When administered by a medically qualified practitioner using a licensed product, botulinum toxin has an extraordinary safety record. In over thirty years of licensed cosmetic use, encompassing hundreds of millions of treatments worldwide, it has never caused a confirmed death in cosmetic use. Significant complications are rare and, in the vast majority of cases, temporary and manageable. We explain this more fully here.

A consultation is the most important part of the process. It allows us to take a full medical history, assess your facial anatomy, understand your goals, and determine whether treatment is appropriate for you. It is also where we discuss realistic expectations, potential risks, and obtain your informed consent. No responsible practitioner should treat without one.

The most commonly treated areas are the horizontal forehead lines, the frown lines between the brows (glabella), and the crow's feet around the eyes.

Other areas include the brow, the bunny lines on the nose, the lip lines, the chin, the jaw (for slimming or teeth grinding), the neck bands (Nefertiti lift), and the underarms for excessive sweating.

Most patients find the injections easily manageable. The needles used are very fine, and any discomfort is brief and localised. A topical anaesthetic cream can be applied beforehand for patients who are particularly sensitive.

At the Cosmetic Doctors Company in Esher, Surrey we routinely use an ice cube, briefly held on each treatment area, to reduce any discomfort to an absolute minimum. The procedure typically takes fifteen to twenty minutes and most people return to normal activities immediately afterwards.

This varies depending on the areas being treated. A typical treatment of just the frown lines would entail 5 injection points. A full 3-area treatment of horizontal forehead lines, frown lines and crow's feet might involve 15 to 20 injection points in total.

Although this might sound like a lot of injections, remember that the needles are very fine and the vast majority of our patients tolerate a Botox treatment very well and happily return for repeat treatments. Our doctors will determine the appropriate number and placement during your consultation and assessment.

Results gradually begin to appear over the first two to five days, with the full effect visible at around ten to fourteen days. The gradual onset is one of the reasons results look natural, the change develops subtly rather than suddenly appearing overnight.

Most patients find that results last between three and four months, though this varies between individuals. Factors including metabolism, the strength of the treated muscles, and the dose administered all influence duration.

With regular treatment over time, many patients find that results last progressively longer.

Side effects include temporary bruising, mild swelling, and very occasionally localised tenderness at the injection sites, all of which typically resolve within a few days. Although the majority of patients will experience no bruising or swelling, they remain a possibility.

Headache following treatment is occasionally reported and usually mild and short-lived. These are expected and manageable rather than serious concerns.

For the first few hours after treatment, avoid rubbing or massaging the treated areas, strenuous exercise, lying flat, and exposure to excessive heat such as saunas or sunbeds. These precautions will reduce the risk of bruising and rare risk of the product migrating beyond the intended area.

We recommend a follow-up appointment at 2~3 weeks following your first treatment. This allows us to ensure you are happy and make any minor adjustments if needed.

It is also an important opportunity to refine the treatment plan for future sessions based on how your muscles have responded.

Serious side effects in licensed cosmetic use are exceedingly rare. The most clinically significant is temporary ptosis, drooping of the eyelid, which resolves as the product wears off. Spread of toxin effects is recognised but very rare at cosmetic doses.

The key point is that serious complications are significantly more likely with unlicensed products or unqualified practitioners. Read our dedicated safety piece which covers this in detail.

Temporary drooping of the upper eyelid occurs when the product migrates slightly beyond the intended injection site and affects the muscle that lifts the lid.

It is uncommon, temporary, and preventable with correct injection technique and careful anatomical placement. It resolves completely as the product wears off, typically within two to six weeks.

It is a reasonable question, and one worth answering honestly. Botulinum toxin is indeed a potent biological substance but the licensed aesthetic product bears little resemblance to the raw toxin in terms of dose and clinical context.

The concentrations used in cosmetic treatment are minute, and the product has been used safely in medical practice since the 1980s. The word toxin describes its mechanism; it does not describe its risk profile when used as a licensed pharmaceutical. We cover this more fully in our blog post Should we worry about the “Tox” in Botox.

The frozen look is a consequence of over-treatment too much product, placed without sufficient regard for natural expression and movement. It is not an inevitable outcome of botulinum toxin treatment.

