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 Tweakments

Toxins

Toxins – or botulinum toxin A if you want to get technical – is one of the best-known drug names in the world. You’d be forgiven for thinking that toxins is the proper term for all wrinkle-relaxing injections, but it’s actually just one of a number of brands on the market. It is, however, the best-known brand of wrinkle-relaxing injections and the one most commonly used by practitioners. toxins is extremely popular in the aesthetics world due to its relatively cheap cost (compared to a surgical face-lift, for example), reliable results, minimal pain level, and the short time it takes to perform the procedure. Scroll down for all the toxins FAQs.

CATEGORY

Injectables

EXPECT TO PAY

£ 200 - 300

TWEAKMENT TIME

30 minutes

LONGEVITY

3 - 6 months

ANAESTHESIA

None

DOWNTIME

None

Find a Practitioner Near You


VIDEO GALLERY


FAQ ABOUT Toxins


Are toxins safe?

Let’s address the elephant in the room. As its full name suggests, toxins is a toxin. A nerve toxin, to be precise, that, let’s be honest, someone else is going to inject into your face. However, because of its toxic nature and widespread usage, there have been a lot of studies done to ensure its safety. It is widely accepted that, when administered by a skilled and responsible practitioner, you have nothing to fear.

How does toxins work?

The toxin interferes with the transmission of nerve impulses that tell muscles to contract. It does this by blocking the acetylcholine receptors in the muscle. It is injected into the muscles to soften the appearance of frown lines and other ‘dynamic’ wrinkles which form where we use facial muscles to make expressions. toxins reduces the ability of these muscles to contract, so it can soften frown lines, or lift downturned corners of the mouth. The product is injected into the muscles responsible for making these expressions, to weaken them for three-six months, which in turn will, for example, soften your frown lines, or lift downturned corners of the mouth.

What can toxins be used for?

There are so many ways in which toxins can be used, but some of the more common ones are:

  • The ‘eleven’ lines between the eyebrows.
  • Crow’s feet wrinkles at the sides of the eyes.
  • In the forehead, to soften horizontal lines
  • In the ‘bunny lines’, the horizontal wrinkle-lines at the top of the nose.
  • In the jaw, to reduce muscle clenching of the masseter, the main chewing muscle
  • In the chin, to relax a ‘cobblestone’ chin
  • Beneath the corners of the mouth, to reduce a habitual grumpy downturned-mouth expression.
  • In the upper lip, to reduce the lip retraction which makes a smile look ‘gummy’
  • In the neck, to soften a stringy-looking neck

For more uses, including toxins as a treatment for depression, download my full toxins factsheet.

Where can I get toxins?

toxins is a prescription-only drug, so has to be supplied by a medical professional who is qualified to prescribe — in the UK, that means a doctor, a surgeon, a dentist, or a nurse-prescriber (a qualified nurse who has taken a further course to become a non-medical prescriber). Prescribing pharmacists can also prescribe toxins, and many are taking training courses in injecting the toxin, too. The injections can legally be given by someone working under the supervision of that qualified professional, though the prescriber is the one who takes responsibility for the treatment. The makers of toxins – and the makers of other wrinkle-relaxing toxins such as Xeomin/BoCouture, and Dysport/Azzalure – are scrupulous about only supplying their products to medical professionals. Does that mean that the system is watertight? Unfortunately not. Unscrupulous practitioners find ways around the system, which is why it’s so important to make sure you choose a really good toxins practitioner.

In my full toxins factsheet, I go into more detail about finding a good practitioner.

How much does toxins cost?

This varies depending on how many areas you have treated, but expect to pay from £150 per area (the lines between the eyebrows is one ‘area’, the crow’s feet are another ‘area’, horizontal lines on the forehead are a third ‘area’) at a reputable clinic and £450 or more for a top practitioner. Bear in mind that prices at prestigious clinics at prestigious addresses, like Harley Street in London, will be higher than elsewhere.

Download my guide to toxins for an insider tip to keeping the cost down while still getting the best treatment.

How long does toxins take to work?

You’ll start seeing the effects take hold within a week and the treatment will reach full effect in 10-14 days. The procedure itself takes hardly any time. About 10 minutes if you’re getting one or two areas done. The initial consultation is a longer process (which is a good thing and one of the hallmarks of a good practitioner) so set aside an additional 30-40 minutes for your first time. All said and done, you’ll be in and out within an hour.

I would always recommend always booking in for a review two weeks after treatment, by which time the full effects of the treatment will be showing. That way, if you end up with, say, one eyebrow arching higher than the other, your practitioner can make a small adjustment to even things out. Most practitioners will not charge you for this review appointment, and you can always cancel it if you are happy with the way your face is settling down.

