Botulinum Toxin (Botox)

Botulinum toxin is used in controlled doses to temporarily relax selected muscles. Common treatment areas include the forehead, frown lines and crow’s feet.

The substance temporarily blocks the signal from nerve to muscle, so the treated muscle contracts less and the overlying skin creases less. The effect is reversible: muscle activity returns gradually as the substance wears off. At Detalii Med in Baia Mare, treatment is carried out by Dr Greta Jurj, a specialist in dermatology and venereology working in aesthetic dermatology, and by the plastic surgeons Dr Marius Pruna and Dr Valeria Pruna.

It may suit adults concerned by dynamic wrinkles after assessment of expression, symmetry and eyebrow position.

Dynamic wrinkles are those that appear or deepen when frowning, raising the eyebrows or smiling. Treatment may also be considered when lines have started to remain visible at rest, to limit their progression.

It is not recommended during pregnancy and breastfeeding, where there is infection in the treatment area, or in people with certain neuromuscular conditions or a known allergy to the product’s components. Some medicines can influence the effect and are discussed at consultation.

It can soften movement-related lines and limit their progression. It does not fill deep folds, remove excess skin or replace surgery.

• It can: reduce horizontal forehead lines, vertical lines between the eyebrows and crow’s feet at the corners of the eyes, giving the face a more rested appearance.
• It cannot: restore lost volume, correct eyelids that droop because of excess skin or fully erase deep static lines, which may need complementary treatments agreed at consultation.

The doctor assesses expression at rest and in motion, medical history, current medication and any previous injectable treatments.

Eyebrow position and symmetry, the strength of the muscles involved and the way the patient habitually uses their expression are observed. The desired result is discussed, for example a subtle softening or more marked relaxation, along with what is realistic. The patient is asked about neurological conditions, medication, allergies and important upcoming events, so that the timing of treatment is chosen appropriately.

Small amounts are injected at precise anatomical points. Dose and distribution are personalised to achieve a balanced result and avoid unnecessary loss of expression.

The skin is cleansed, and the doctor may mark the injection points while asking the patient to contract the muscles. Injection is performed with a very fine needle, and a session usually takes 15–30 minutes. The patient can leave straight after treatment. Depending on the case, a follow-up visit may be scheduled at around two weeks, when the doctor assesses the effect and, if necessary, makes small adjustments.

General anaesthesia is not required; local cooling or topical anaesthetic may be used when needed.

Most patients describe the injections as a series of brief pricks that are generally well tolerated. Sensitivity varies from person to person and from area to area.

Small bumps, redness, tenderness or bruising can occur briefly. Instructions about exercise and handling of the area should be followed during the first hours.

Patients are usually advised not to lie down, rub or press on the treated area for the first few hours after treatment. Strenuous exercise, saunas and excessive heat are generally avoided until the following day. The small bumps at the injection sites usually settle quickly. Routine activities, including work, can be resumed the same day.

Possible unwanted effects include asymmetry, temporary eyelid or brow droop, headache and an insufficient response. Serious complications are uncommon.

• Local and temporary: redness, small bumps, tenderness, bruising.
• Related to the effect: eyebrow asymmetry, a feeling of heaviness in the forehead, temporary eyelid or brow droop, a weaker effect than intended.
• General: passing headache or, rarely, allergic reactions.

Unwanted effects related to the action of the substance generally improve as the effect wears off. Difficulty swallowing, speaking or breathing is very rare but requires immediate medical contact.

The effect develops over several days and settles at around two weeks. It is temporary and repeat treatment is planned individually.

As a guide, the effect usually lasts around three to four months, varying with the area, dose, muscle strength and metabolism. As movement returns, lines gradually reappear. The interval between sessions is agreed with the doctor, avoiding treatments repeated too often.

Botulinum toxin is an option for softening expression lines, with a temporary and reversible effect. A natural result depends on careful assessment of facial expression and doses tailored to each patient. At Detalii Med in Baia Mare, the indication, areas and doses are decided by the doctor at consultation.