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Botulinum toxin (Botox, Azzalure)

Treatment overview

Botulinum toxin – natural toxin with very strong effects, which hinders the release of acetylcholine – neurotransmitter responsible for transmitting impulses between nerves and muscles. Botulinum toxin acts by blocking connections between nerve ends and the muscles innervated by them, i.e. it blocks so-called nerve-muscle synapses. Contractions of the paralysed muscle do not take place then. Botulinum is equally effective in case of men and women.

In medicine, botulinum toxin is applied in the treatment of various diseases such as strabismus, neurological diseases progressing with excessive muscle tension, as well as excessive sweating. Removal of expression lines requires very low concentrations of the toxin, which do not impact other elements of the nervous system apart from the area where the injection is administered.

Is this a painful treatment?

Many patients compare it to an ant or mosquito bite which lasts for a few seconds. The treatment does not require local anaesthesia. Because of patient comfort, anaesthetic cream is sometimes applied (e.g. EMLA) approximately 1 hour before the treatment.

When does the effect appear and how long does it last?

The effect appears after approximately 7 days and maintains for app. 4-6 months. Then, the treatment should be repeated.

Therapy schedule

Application of botulinum toxin does not require any specific diagnostic tests. Botox is injected using a disposable syringe with a very thin needle. A small quantity of the preparation is precisely injected into several areas of the face. The treatment does not last long. Depending on the number of treated areas (injection points), this takes approximately 15-20 minutes. Pain connected with the injection is minimal.

Treatments may be repeated every 6-8 months, but not more often than every 3 months. It is one of the treatments which patients willingly repeat, as it provides very quick and lasting effects, noticed by everyone around, and at the same time it is a non-invasive and easy to perform treatment.

Post-treatment recommendations

  • Within 0.5-1 hour exercise the mimic muscles at the place of the injections;
  • Avoid massage at the place of the injections;
  • Within 4 hours after the treatment do not lean the head down (e.g. when tying the shoes or while sleeping).

After the treatment, the patient may return to the daily activity. Marks after the injections are almost invisible.

Contraindications and adverse effects


  • Neuromuscular transmission disorders (miastenia gravis, Lambert Eaton syndrome);
  • Hypersensitivity to ingredients of the preparation (human albumins);
  • Therapy with the following medicines or the period of up to 1 week after their use is stopped:
    • Aminoglycosides (streptomycin, gentamycin, amikacin, kanamycin, etc.)
    • Aminoquinoline (chloroquine, hydroxycholoroquine)
    • D-penicillamine (Cuprenil)
    • Cyclosporine
    • Tubocurarine, pancuronium, galamine
    • Succinylcholine
    • Lincomycin, tetracycline, polymyxin
    • Local skin infections
    • Pregnancy, lactation

Side effects:

  • Pain at the time of injection;
  • Small haematomas which may appear at the place of injection if the needle punches a small blood vessel;
  • Excessive lowering or lifting of eyebrows in case of forehead wrinkle treatment;
  • Small, temporary swelling with gentle formication feeling at the place of the injection;
  • Excessive atonicity of muscles (falling eyelid, falling lip corner);
  • Headache, disappearing after an analgesic.

These reactions are temporary, most of them usually disappear after a few days. The effect of excessive muscle atonicity may remain for 2-6 weeks.


  • Expression lines, mainly in the upper part of the face,
    • Around the eyes (“crow’s feet”),
    • Transversal forehead lines,
    • Between the eyebrows (“lion’s wrinkle”),
  • Wrinkles of the lower part of the face – “marionette’s furrows”, on the neck, chin,
  • Excessive sweating of hands and feet.
Klinika Ambroziak

al. Gen. W. Sikorskiego 13/U1
02-758 Warszawa

Mon-ri: 10:00-18:00
Sat: 10:00-18:00

Szpital Ambroziak

ul. Młynarska 2a
05-500 Piaseczno

Mon-Fri: 10:00-20:00
Sat: Closed

Szpital Ambroziak

Wilanów, ul. Kosiarzy 9 A
02-953 Warszawa

Mon-Fri: 9:00-20:00
Sat: Closed