How long does toxins last?

toxins lasts from two to six months, depending on how much is used and the level of muscle activity in the area. A very light treatment with toxins, perhaps described as ‘baby toxins’ or a ‘microdose’ of toxins, will be wearing off after two months. An average treatment will last for three months. A stronger treatment of more toxin will give a more obvious result (i.e. it will pretty well stop all movement in the area where it is injected) but will last for five or six months.

What happens if I stop getting toxins?

After two to six months, the effects of toxins will be wearing off as the muscle develops more acetylcholine receptors to pick up signals from the nerves, and the muscles will fully recover their function. Amazingly, this is a reliably observed process that happens time after time, even with serial toxins fanatics. (More seriously, this effect has been studied over many years with patients who have repeated treatment with toxins treatment to control muscle spasticity . With this sort of treatment, much larger doses of toxins are used than in cosmetic treatment.)  The upside of this is that if there’s something you don’t like about the result then you can tell your practitioner and they can make sure to adjust your treatment accordingly. The downside, of course, is that this is a repeat cost that adds up over time.

Are there any side effects to toxins?

As with any injections, there can be bruising or bleeding at the injection site, but the main issues with toxins stem from over-treatment. Aesthetically, too much of it results in a frozen-looking face that can’t express emotion. If muscles are poleaxed with toxins for too long or too often and don’t get a chance to regain their full range of motion, they may begin to waste away through lack of use. Inexpert injecting can lead to drooping (ptosis) of the eyelid or brow, which will last until the effects of the toxin start to wear off — another good reason for starting with a low dose.

Download my guide to toxins for more information about side effects.

What are some alternatives to toxins?

Nothing will relax the muscles that create dynamic wrinkles in the way that botulinum toxins can. But if you don’t fancy it, there are many other approaches to try. You could:

  • Try other treatments that will reduce the appearance of lines by boosting collagen growth within the skin, such as microneedling, fractional laser treatment or Tixel.
  • Use stick-on patches that will remind you when you are frowning, such as frownies.co.uk. Relax your forehead and stick on a patch. When you frown, the patch will tweak at your face and remind you to relax your expression.
  • Try serums containing Argireline. This is a peptide that has a relaxing effect on dynamic wrinkle lines around the eyes. It will not have as marked an effect as toxins, but studies suggest that it can help, if used at a concentration of 10 per cent.
  • Use a night cream containing retinol. This will stimulate the growth of collagen within the skin and this will reduce the appearance of wrinkles.
  • Practise feeling serene. I’m not joking. Sit in front of a mirror, frown, and then work out how to actively relax your forehead. Practice that movement, along with an exhale.

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ASK ALICE

Alice answers your question. Want to ask Alice a question? Pop it in here and check back in a few days for the answer.


Hello Alice, hope you are keeping safe. From following your social accounts and reading your articles on the new treatments and best practitioners to go to, I wanted to know your opinion on Dr Mayou at the Cadogan Clinic for toxin and fillers?

Hiya, TTG editor Georgia here. Dr Mayou isn’t one of our listed practitioners so Alice and I aren’t able to recommend her as such, but she’s a well-known and experienced dermatologist and GMC-registered doctor, and The Cadogan Clinic is very reputable.

Hi Alice, I have been using Carita My CLE facial device which is a microcurrent plus LED device. I understood I should not use this on toxins-treated areas which makes sense as this would work against the effect of toxins. But what about after…

Hi, oddly enough, microcurrent devices work really well on faces treated with toxin - because the microcurrent helps keep muscle tone in the muscles while they aren't being worked by the usual facial expressions (toxin doesn't do anything to the muscles; it disables the neurotransmitters that send messages to the muscles to contract. So, microcurrent is not directly counteracting the treatment). All the device manufacturers suggest you wait for two weeks before using microcurrent after toxin injections, and the same after filler injections (after two weeks, the filler will be properly settled).

How do I get rid of downward lines on my forehead? Vertical at the sides of my face I think from squishing my face into the pillow at night. toxins? I have regular toxins for my frown lines on my forehead so I don’t appear to be cross when I’m…

If your practitioner says toxins won't work on these lines, maybe that is because they're being made by the way you sleep, as you suggest, rather than by muscle movement. It might be worth trying something simpler than tweakments, like the Dr Harris Anti-Wrinkle Sleep Mask, which looks like a normal sleep mask but has small silicone bumps on the inside that press on muscle receptors in the face to relax them (it's clinically proven to relax frown lines between the brows). These slight bumps are set in a pattern that goes over the eyebrows and around the sides of the eyes, and they grip the skin very gently and I find that these stop me from…

If I want multiple items – toxins, filler and Profhilo – but cost is an issue, what would the cost and results difference be between a great clinic like PHI in London and Skintique in Leicester?

