Cosmetic Medicine | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao

Botulinum toxin

Cosmetic Medicine - Botulinum toxin - Botulinum toxin

Botulinum toxin

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Botulinum Toxin is a treatment that consists of infiltrating into the skin a liquid which contains natural purified protein to eliminate expression lines. It is not a filler material, nor does it eliminate wrinkles through the provision of volume, but rather it acts on the muscles of the face by relaxing them, which enables the maintenance of a natural expression.
The infiltration of Botulinum Toxin is a safe treatment which does not require allergy testing.  In the USA, it has been used for years with exceptional results.  In our country, it has been used since the year 2000 with excellent results.
The doses administered are very low and do not accumulate over the years, in other words, our organism reabsorbs it and eliminates it through the kidneys.


Botulinum Toxin attenuates wrinkles produced by facial movement and mimicry such as crows’ feet, the horizontal lines on the forehead or those between the eyebrows.


The treatment is performed in the consulting rooms on an outpatient basis and does not require anaesthetic, as it is painless. It consists in introducing with a very fine needle some drops of the product into the skin, in a very superficial manner, in the area where there are facial expression lines such as between the eyebrows.
Immediately after the treatment no appreciable change can be observed and the patient’s everyday life can be resumed without any outward signs of having undergone the treatment.  Although it is not common, there is the possibility of slight bruising, which can be disguised with make-up and disappear in a few days.


Botulinum toxin type A when injected causes the relaxation of the muscles treated. Muscular relaxation erases wrinkles caused by muscular contraction.


Currently there are diverse commercial preparations with Botulinum Toxin in our country.
Your plastic surgeon will be able to advise you in relation to the suitability of one or other product, bearing in mind whether it is a medical or cosmetic treatment.


The results of the infiltration of Botulinum Toxin begin to be noticed between the third and fifth day and during the first 15 days the wrinkles progressively disappear. The rejuvenation is evident and facial expression remains more relaxed.
During the first year, the treatment is performed every 4 months and from the second year one application every 6 months is sufficient.


As a cosmetic treatment, it can be used for the temporary improvement in the appearance of vertical lines of moderate to severe intensity, between the eyebrows when frowning, in adults under the age of 65, when the severity of these lines has a significant impact on the patient.  Similarly for wrinkles/creases on the forehead, as well as to relax excessive traction of the brows downwards (something which occurs with the passage of time) or to relax the area of crow’s feet.
In select cases, it can attenuate the barcode of lines on the top lip, lifting the labial angles.
On the neck, in certain cases, it can be used to attenuate the imprint of the platysma muscle (bands on the neck which appear with age).
The medical application of botulinum toxin is: for muscular spasm (for example in blepharospasm), spasticity, hiperhidrosis or migraine.
The treatment benefits all those who use it.  It is ideal for people with incipient wrinkles and very satisfactory results can be obtained in people with already established wrinkles.


The use of Vistabel- Botox does not require an allergy test.  The treatment is contraindicated in people who are allergic to egg protein, or people with neuromuscular diseases such as myasthenia gravis or myopathies or in situations of pregnancy or breastfeeding.
Given that the treatment is administered through the injection of a small quantity of the product with a very fine needle, it is advisable to refrain from taking aspirin or anti-inflammatory medication during the three days prior to the procedure for the purposes of avoiding the appearance of bruising in the injection sites.


It is a treatment applied in the consulting rooms.  The application takes approximately 15-20 minutes.  The effects begin to be noticed after 48-72 hours and a maximum of 10 days.  Towards the 15th day after application a follow-up appointment is advisable to evaluate whether retouching is required.
During 12-16 weeks, the effect obtained is maintained and from that moment on a slight muscular movement resumes which becomes more evident at 6 months, moment at which a new treatment can be performed.


Between the 4-6 hours subsequent to its application it is advisable to:
- Avoid any pressure on the areas in which the treatment has been performed in order to avoid the diffusion of the product to other muscular areas.  This is why it is important to bear in mind that you cannot wear a motorbike helmet or a headband.
- It is advisable to avoid laying the head down or to the side in the hours after the treatment.
- It is very advisable to try to gesticulate in the 4 hours following the injection (with the muscular groups treated), as this will improve the results of the treatment.
- You must avoid alcohol for 24 hours (it can favour the appearance of bruising in the injection site).
- Do not take aspirin (Salicylic acid) for 48 hours.
- Avoid direct exposure to the sun (without sun screen) for 48 hours.