Botulinum toxin
beyond the forehead and eyes

Bruxism, migraine, sweating, the lower face, the neck and other uses of botulinum toxin beyond the forehead, the glabella and around the eyes.

Most people associate Botox with three areas — the forehead, between the eyebrows and around the eyes. These are the most commonly treated areas, but botulinum toxin has a much wider application. It blocks the signal from the nerve to the muscle (and, in the skin, to the sweat glands), so it is used wherever the problem is an overactive muscle or gland.

Bruxism and the masseters

Grinding the teeth and clenching the jaws put strain on the chewing muscles (the masseter and temporalis muscles). Injecting them weakens the force of contraction, which can reduce facial pain and headache. The studies are small, and the effect on the grinding itself is not uniform.

• It does not replace dental treatment and the splint — it complements them.
• Over time the masseters weaken and become thinner, which shapes a narrower lower face.
• The effect starts after 1–2 weeks and lasts about 4–6 months.
• Temporary weakness when chewing hard food and slight asymmetry of the smile are possible.

Migraine

Botox is approved in a number of countries for the treatment of chronic migraine (headache on at least 15 days a month). It is given by a set protocol, with many very small injections into the muscles of the head and neck, usually every 12 weeks. The diagnosis and the indications are established by a neurologist.

Excessive sweating (hyperhidrosis)

It is injected into the skin of the armpits, palms, soles and sometimes the forehead to block the signal to the sweat glands. The effect is best in the armpits and lasts between 4 and 12 months. The palms are more painful, and temporary weakness of the grip may occur.

Lower face

• Gummy smile — when the upper lip rises too much and exposes the upper gums.
• Corners of the mouth that are pulled downwards, giving a sad look.
• A “cobblestone” chin — dimpled skin because of an overactive muscle.
• Vertical lines around the mouth (barcode lines) — in small doses.
• Masseters — to shape the contour.

Neck and platysma

The platysma is the thin muscle of the neck. With age it forms vertical bands — platysmal bands. Small doses of Botox soften them and can improve the jawline. It is suitable for mild and moderate changes; with marked laxity of the neck, an operation is needed.

Other uses

• A subtle lift of the outer part of the eyebrow.
• Muscles of the nose — lines, lifting the tip of the nose or blocking movement of the nostrils (“bunny lines”).
• A range of neurological and medical indications that are treated by the relevant specialists — e.g. spasticity, blepharospasm, stress incontinence.

What you need to know

• Some of these uses are outside the official indications (off-label) — the doctor must tell you this clearly.
• The dose and the sites are determined individually — there is no “one scheme for everyone”.
• The effect is temporary: from 3 to 6 months, and for the masseters — longer.
• Possible: bruising, headache, temporary asymmetry, drooping of an eyelid (very rarely).
• It is not given in pregnancy, while breastfeeding or in some neuromuscular diseases.