Used conservatively and with clinical precision, the result should be a softening of lines that leaves the face looking rested and animated rather than static. The goal is always natural expression, not its elimination. We look at the ‘frozen’ concern in our blog here.

Yes, most definitely. If treatment is delivered conservatively and by a practitioner who understands facial anatomy and prioritises natural results.

At the Cosmetic Doctors Company, the standard we work to is that friends and colleagues notice that you look refreshed and well, not that you have had something done. The best results are the ones nobody can point to. We very much adhere to the Why Less Is Now More approach.

Overdone results are almost always a consequence of excessive doses, inappropriate placement, or a practitioner who has not assessed the individual face carefully enough. There is also a perception paradox worth understanding, the results that attract attention are the ones that went wrong.

The vast majority of well-delivered treatments go entirely unnoticed, because looking natural is the whole point. Additionally, the ‘overdone’ look often attributed to Botox is frequently a combination of too much dermal filler, too much surgery added to some Botox.

With so many new treatments around, why does Botox still remain so popular? Because nothing else does what it does. Botulinum toxin is the only treatment that addresses the muscular component of facial ageing, the repeated contractions that drive the formation of expression lines over time.

Biostimulators address collagen and tissue quality. Fillers restore volume. Botulinum toxin relaxes the muscles that create lines. Each plays a different role, and botulinum toxin's role remains unique and irreplaceable in a comprehensive treatment plan. Read more about Why Wrinkle-Relaxing Injections Still Have a Role in Modern Aesthetic Medicine

We do not publish a fixed price list because treatment is never one-size-fits-all. The dose, the number of areas treated, and the complexity of the assessment all vary between patients.

Our Botox prices start at £295 and we are happy to provide a guide range when you get in touch, and all costs will be discussed clearly and in full before any treatment is agreed. No treatment will proceed without your fully informed consent.

Pricing varies for several reasons:

• the qualifications and experience of the practitioner,

• the quality and provenance of the product used,

• the clinical environment,

• the standard of the consultation and aftercare provided,

• And importantly the number of units of Botox used per treatment area. Bargain prices are frequently achieved by using only small doses of Botox. This likely will result in a less than optimum result and a short duration of action.

Very low prices frequently reflect compromises in one or more of these areas. The cheapest treatment is rarely the best value when it is being injected into your face.

Baby Botox refers to the use of very low doses of botulinum toxin to produce a very subtle softening of lines while preserving more natural movement. It suits patients who want minimal intervention, those new to treatment, or those with lighter expression patterns who do not require a full dose.

Although the principle is sound - conservative treatment that leaves room for natural animation can be a valid starting point. However, how long your Botox lasts is largely determined by the doses used. This means that Baby Botox never lasts for very long.

There is no single correct answer, it depends on the individual's facial movement patterns, skin quality, and goals. Some patients with strong, habitual expression lines benefit from beginning treatment in their late twenties or early thirties before those lines become established at rest.

Others are better served by waiting. A clinical assessment will determine which applies to you; age alone is never the deciding factor. Read At What Age Should You Start

For some patients, yes. Those with strong, habitual expression patterns, deep frown lines or forehead lines visible even in repose at a young age may genuinely benefit from early, conservative treatment.

For others, with lighter movement patterns and good skin quality, there is no compelling clinical case for starting early. A proper assessment will determine which applies. We discuss this in detail in our dedicated preventative treatment piece.

The Nefertiti lift uses precisely placed Botox to sharpen the jawline and soften the neck.

In the right patient, the results are quietly impressive; a sharper jawline, softer platysmal bands, a cleaner neck contour. None of this is dramatic, and it should not be. The goal, as always, is a result that looks like a better version of the patient rather than evidence of treatment.

For more information see our post Redefining the Jawline Without Surgery.

With consistent, conservative treatment over time, patients tend to develop fewer and less pronounced static lines in the treated areas, which is precisely the intended effect.

The face does not change character or lose its identity. What changes, gradually and coherently, is the accumulation of the lines that repeated expression would otherwise have produced. Used well, the result is a face that ages more gracefully.

