Am I suitable for botulinum toxin:
who it suits, who should wait, and what is checked first

Is botulinum toxin suitable for my lines: dynamic or static?

Botulinum toxin is suitable when the line is made by a muscle. It reduces the nerve signal to a chosen muscle so the line that muscle makes is softened while the rest of the face keeps moving. That is why the first question at assessment is not how deep the line is but whether it is dynamic or static. A dynamic line appears on expression, between the brows when you frown, across the forehead when you raise the brows, at the outer eyes when you smile, and fades when the face is still. A static line is there in the mirror at rest, in a relaxed face, and has become a crease in the skin itself.

Dynamic lines respond to relaxing the muscle. Static lines do not disappear when the muscle is quietened, because the skin has already folded; they are a question for skin remodelling or, where volume has been lost beneath them, for a dermal filler. Many faces have both: a frown line that deepens on expression and leaves a faint crease at rest. Those are planned as two problems, and the botulinum toxin versus fillers comparison explains why one does not substitute for the other. The botulinum toxin page sets out every area treated; this page answers whether your own face qualifies.

Contouring follows the same logic. A square jaw from a bulky masseter is a muscle problem and suits the medicine; a wide jaw from bone does not, and the jaw slimming page explains how the two are told apart on clenching.

Why brow position and eyelid reserve decide suitability for the forehead

The frontalis is the only muscle that lifts the brows. Relaxing it softens horizontal forehead lines, and it also takes away whatever lift the forehead was providing. In a face where the brows sit comfortably above the bony rim of the eye socket and the upper lids are clear of the lashes, that trade is small. In a face where the forehead is quietly holding heavy lids open, it is not: relax the frontalis and the brow drops, the lid skin lands on the lashes and the eyes look smaller and more tired than before.

So before any forehead plan, the brow is checked against the bony rim and the upper lids are checked for skin that would fold onto the lashes once the frontalis stops helping. A person with a low brow or heavy lids is either dosed conservatively high on the forehead, has the frown complex treated at the same time so the brows are not pulled down, or is redirected to the lid altogether. Droop that comes from the lid muscle or from redundant skin is not a botulinum toxin problem and is referred to an oculoplastic or plastic surgery specialist for assessment. The forehead lines guide explains the anatomy in more detail.

Other anatomy read before a dose is set

• One brow habitually higher than the other, or lines deeper on one side: doses are adjusted side by side, not mirrored.
• Muscles that shape the smile sit next to targets such as the nasalis and the outer orbicularis, so placement matters more than dose there.
• A jaw that is bulkier on the chewing side is treated asymmetrically after examination on clenching.

“If the line is there at rest, reducing muscle movement will not remove it.”

Dr Sin YongOn dynamic versus static lines

Who should not have botulinum toxin, or should wait

Some findings mean the treatment is not offered at that time. Pregnancy and breastfeeding are the commonest: the medicine is not used during either, so a person planning a pregnancy is asked about timing. A neuromuscular disorder such as myasthenia gravis, Lambert-Eaton syndrome or a motor neurone disease is a reason not to treat, because a medicine that reduces nerve signalling to muscle is unsafe where that signalling is already impaired. A known allergy to a botulinum toxin product or to its components, including the human albumin used as a stabiliser, rules it out.

Other findings call for review rather than refusal. Medicines that affect neuromuscular transmission, including some antibiotics such as aminoglycosides and some muscle relaxants, are checked against the plan. Blood-thinning medicines and supplements such as fish oil make bruising more likely and are declared so the plan can be timed. Active infection or inflamed skin at an injection point is allowed to settle first. Because units are specific to each formulation and cannot be converted between brands, the record of any product used elsewhere, including the date and the areas, is asked for before a dose is set.

What is checked at the assessment before botulinum toxin

Photographs taken at rest show almost nothing in the upper face, so the examination is live. The face is examined at rest, on a full brow raise, in a frown, and with the eyes closed and then reopened. Which muscles are recruited, how strongly, and how high up the forehead they are active decide where small doses are placed and how much each point receives. The jaw is examined on clenching, and the neck on grimacing where platysmal bands are the complaint.

The medical history covers the conditions and medicines above, earlier treatment elsewhere, and what you want the result to look like. A goal that the medicine cannot meet, such as erasing static lines, adding volume or lifting loose skin, is said plainly at this stage, and the consultation process page describes how a written plan follows, including the areas, the formulation and the review. Dosing starts conservatively, so a follow-up is timed individually once the medicine has taken effect; that visit is when early asymmetry is balanced and the timing of any repeat is decided. Answers to the questions patients ask before booking are collected on the botulinum toxin questions page.

What is suggested when botulinum toxin is not the right fit

Being unsuitable for botulinum toxin usually means the line has a different cause, not that nothing can be done. A static crease at rest is a skin problem and is assessed for resurfacing or collagen stimulation; a fold that sits over a hollow is a volume problem and is assessed for a dermal filler. Loose skin along the jawline is a laxity problem, which belongs to the lifting cluster rather than to any injectable. Upper lids that droop from the lid muscle or from redundant skin are referred to an oculoplastic or plastic surgery specialist.

For someone who is pregnant or breastfeeding, the honest answer is to wait and to use the time for a skincare and sun-protection routine. For someone with a neuromuscular condition, the medicine is not revisited later; the alternatives for the line in question are discussed instead. The consultation can end with no treatment advised, which is a normal outcome.