Biomedical Research

Botulinum Toxin A: A Guide Towards Enhancing One’s Features

When talking about maintaining a youthful look, there are many things that can be done to stop the aging process, one of which is Botox treatment.


Signs of aging start to appear on every person no matter how young the person is. One must have probably heard the term facial aesthetics either in terms of the overall attractive level of someone’s face or the set of treatments available to help people enhance their features and allow their natural beauty to shine through. These treatments often make use of Botox to soften expression lines and define facial contours adding a glow to one’s face.[1] Botox is considered the best treatment and involves using a purified version of the botulinum type A toxin to reduce unwanted lines and wrinkles on the face restoring a more youthful appearance.[2] 

The face has sets of muscles that contract due to everyday facial expressions which leads to the skin wrinkles as the muscle shortens during contraction, making it move in different directions.

Botox best targets Dynamic wrinkles which are formed by facial movements, such as squinting, smiling and furrowing of the brow. A tiny injection of Botox in the right place weakens the muscle, allows it to relax, and thereby removes the wrinkle.

Along with maintaining wrinkles, it helps in slimming and contouring the face which is achieved by targeting the masseter muscles at the back of the jaw giving a proper square shape to the face. This is called as the masseter reduction. This reduction results in loss of pounds of weight making one’s face look elegant, thus maintaining facial balance which must be enhanced from time to time.

Figure: Illustration of biologically active botulinum toxin protein complex

Mechanism of Action

Botulinum toxin is a two-chain polypeptide consisting of a light chain (approx 50 kDa) and a heavy chain (approx 100 kDa) which are joined by a disulfide bond.[4]This toxin binds to specific receptors on the surface of the presynaptic nerve cells, mediated by the C-terminal of the heavy chain, which takes around half an hour. The plasma membrane of the nerve cells invaginates around the toxin-receptor complex, forming a vesicle containing a toxin in the nerve terminal, the process is known as internalization. Following internalization, is the process of Translocation in which the disulfide bond is cleaved and the 50-kDa light chain of the toxin is released across the endosomal membrane of the endocytic vesicle into the cytoplasm of the nerve terminal.[3]Botulinum toxin can be serologically divided from A to G[4]. The light chain of serotypes A and E inhibit the release of acetylcholine by cleaving the cytoplasmic protein needed for the docking of acetylcholine vesicles on the inner side of the nerve membrane of the nerve terminal[3], thus leading to blocking of the nerve impulses to the tiny facial muscles, forcing them to relax and smoothing out the skin to lessen the appearance of lines and wrinkles.[2]. Following the injection, the toxin diffuses into the tissue until it binds selectively and reversibly in the presynaptic terminal of the neuromuscular junction and then attaches to the specific protein-membrane responsible for acetylcholine excretion.[3] 

Botox is generally injected into the muscles of facial expression which are attached to muscles rather than bones and by contracting, they pull across the skin to give facial expressions.[5]

The After Effects and Precautions

The clinical effects of Botox are seen on the first to the fourth day after injection followed by 1 to 4 weeks of maximum effect, which will resolve after 3–4 months. The effects are temporary and remain maximum for around 6months. In order to prolong its effect from six months to one year, the treatment should be repeated for one year or more. The duration of the Botox effect varies among individuals due to differences in muscle arrangements. According to the American Board of Cosmetic Surgery, Botox injections are the most popular cosmetic procedure nationwide.It is used for reducing glabellar frown lines, crow’s feet at the side of the eyes, horizontal forehead creases, wrinkles around the mouth, nasolabial folds, smoothing out neck and chest or cleavage wrinkles. The procedure takes around 15 to 30 minutes and effects are fully visible in around 7-14 days. Some measures should be taken into consideration before and after the procedure. It’s best to avoid alcohol starting one week before the procedure. One should discontinue medications like Aspirin and anti-inflammatory ones before 2 weeks of the procedure to avoid bruising. After the procedure, one should prefer not to rub on the injection site for at least 24 hours to avoid the spread of Botox to another area. The doctor also advises to stay upright for about 4 hours after the procedure and take a day off from exercising. Like every other treatment, Botox has some advantages along with that some disadvantages also. The disadvantages include crooked smile or drooling, eye dryness or severe tearing, mild pain or swelling around the injection site, weakness in the muscles,flu-like symptoms or a feeling of being unwell, upset stomach, numbness.[5]

Figure: After effects of Botox

Ideal Age

This depends on the benefits of BOTOX on our skin.More sun damage may lead to start treatments in  late twenties to early thirties, while different skin types or lucky genetics could allow one to wait until age 40 or above.

Botox in 20’s: During this age if one has smooth and wrinkle free skin they may go with less or no Botox.If exposure to the sun is more or use tanning beds, are a smoker, or showing early signs of wrinkles due to family tendency, then one must consult a dermatologist for light Botox.

Botox in 30’s: In one’s 30’s firstly the sun exposure is the most important factor common in all age groups. More refined wrinkles may start appearing at this age so this is the best age for Botox treatment. Also if one is a smoker or live in higher altitudes, in such conditions strain on skin is more  thus Botox is the best at this time.

Botox in 40’s: At this time wrinkles are more defined as the skin starts thinning along with the breaking down of the elastin and collagen start becoming more visible. Once the wrinkle lines have etched in and are visible at rest and even remain when one stretches their skin with their fingers, it’s an indication of the ideal age group for Botox.[6]


For many generations, a lot of people have benefited from BOTOX Treatment. Not only it is highly effective for smoothing wrinkles and reducing fine lines but is also used as a facial relaxation treatment which also aids in treating disorders like eye-twitching, hyperhidrosis, and certain cases of Bell’s Palsy. An injection of Botox temporarily prevents muscles from moving and blocks certain chemical signals from nerve endings. This can relax the skin around the area and relieve pain or discomfort from spasms treating eye twitching. They make use of botulinum toxin to block the nerve signals responsible for sweating, stopping the sweat glands from producing too much sweat thus treating hyperhidrosis. A Botox treatment for permanent or longstanding Bell’s palsy is available to help patients mitigate the effects of unilateral facial weakness. It relaxes hyperactive muscles and temporarily restores facial symmetry, resulting in an improved facial appearance.

Botox injections have been widely acclaimed for their short-term, anti-ageing properties. The procedure has gained popularity as it is non-invasive, leaves no scars and the recovery period is low. However it should be remembered that Botox is an addiction inducing substance and its patrons may become heavily dependent on the drug to make one look young and feel good.

Pratiksha Baliga, Youth Medical Journal 2020


[1]Dental, S. (2019). What are Facial Aesthetics? A Guide to Enhancing Your Features. Retrieved December 02, 2020, from

[2]Care, V. (2016, March 16). Botox and facial aesthetics: The perfect complement to cosmetic dentistry. Retrieved December 02, 2020, from

[3]Satriyasa, B. (2019, April 10). Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect. Retrieved December 02, 2020, from

[4]Satriyasa, B. (2019, April 10). Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect. Retrieved December 02, 2020, from

[5]Cassoobhoy, A. (2020, July 24). Botox Injections: Purpose, Procedure, Risks, Results. Retrieved December 02, 2020, from

[6]Krant, J. (2018, February 22). What Is The Right Age To Start Getting BOTOX®? – Art of Dermatology: New York. Retrieved December 02, 2020, from

























By Pratiksha Baliga

Pratiksha Baliga is a medical student residing in Mumbai,India. She's interested in the fields of Neurology, Radiology, Medicine. She aspires to be a Neurologist.

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