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Botulinum toxin at Dr. Nüchel Aesthetik in Mönchengladbach

Injectables

Botulinum toxin

Targeted relaxation of the facial muscles to smooth forehead lines, frown lines and crow's feet – and also used for excessive sweating and teeth grinding.

Treatable areas

  • Forehead lines
  • Frown lines
  • Crow's feet
  • Underarms
  • Jaw muscles

Botulinum toxin is a medical substance used for many years that, in precisely measured doses, temporarily relaxes specifically selected muscles. In this way, expression-related lines such as forehead lines, the frown line (glabellar line) or crow's feet can be visibly softened, without losing your natural facial expression. The effect begins after a few days and typically lasts three to six months.

Beyond the treatment of lines, the substance can temporarily calm the sweat glands in cases of excessive sweating (hyperhidrosis), for example in the underarm area, and reduce the tension of the jaw muscle (masseter) in cases of nocturnal teeth grinding (bruxism).

All information is provided for general guidance and does not replace personal medical advice. Treatment results can vary from one individual to another.

Indications

Who it is suitable for

Whether a treatment makes medical sense in your case is something we determine together in a personal consultation. Typical concerns include:

  • Horizontal forehead lines that remain visible even in a relaxed state
  • Frown line between the eyebrows (glabellar line)
  • Crow's feet – fine lines at the sides of the eyes
  • A wish to counteract the deepening of expression-related lines at an early stage
  • Excessive sweating (hyperhidrosis), particularly in the underarm area
  • Teeth grinding (bruxism) with tension in the jaw muscles (masseter)
  • A wish for a more relaxed, fresher facial expression without surgery

Step by step

How the treatment works

This is how the treatment usually proceeds with us – from the first consultation through to aftercare.

  1. Medical consultation and information

    In a personal conversation we discuss your wishes, analyse your facial expressions or the condition concerned, and clarify whether a treatment is suitable for you. You receive detailed information about the procedure, realistic results, possible risks, alternatives and contraindications.

  2. Treatment planning and preparation

    The areas to be treated are determined by the physician and, where appropriate, marked; the skin is cleansed and disinfected. On request, an anaesthetic cream can be applied or the area cooled; photo documentation makes it possible to assess the result later on.

  3. Injection of the substance

    The substance is injected with a very fine needle in small, individually measured amounts, specifically into the relevant muscles or, in the case of hyperhidrosis, superficially into the skin. Depending on the number of areas, the treatment takes only a few minutes.

  4. Follow-up and, if needed, fine correction

    For the result, a single session is usually sufficient; the full effect appears after about 14 days. At an optional follow-up appointment the result can be assessed together and, if sensible, a selective top-up carried out.

Transparency

Prices

1 Zone
200 €
2 Zonen
350 €
3 Zonen
450 €
Brow Lift
100 €
Lip Flip
150 €
Masseter (Bruxismus)
450 €
Hyperhidrose (übermäßiges Schwitzen)
550 €

All prices are guide values for initial orientation. Medical services are billed according to the German scale of fees for physicians (GOÄ); the final amount depends on the individual effort involved and is discussed transparently with you before treatment. For treatments without a listed price, we are happy to give you a guide value during your consultation.

Enquire about this treatmentView the full price list →

Patient information

Safety & patient information

Responsible treatment includes open information about possible risks and side effects – even when they occur only rarely.

  • Redness, swelling and small bruises at the injection points

    At the injection points, slight redness, small swellings (wheals) or bruises may temporarily occur. They usually subside within a few hours to days and can generally be covered well with make-up.

  • Headache and a feeling of tension

    In the first few days after the treatment – particularly in the forehead and eyebrow area – mild headaches or a feeling of tension may temporarily occur; they are usually mild and short-lived.

  • Temporary asymmetry

    During the onset phase, the effect may develop at different rates on the two halves of the face, so that the face temporarily appears slightly uneven. This often balances out by the time the full effect sets in after about two weeks; otherwise a fine correction is possible.

  • Drooping of the eyebrow or upper eyelid (ptosis)

    If the substance spreads beyond the target area or neighbouring muscles are affected, an eyebrow or the upper eyelid may temporarily droop (ptosis). This is rare, time-limited and resolves completely; careful injection technique reduces the risk.

  • Unwanted change in facial expression

    With too high or unfavourably placed a dose, the expression may temporarily appear more rigid or the facial movement unnatural. A restrained, anatomically planned dose prevents this; this effect, too, is reversible.

