. We would rather see you and add a small amount than have started too heavy.
Recovery
Downtime, honestly
The same day
Small blebs at the injection points settling within an hour, and occasionally a pinpoint bruise. Nothing prevents you returning to work directly.
The first few hours
Avoid lying flat, rubbing the area and heavy exercise. This is convention rather than something a trial has established, but it costs nothing.
Days three to seven
The effect begins. Asymmetry during this window is normal and is not a reason to come back yet.
Day fourteen
Maximum effect, and the correct moment to review. Anything that needs adjusting is adjusted now.
Months three to four
Movement returns gradually. Retreating sooner than three months adds nothing and is the one interval worth avoiding.
Risks
What can go wrong
Expected
Transient blebs, occasional small bruises, a mild headache in the first day or two.
Uncommon
Temporary asymmetry. Brow heaviness where the forehead has been treated too generously or too low. A dropped eyelid, which settles as the effect wears off but takes weeks to do so.
Rare but serious
Spread of effect beyond the intended muscle, producing weakness that was not wanted. Allergic reaction. Both are rare at the doses used for facial lines, and both are dose- and placement-dependent, which is the argument for conservative treatment reviewed at two weeks.
Evidence
What the evidence shows
Strong for movement, weak for skin qualityFor dynamic lines the evidence is among the best in this field: randomised, placebo-controlled, with a pooled duration figure and a documented progressive effect across repeated cycles.
For skin quality it is not. Intradermal or “micro” dosing is widely offered for pores, oiliness and texture, and the entire evidence base is ten studies and 153 participants, none of which reached the information size needed to be conclusive, with high risk of bias in assessment blinding in most. More tellingly, a split-face study that compared intradermal toxin against saline on the other side of the same face found improvement on both sides and no difference between them — the authors concluded the benefit came from the needling, not the toxin.
So we use it for movement. If the complaint is pore size, oiliness or surface quality, we will say that there are better-evidenced ways to address it.
If you are travelling
No travel implication at all. You can fly within the hour.
The only thing worth planning is the two-week review, which for international patients is done on photographs taken at home in consistent light.
If this is being combined with anything resurfacing, the toxin is usually given first and the resurfacing later, not the other way round.
Questions
Good to know
If your question is not here, ask it in the enquiry form — Dr. Henningsen answers these personally.
Ask a question- Will my face look frozen?
- How long does it last?
Typically three to four months. Regular treatment over years tends to extend the interval as the muscle deconditions and etched lines soften.
- Can it be used preventively?
There is reasonable logic to treating a line before it becomes etched, and it is a common reason younger patients seek treatment. It is a personal decision rather than a medical necessity, and we will say so.
- What are the risks?
Bruising, temporary asymmetry and, uncommonly, a heavy or drooping brow or eyelid if the product diffuses beyond the intended muscle. These are temporary. Injecting anatomy rather than a template is what keeps them rare.
Consultation
Ready to talk about your skin?
Consultations with Dr. Henningsen are arranged individually. Tell us what you would like to change and we will come back to you with the options, the honest downtime and the realistic result.