Type A botulinum toxin has been used in medicine since 1975 to treat strabismus (squint) in children, facial tics and uncontrollable blinking of the eyelids. Its aesthetic indications have been, since 2003, for the temporary correction:

  • Of the vertical frown lines between the eyebrows that are particularly prominent when frowning
  • Crow’s feet wrinkles
  • Forehead wrinkles

There are several presentations of botulinum toxin, including VISTABEL™ (BOTOX™), AZZALURE™ (DYSPORT™) and BOCOUTURE™, depending on the laboratory that distributes them. Their effects are similar.


  • Contra-indications: Known hypersensitivity to the botulinum toxin and myasthenia gravis; also inadvisable for pregnant women.
  • Infection or inflammation of the injection site, existence of peripheral neuro-muscular disorders or amyotrophic lateral sclerosis require precautions to be taken if using.
  • Usage during treatment with aminosides is inadvisable since there is a risk of an increase of the effects of the toxin.
  • There also needs to be vigilance in the case of haemostatic disorders linked to illness or the use of certain medications (risk of subcutaneous bleeding). Avoid taking aspirin or an anti-coagulant during the fortnight before the injection.
  • Finally, it is wise to be cautious with patients who are psychologically unstable.


  • Injections are performed at the doctor’s office after an information consultation. They are virtually painless because very fine needles are used and anaesthesia is not needed.
  • The results become visible after four days. An attenuation of the wrinkles is visible while retaining small movements.
  • In a few cases, a correction asymmetry or the persistence of a few small lines can be observed. In general, this means performing an additional injection.
  • The effect diminishes after four to six months and the session has to be repeated. With time and injections, the effect is often more lasting and the injections can sometimes be spaced out.
  • Any sequels and possible complications will be explained by Dr COURBIER during the consultation and in the literature supplied to you.