  • Temporary functional limitations

    Depending on the area, rare, temporary effects are possible – such as an altered sensation when smiling, a slight impairment when drinking from a glass (when treating the mouth area) or a feeling of dry eyes. Such effects disappear as the effect wears off.

  • Local infection

    As with any injection, there is a very low risk of infection at the injection site; thorough skin disinfection and sterile working minimise it as far as possible.

  • Allergic reactions

    Hypersensitivity reactions to the substance or accompanying ingredients are rare but possible. A known allergy to components of the preparation must therefore be reported before the treatment without fail.

  • Antibody formation and diminishing response

    In rare cases the body can form antibodies against the substance, as a result of which the effect may be weaker or absent in repeated treatments. Doses kept as low as possible and sufficient intervals between treatments can reduce this risk.

  • Very rare systemic effects

    Very rarely, complaints have been described that could indicate a spread of the effect beyond the treatment area – such as muscle weakness, difficulty swallowing or breathing. With the low doses customary in aesthetic medicine, this is extremely unlikely; should unusual symptoms nevertheless occur, please seek medical help immediately.

When we do not treat

In certain situations we do not carry out a treatment, or only at a later time – for your safety.

  • Pregnancy and breastfeeding – the treatment is not carried out during these phases of life, as there are insufficient safety data.
  • Known hypersensitivity or allergy to botulinum toxin or one of the accompanying ingredients.
  • Disorders of neuromuscular signal transmission, such as myasthenia gravis, Lambert-Eaton syndrome or certain forms of amyotrophic lateral sclerosis (ALS).
  • Acute inflammation, infections or skin conditions in the planned treatment area (e.g. herpes, inflamed acne, open wounds).
  • Use of certain medications that can affect neuromuscular transmission (e.g. certain antibiotics or muscle relaxants) – an individual medical assessment is required here.
  • Known bleeding disorders or the use of anticoagulant medication (blood thinners) – a treatment is only possible after medical consultation and careful consideration.
  • Unrealistic expectations of the result or the wish for a completely motionless face.
  • Lack of capacity to consent, as well as treatment of minors without an explicit medical indication.

This information does not replace a personal medical consultation. Before every treatment we inform you individually about the procedure, risks and alternatives.

In depth

Medical details & background

How it works & the evidence

Botulinum toxin is a protein produced by bacteria that is used in a highly purified, precisely measured form. It temporarily inhibits signal transmission between nerve and muscle: at the motor end plate it blocks the release of the messenger substance acetylcholine, so that the muscle concerned no longer fully receives the nerve impulse and relaxes. Because overactive facial muscles are a key cause of dynamic lines – that is, lines created by movement – these lines can be softened in this way.

Decisive is its reversibility – the effect is time-limited from the outset. Over the weeks, the body forms new nerve endings (“sprouting”) and renews the structures at the end plate (receptor turnover), so that signal transmission gradually returns and the substance is completely broken down. Nothing remains permanently in the tissue – a central difference from surgical procedures.

The same basic principle can be transferred: for hyperhidrosis, the eccrine sweat glands regulated via acetylcholine are targeted, so that a superficial injection temporarily reduces local sweat production considerably; for bruxism, the strong jaw muscle (masseter) is relaxed. The quality of the result depends largely on a precise knowledge of facial anatomy and a restrained, individually adjusted dose – the aim is not to switch off facial expression, but to selectively relax individual overactive muscle areas.

Botulinum toxin is among the best-studied substances in aesthetic medicine. For expression lines in the upper third of the face – in particular the frown line and the lateral eye lines – as well as for excessive sweating in the underarm area, numerous controlled studies and systematic reviews are available which describe a temporary smoothing and a favourable safety profile when applied appropriately by a physician.

The significance of such studies has its limits, however: results cannot be transferred one to one to the individual case because of individual differences in skin condition, muscle strength, anatomy and expectations, and for individual applications such as the treatment of the jaw muscle in bruxism the evidence is less extensive. Responsible information therefore neither promises success rates nor guarantees a particular result; how pronounced and how long-lasting the effect is in the individual case cannot be predicted exactly.

Preparing for your treatment

A few simple measures before your appointment help you contribute to the best possible result with as few complications as possible.