The product wears off naturally and the treated muscles gradually return to their previous level of activity. Lines and wrinkles return to approximately how they would have looked without treatment, they do not become worse as a consequence of having had treatment.

There is no rebound effect, no dependency, and no lasting change from stopping.

Yes, this is the principle behind preventative botulinum toxin treatment. By reducing repetitive muscle movement before lines have become permanently established in the skin, treatment can slow or prevent the formation of static wrinkles in the treated areas. The evidence for this is clinically sound.

Whether it is appropriate for a specific individual depends on their movement patterns, skin quality, and age - not a one-size-fits-all recommendation.

Botulinum toxin addresses muscle activity rather than skin quality directly. However, by reducing the repetitive creasing of skin by overactive muscles, it slows the rate at which dynamic lines become established permanent creases. This has an indirect benefit on skin quality over time.

For direct improvement in skin texture, hydration, and collagen content, biostimulatory treatments and medical-grade skincare are more appropriate tools.

Botulinum toxin produces a temporary, targeted effect by relaxing specific muscles. Biostimulatory treatments, such as Sculptra, Profhilo, and polynucleotides work by stimulating the body's own collagen and elastin production, producing gradual improvements in skin quality and structure over months.

They address the biological processes of ageing rather than its immediate surface expressions. The two approaches are complementary rather than interchangeable.

Botulinum toxin relaxes muscles; it addresses the dynamic component of facial ageing, the lines produced by repeated expression. Dermal fillers add volume; they address the structural component, restoring the fullness that depletes with age.

The two treatments work on different tissues and at different depths, and they complement each other in a comprehensive treatment plan rather than competing.

Yes, in theory but probably not much difference in practice. Although all licensed brands contain botulinum toxin type A, they differ in their formulation and the units in which they are measured. In the UK the currently licensed brands, as of June 2026 are Botox, Azzalure, Bocouture, Alluzience, Letybo and Nuceiva.

The individual companies responsible for the manufacture, licensing and distribution of these six brands of ‘botulinum toxin type A’ each claim that their product has advantages in terms of efficacy and duration. Certainly, each has its own company funded, research evidence base and its own characteristics. However, we believe that they are all broadly comparable in clinical usage. At the Cosmetic Doctors Company we prefer Bocouture because of its, albeit theoretical, advantage in triggering less antibody response than some of the others.

In the UK, the regulatory position is more complicated than most patients realise. While the law requires botulinum toxin to be prescribed by a qualified prescriber, the administration of the treatment is not legally restricted to medically qualified practitioners in the way that many people assume.

This means that non-medical practitioners can legally administer it under a prescriber's authority, a situation we believe is inadequate for patient safety. We discuss this in detail in our blog post Can Anyone Perform Aesthetic Treatments in the UK ?

Definitely A No. A Botox party, in which treatments are administered in a social setting, with a glass or two of Prosecco, often by a non-medical practitioner, frequently without a proper individual consultation - fails to meet even the most basic standards of clinical care.

Botulinum toxin is a prescription medicine administered by injection. It requires individual clinical assessment, informed consent, appropriate facilities, and a practitioner capable of managing complications. A social setting provides none of these things.

You would be entitled to think, of course, our answer is at The Cosmetic Doctors Company, serving patients across Surrey and South-West London from our clinic in Esher.

Read why patients choose The Cosmetic Doctors Company.

Every treatment is performed by an experienced, medically qualified doctor, using licensed products, following a thorough consultation.

We would be delighted to hear from you.

A medically qualified doctor with specific training and experience in aesthetic medicine, a thorough understanding of facial anatomy, and the clinical background to assess suitability, obtain informed consent, and manage complications if they arise.

Qualification alone is not sufficient - experience, clinical judgement, and a genuine commitment to patient safety matter equally. These are the questions worth asking before choosing a practitioner.

Read how to choose a safe aesthetic practitioner.

Unlike hyaluronic acid fillers, botulinum toxin cannot be dissolved or immediately reversed. It wears off naturally over three to four months. Minor adjustments, adding a small amount of additional product to address asymmetry or under-treatment can be made at the two-week review.

This is one of the reasons a conservative approach at first treatment is always our preference; it is considerably easier to add than to take away.