The cost of procedures is less outside London; in terms of the results you'd get, what you really need to factor in is the skill and experience of your practitioner. They will discuss with you at consultation stage what your concerns are, what procedures would be beneficial for you, how much treatment you might need to move towards the outcomes that you're after. That way you can decide, with their help, where your tweakments budget is best spent. The practitioner is crucial in all this, and the lead doctors at both PHI Clinic (as well as Dr Manav Bawa and Dr Amanda Penny who run clinics at PHI) and Skintique are very good and are on my list…

Qualified nurse does my toxins in North West England. She said it costs her £120 to buy the amount that does 3 areas on me (crow's feet, frown lines & forehead). Is it too cheap to be real/ safe toxins? Im concerned after seeing your post on unsafe…

Hiya, editor Georgia here answering on Alice's behalf. This is a difficult question to answer as toxins is bought by the vial but priced for the consumer (you) by the unit (usually there are 100 or 200 units to a vial) or area – whichever way your practitioner chooses to price it. Unless your practitioner is offering it to you at cost price – meaning she wouldn't be making any money – I'd say £120 in total for the three areas you mention is cheap enough to raise alarms. Better to find a practitioner you trust than risk it. Enter your postcode into our Practitioner Finder to find someone reputable near you to visit instead. It's…

I think I have ‘pebble chin’ and was wondering what tweakment could help with this problem?

Hiya – editor Georgia here answering on Alice's behalf. It's the overuse of the muscles in the chin that causes this uneven 'pebbly' or orange-peel type texture. You can have a little bit of toxin injected to relax the muscles and give a more even skin texture.

Hi, I'm only 29 but am thinking of getting baby toxins to prevent fine lines and wrinkles. Is it unwise to start too early?

Hiya, editor Georgia here answering on Alice's behalf. While I'm sure it's not necessary for you yet, it's not at all unwise to start anti-wrinkle injections in your late twenties – in fact, preventative toxin has been clinically proven to stop imprinted lines (the ones that are still present when the face is at rest) settling in in later years. Alice actually made a video and wrote about this topic in December. 'Baby toxins' is a good approach at your age, too – a sprinkling of just enough toxin to soften and freshen. Just don't have too much or get it too often and keep in mind the financial investment that comes with starting at a…

Hi Alice, is there an age you’d say is too young for toxins? I’ve turned 28 and am considering it around eyes. Thank you!

Hiya, editor Georgia here answering on Alice's behalf. 28 is probably around the youngest age I'd advise having toxin, as long as you can afford it – bear in mind that if you like the results it will be an ongoing investment around every 3 months or so. It's also worth using a decent eye cream if you don't already, either before you decide to have toxins or alongside, as a good one really can make a difference to crow's feet, assuming that's what you're looking to treat. Here are some we recommend. Finally, as you're young, stick to a small amount so you don't inhibit too much expression around your eyes.…

I had toxins for the first time with an experienced dermatologist. It didn’t work so we did two top-ups, which also didn’t work. Then we tried two different brands but also didn’t work. Seems like I have antibodies. Any tips about where to…

It sounds like you are resistant to the drug, but this is really quite rare. Manufacturer clinical trials showed that no more than 1.5% of patients develop “neutralising antibodies”, and the figures are something like 1 in 10,000 that it doesn’t work for. Usually, if the treatment doesn’t work, it can be because of the dosage (not everyone’s the same, and some people need a higher dose) or the dilution of the product. But you say the practitioner was an experienced dermatologist. It’s hard to tell if you had all the treatments at the same clinic. It may be worth getting a second opinion, but you could be wasting your money if…

Hi, I am looking for practitioner recommendations – ideally for injectable moisturisers/ toxins in Buckinghamshire/ High Wycombe/ Aylesbury/ Beaconsfield area. I did put my postcode in the finder tool but it came up with just one option in…

Hiya, editor Georgia here answering on Alice's behalf. I tried this search again for you with an Aylesbury postcode and a 23 mile radius – here are the results. Hope that helps!

Please recommend a Dr or dermatologist that can deal with all skin and injectable issues in Manchester. I cannot find anyone please help!!! Thank you in advance.

Hiya, editor Georgia here answering on Alice's behalf. I put a central Manchester postcode into our practitioner finder and you can view the results here. Any of these practitioners should be able to help you.