  • Where possible, avoid anticoagulant painkillers (e.g. acetylsalicylic acid) as well as anti-inflammatory and circulation-promoting preparations for about a week before the treatment – this reduces the risk of bruising. Never stop permanently prescribed blood thinners on your own initiative, but only after consulting the prescribing physician.
  • Limit alcohol in the 24 hours before the appointment, as alcohol can increase the tendency to bruise.
  • Ideally come to the appointment with clean, make-up-free skin, or allow some time to remove make-up.
  • Inform us in advance of all pre-existing conditions, allergies, regularly taken medications as well as previous treatments with botulinum toxin or fillers.
  • Avoid intensive sunbathing or tanning beds immediately before the treatment; the skin in the treatment area should be free of irritation and not acutely tanned or sunburnt.
Aftercare

The right care after treatment supports healing and the result. You will receive individual recommendations from us – as a rule:

  • Remain upright for the first four hours after the treatment and avoid lying flat, so that the substance does not distribute unintentionally.
  • Do not rub, massage or press the treated areas on the day of treatment; tight headwear or pressure on the areas should also be avoided.
  • Avoid intensive exercise, heavy physical exertion as well as sauna, steam bath and pronounced heat for about 24 to 48 hours.
  • In the case of slight swelling or redness, cool the injection points carefully and without strong pressure.
  • Protect the skin from intensive UV radiation in the days after the treatment and use a sun protection with a high sun protection factor (SPF 50+) on the face.
  • Avoid facial treatments, microneedling, peels or other mechanical irritation in the treated area on the day of treatment.
  • Move the treated muscle areas gently and consciously in the first few hours (e.g. through normal facial expression) – this can support the even distribution of the substance.
  • If needed, attend a follow-up appointment after about two weeks, so that the result can be assessed and, if necessary, finely adjusted. In the event of unusual or persistent complaints, please contact the practice immediately.

FAQ

Frequently asked questions

Answers to questions we are asked particularly often about “Botulinum toxin”.

The injections are carried out with very fine needles and are described by most patients as well tolerable – often only a brief pinprick is felt. On request, the area can be cooled beforehand or prepared with an anaesthetic cream, for example when treating the underarms for hyperhidrosis.

A natural result is a matter of dosing and a precise knowledge of facial anatomy. The aim is not to switch off facial expression, but to selectively relax overactive muscle areas. With a restrained, medically planned dose, your expression and movement are preserved; at the follow-up after about two weeks, the result can also be finely adjusted.

There is no fixed age limit; in aesthetic use, botulinum toxin is generally applied from adulthood. Whether and when a treatment makes sense depends less on age than on the individual findings and your goals. In minors, a treatment is carried out only where there is a clear medical indication.

Botulinum toxin can be used all year round, as the substance itself is not light-sensitive. Those who react sensitively to the sun or are prone to pigment changes sometimes prefer to schedule treatments in the months with less sunshine.

The treatment is exclusively planned and performed by physicians – by licensed doctors with a dermatological background and experience in aesthetic medicine. Precise knowledge of facial anatomy is decisive for a natural, safe result. For this reason it is a medical service and not a purely cosmetic application.

“Botox” is the protected trade name of a single botulinum-toxin-containing medicine that has become established in everyday language as a general term for the entire treatment method. The medically correct name of the substance is botulinum toxin type A; in Germany several preparations from different manufacturers are approved. As these are prescription-only medicines, we deliberately do not advertise with product names.

Sources & guidelines

  • AWMF guideline register – guidelines of the scientific medical specialist societies, including on the treatment of hyperhidrosis (available via the portal of the Association of the Scientific Medical Societies, AWMF).
  • German Dermatological Society (DDG) – professional recommendations and statements on aesthetic and dermatological use.
  • German Society for Aesthetic Botulinum Toxin Therapy (DGBT) – specialist society with training and quality standards for the use of botulinum toxin.
  • Prescribing information for the approved botulinum toxin preparations as well as information from the European Medicines Agency (EMA) on effects, side effects and contraindications.

Personal consultation

Arrange a personal consultation

In a confidential conversation on our practice floor at the Albertus Zentrum in Mönchengladbach, we take time for your questions and assess whether the treatment may be suitable for you.

Book a consultation

More treatments

You might also be interested in

Botulinum toxin acts specifically on expression-related lines; for volume-related or static lines, hyaluronic acid fillers may be a complementary option, and for skin quality as well as pigment or vascular changes, laser procedures. Where the concern is localised fat deposits or body weight, injection lipolysis or medically supervised weight management may be considered, depending on the findings.

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