It is worth noting that Botox continues to be the most popular aesthetic treatment world-wide and the vast majority of our first-time Botox patients like the result and continue with further treatments. However, patients can be reassured that Botox always completely wears off when left to its own devices. This progressively happen over a period of 3~4 months. Having completely worn off you will be left with your face exactly where it was before treatment.

Defintely Not.

Botulinum toxin is contraindicated during pregnancy and breastfeeding. While the risk of systemic absorption at cosmetic doses is exceptionally low, the absence of safety data in these populations means that treatment should not proceed. Any patient who is pregnant, trying to conceive, or breastfeeding should postpone treatment until this is no longer the case.

Yes. Neuromuscular conditions including myasthenia gravis, Lambert-Eaton syndrome, and motor neurone disease are absolute contraindications, as botulinum toxin may significantly worsen muscle weakness in these patients.

Certain other conditions and medications require careful consideration. This is one of the reasons a thorough medical history is an essential part of every consultation.

Blood-thinning medications and supplements including aspirin, ibuprofen, warfarin, fish oil, vitamin E, and certain herbal supplements may increase the risk of bruising at injection sites - but will not affect the action of Botox.

Where clinically safe to do so, we advise pausing these for a week before treatment.

Prescription anticoagulants should only be paused under medical guidance. Always disclose your full medication list at consultation.

The principles are the same, but male facial anatomy requires specific clinical consideration. Men typically have stronger, larger facial muscles, particularly in the frown and forehead and may require higher doses to achieve equivalent relaxation.

The aesthetic goals also differ - preserving a natural masculine expression and avoiding feminisation of the features requires careful assessment and precise placement. Experience with male facial anatomy specifically is important.

Yes, and very effectively.

Botulinum toxin injected into the skin of the underarm temporarily blocks the nerve signals that activate sweat glands, significantly reducing perspiration in the treated area.

Results typically last four to eight months. It is one of the most reliable non-surgical treatments available for axillary hyperhidrosis and can be genuinely life-changing for patients significantly affected by the condition.

We look at this further in a blog post.

Yes. Injecting botulinum toxin into the masseter muscles, the large jaw muscles responsible for chewing and grinding, reduces their activity and strength, alleviating the symptoms of bruxism and the associated jaw tension and headaches.

It also may produces a subtle slimming of the lower face in patients with significantly enlarged masseters. Results typically last three to six months and treatment can be repeated as needed.

This is an important question. Licensed botulinum toxin products should be supplied through regulated pharmaceutical supply chains and stored under appropriate refrigerated conditions. At our clinic, we use only licensed, pharmaceutical-grade products sourced through legitimate pharmaceutical supply channels.

If you are ever uncertain about the provenance of a product being used in your treatment, that uncertainty is itself a reason to reconsider the choice of provider.

Several questions matter.

• What are your medical qualifications?

• Are you registered with the GMC or another professional regulatory body?

• Do you carry professional indemnity insurance?

• What product will you be using and where is it sourced?

• What would you do if I developed a complication?

• How do I contact you out-of-hours or on a weekend if I have a problem ?

• What does the consultation involve?

A practitioner who answers all of these clearly and confidently is one worth trusting.

We explore this further in What Questions Should You Ask Before Your Aesthetic Treatment

A medical provider, a doctor, dentist, or nurse prescriber, has the training to take a full medical history, identify contraindications, prescribe the product themselves, and manage clinical complications if they arise. They are registered with a professional regulatory body and carry mandatory indemnity insurance.

A non-medical provider lacks these qualifications and the clinical safety framework that comes with them. In a treatment that involves the injection of a prescription medicine, that difference is not a minor one.

Two reasons. First, accuracy, Botox is a brand name, and other licensed products such as Dysport and Bocouture are equally valid treatments. Using the generic term is more precise. Second, regulatory guidance from the Advertising Standards Authority discourages the casual use of brand names in advertising in ways that could mislead. And in the UK, promotion of prescription-only licensed medicines direct to the public is prohibited.

Many clinics and practitioners therefore use "botulinum toxin" or "anti-wrinkle injections" as the more accurate and appropriate terminology.