Myths about anti-wrinkle injections, answered

Key takeaways

• Cosmetic doses are very small and measured; the medicine is licensed and prescription-only.
• A "frozen" face is a dosing choice, not an unavoidable result.
• When the effect wears off, muscles return to how they were. Lines do not suddenly worsen.
• It is not a filler. It does not add volume, and it does not fix sagging.
• It is optional. Not needing it is a perfectly good outcome of an assessment.

Myth 1: "It is a poison, so it must be dangerous"

I understand why people say this. Botulinum toxin is the substance that, in large amounts from contaminated food, causes botulism. So the name sounds frightening.

See, what happens is, almost every medicine is about dose. Cosmetic treatment uses tiny, measured amounts of a purified, licensed product, placed into specific muscles. The US prescribing information does carry a boxed warning that toxin effects can spread beyond the injection site, causing problems such as swallowing or breathing difficulty, and that risk is described as probably greatest in children treated for muscle spasticity, who receive much larger doses for medical reasons. In cosmetic use on the face, the doses are a small fraction of that.

That does not mean it is risk-free. It means it is a medical treatment that should be given by a doctor who assesses you, chooses the dose and is reachable afterwards. My article on side effects and safety covers this properly.

Myth 2: "Once you start, you can never stop"

You can stop at any time. Nothing is locked in.

When the treatment wears off, the nerve has grown new connections to the muscle and movement returns. DermNet describes the nerve-muscle connection being re-established after around three months. You simply go back to how your face moved before.

People sometimes feel they "have to" continue because they like the result and do not want the lines back. That is a preference, not a dependence.

Myth 3: "My wrinkles will be worse when it wears off"

No. When the effect fades, the muscle returns to its normal strength. Your lines return to roughly where they would have been anyway, carrying on with normal ageing.

If anything, a period of less folding gives the skin a break from that repeated crease. DermNet notes that repeated injections cause gradual muscle thinning, which is why the interval before the next treatment may lengthen over time. What you do not get is a rebound where lines become deeper than before.

Myth 4: "Everyone who has it looks frozen or surprised"

You only notice the ones that are obvious. The ones done carefully, you never notice.

A frozen forehead or a strangely high eyebrow usually comes from a high dose across the whole area, or from treating the forehead without balancing the muscles around it. Basically, the dose is the skill. I prefer to start lower, keep some movement and adjust at a two-week review. Adding a little is easy. Taking it away is not possible, so you wait for it to wear off.

Myth 5: "It fills wrinkles and lifts the face"

This is the most common confusion.

That is very important to understand, because people who expect a lift from botulinum toxin are disappointed, and people who expect it to fill end up with too much of it. If you are unsure which type of line you have, how skin ages explains the layers.

Myth 6: "Starting young prevents all ageing"

Relaxing a muscle that is creasing the skin can slow the setting-in of that particular line while the treatment lasts. It does nothing for sun damage, volume loss, bone changes or skin laxity. And it needs repeating every few months to keep the effect.

The step with the strongest evidence for slowing visible ageing overall is daily sunscreen. I explain the timing question in when to start anti-ageing treatment. If you are in your twenties with no lines at rest, I will usually tell you to wait.

Myth 7: "All anti-wrinkle injections are the same, so go for the cheapest"

Different licensed products contain botulinum toxin, and the US prescribing information states clearly that their units are not interchangeable or convertible. So "one area" at one place and "one area" at another may mean very different doses. Also, a product bought or stored outside proper supply chains is a real concern.

What to compare instead: - The name of the product, written down - The dose in units for each area, written down - Who is injecting, and whether they review you afterwards - What happens if you need a small adjustment

Myth 8: "It is only for women"

Men have it too, often for frown lines and forehead lines, and the dose is still matched to the individual face. The principles are the same: treat the movement lines that bother you, keep the face looking like yours, and do not overdo it.

How we approach this at Dr Tvacha

At our centres in Thane, Andheri, Bandra and Dahisar, I would rather answer your doubts properly than rush you into a treatment. The Rs 499 face assessment covers whether movement lines are actually your main concern. If they are, the product, dose and price are written down before treatment, and I review at two weeks. If they are not, I will tell you. You can read about the Long Game Anti-ageing Plan.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.