Botulinum toxin, area by area
Botulinum toxin is one drug used for several unrelated purposes. Softening a frown line, slimming a jaw and relaxing a trapezius are different treatments that happen to share a vial — different depths, different quantities, different timelines.
Botulinum toxin temporarily reduces the signal from nerve to muscle, so the muscle contracts less. Where that is useful depends on the muscle: in the masseter it reduces bulk and narrows the lower face over weeks; in expression muscles it softens dynamic lines; in the trapezius it lowers a raised shoulder line; injected superficially and dilute as 'skin botox', it addresses oil and pore appearance rather than movement.
The same drug, four different jobs
| Area | Target | What changes |
|---|---|---|
| Masseter — jaw slimming | Masseter muscle | The muscle reduces in bulk with less use, narrowing the lower face. This is muscle, not fat — it does not remove fat from the face. |
| Expression lines | Forehead, glabella (frown), crow's feet | Reduces the movement that creates the line. Lines present at rest respond less than lines that appear on movement. |
| Trapezius | Upper trapezius | Lowers a raised trapezius, lengthening the visible neck-to-shoulder line. Often requested for shoulder tension as much as for shape. |
| Skin botox | Superficial, dilute, over an area | Aims at oil production and pore appearance across the full face, butterfly zone or V-line, rather than at movement. |
| Other areas | Salivary gland, temporalis, hyperhidrosis | Jawline definition, temporal width, and excessive sweating of the underarms, hands or feet. |
Which areas suit you, and how many units each requires, is determined by examining the muscle — including how strong it is and how symmetrical. This table describes purposes, not a menu to order from.
Which product, and why it matters
Several botulinum toxin products are used at DIESTA, and the difference between them is mostly about the accessory proteins in the formulation.
| Product | Origin | Characteristic |
|---|---|---|
| Botulax | Korea | Conventional formulation containing complex proteins. Commonly chosen for a first treatment. |
| Coretox | Korea | Purified — complex proteins removed. Considered where treatment is repeated frequently or resistance is a concern. |
| Xeomin | Germany | 'Naked' toxin, with the least accessory protein of the three. |
The reason this matters: accessory proteins are the part of the formulation the immune system can react to, and repeated exposure — particularly frequent top-ups at short intervals — is associated with a reduced response over time. This is why re-treatment is generally spaced at intervals of around four to six months and why short-interval touch-ups are discouraged. If you have been treated frequently elsewhere and feel the effect has weakened, say so at consultation; it changes which product is appropriate.
Onset, duration and re-treatment
Botulinum toxin is not immediate. The effect appears over several days to about two weeks as the muscle gradually reduces its activity, and the final result is the two-week result — not the three-day one. Judging the outcome, or requesting more, before two weeks have passed is how patients end up over-treated.
Duration is commonly in the range of three to six months, varying by area, dose and individual metabolism. The masseter and the trapezius are large muscles and tend to follow a slower cycle than fine expression lines.
For travel planning: bruising at injection points is possible and settles over days. The effect will not have appeared yet when you fly home if you are treated at the end of a short trip — which is fine, but worth knowing so it does not read as a failed treatment.
Side effects and who should not be treated
Reported effects include bruising, swelling and headache, temporary weakness in the treated muscle, and — uncommonly — spread to an adjacent muscle producing temporary asymmetry, such as an eyelid or eyebrow sitting differently from the other side. These are generally temporary and resolve as the effect wears off, but they are real and worth understanding before treatment rather than after.
Botulinum toxin may not be appropriate if you are pregnant or breastfeeding, if you have a neuromuscular disorder, or if you take certain medications. Bring the actual names of what you take to the consultation.
Frequently asked questions
It is not immediate. The effect develops over several days to about two weeks, and the two-week point is when the result should be judged. Duration is commonly three to six months depending on the area, the dose and your own metabolism — larger muscles such as the masseter and trapezius generally follow a slower cycle than fine expression lines. Asking for more before two weeks have passed is the most common route to an over-treated result.
No. Masseter treatment acts on the masseter muscle, which reduces in bulk when it is used less. The narrowing you see is muscle volume, not fat. This distinction matters for expectations: if the width of your lower face comes from fat or from bone structure rather than from a developed masseter, botulinum toxin will not change it, and an examination will tell you which of the three you are dealing with.
A reduced response with repeated treatment is recognised, and it is one reason products differ in how much accessory protein they contain — the purified formulations exist for this reason. It is also why intervals of roughly four to six months are preferred and why frequent short-interval top-ups are discouraged. If you have been treated often elsewhere and feel the effect has faded, tell the physician; it changes which product is selected.
Skin botox is injected superficially and in dilute form across an area — full face, the 'butterfly zone' across the cheeks and nose, or along the V-line — rather than into a specific muscle at depth. The purpose is different: it addresses oil production and the appearance of pores and fine texture, not movement. It does not slim the jaw and does not soften a frown line, because it is not reaching the muscles that do those things.
Two reasons, and patients usually have both. Aesthetically, lowering a raised upper trapezius lengthens the visible line from neck to shoulder — the same reason it is often combined with shoulder filler, which addresses the opposite end of that line. Practically, many patients arrive because of the tightness and tension in a chronically raised trapezius. It is a large muscle, so it uses more product than facial areas and follows a slower onset and longer cycle.
Yes, with one expectation set correctly: you will almost certainly fly home before the effect appears, since onset takes days to about two weeks. Bruising at the injection points is possible and settles over several days. What you should not do is book a treatment, decide after three days that nothing has happened, and seek a top-up elsewhere — that is how an over-treated, frozen result happens.