Hi please can you tell me if you think 63 is too old to start toxins or fillers? I need something to make me look less grumpy around my mouth area.

Hi, what a great question but please, let me reassure you, you are never too old to start with toxins or fillers. Many practitioners have patients who are in their eighties or even nineties, who love the treatments and the benefits they see from them. Toxin and fillers are great for improving a grumpy-looking mouth. The toxin weakens the strength of the muscles that pull the mouth down, and the fillers can prop up the sides of the mouth just a little, or lift the cheeks a fraction which stops the lower face looking so saggy... so hop over to the practitioner section of the website, find someone in your area and have a consultation to see…

Good morning, will the NuFace help with platysma vertical bands on my neck?

Hi, much as I love the Nuface, its strength is for tightening and contouring the face. When you already have those tight platysmal bands on the neck, the best way to treat them is with injections of wrinkle-relaxing toxin eg toxins. These relax the muscles and soften the 'stringy' look - it's something I have done regularly. Take a look at my practitioner finder - these are all people I would trust with my neck!…

Hi Alice, how long after the Covid vaccination is it safe to have fillers/toxins?

Hi, most doctors advise waiting a couple of weeks after having the vaccination before having fillers (or, if you've had fillers, to wait a couple of weeks before having the jab). There are relatively few instances where having the vaccination causes an immune reaction that makes fillers swell temporarily  - but it can happen. With toxins or other wrinkle-relaxing toxins, the general advice is the same - to wait two weeks after having the vaccine.

Hi Alice, I've got what I would describe as an old lady chin - ie dimply, lined, irregular, not smooth. I can't see anything on your site that mentions this. Can you advise please?

Hi, what a great question -- and you're right, there's nothing specific on the site about it - perhaps I should add 'old-lady-chin' as a new concern as I think we all know what you mean. Start with some effective skincare (vitamin C serum, retinoids, sunscreen) to help with the surface condition and quality of your skin, and then... As for tweakments - I'd say my usual thing of getting yourself in front of a great practitioner (lots on the site, here's the link, you can search by postcode) and discussing it with them. Here are some things they might suggest. Wrinkle-relaxing injections eg toxins - which I like because they stop the…

toxins at Superdrug - Did you ever get a toxins treatment done at Superdrug and how did you find it? I am considering it but general feedback has been very negative (although not from people who have used clinics) because of it being a High Street…

I think that negative feedback is so unfair. Let me explain. I was sent by one of the papers to be the first person to get a toxins treatment at Superdrug  - and the only reason I didn't get the treatment was because they (quite rightly) turned me down because, working through the very detailed questionnaire that you have to fill in before treatment, they discovered I'd had a toxin treatment only two months before and they correctly insist there should be a three-month minimum gap between appointments. It maddens me that the feedback is so negative because Superdrug has done everything very correctly. They have partnered with the…

Nearly two weeks ago I had toxins for the first time. It was by someone local to me who had been recommended. I’m 49 and had it in my forehead. Unfortunately (and now I’ve seen lots of references to this online and in your book) it has lowered…

Your poor thing, huge sympathies, I completely understand how distressing this is. I would strongly suggest that you just leave well alone and let it wear off. Yes, technically a really skilled and experienced practitioner might be able to achieve some improvement – but the trouble is that the muscles that lift your eyebrows are already disabled for the time being, and nothing can change that. But hang on in there, your forehead muscles will regain their former movement. How long will it take? That depends on how much toxin the practitioner used, but your normal movement patterns should start to return between 6 weeks and three months.

MORE POSTS ON Toxins


5 places you didn’t know you could have toxin

We all know that botulinum toxin (the substance used for anti-wrinkle injections) is fantastic at smoothing lines and wrinkles caused by muscle movement and the ageing process, but there’s so much more to this wonder drug. And yes – it is a

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No! Not yet! Why Georgia wants toxins in her 20s, and why Alice wishes she wouldn’t

Georgia Seago, 29 I had my first toxins treatment this year, at 29. Will I do it again? Absolutely. I love what it did to my face. It made me a look fresher, a little smoother and softly lifted. The effects were subtle and probably undetectable to

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Toxin in your 20s – five things you need to know

Alice and I get asked about wrinkle-relaxing injections in your 20s fairly frequently. So, here are five things I’d want anyone in their 20s to consider before starting toxin treatment.

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Do you remember your first tweakment?

I certainly remember the first time I had toxins, about 20 years ago – because it wasn’t an unqualified success. I went, on my way in to work, to a very well-known practitioner who didn’t warn me that I’d be leaving his

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