Botulinum Toxin in Uberlândia, Brazil

They act differently and are often complementary. Botulinum toxin acts on the muscle, temporarily reducing the contraction that creates dynamic expression lines — forehead, glabella, crow's feet. Hyaluronic acid is a filler: it restores volume and support where it has been lost, addressing contour and proportion rather than muscle movement. Combining the two in one treatment plan is common, and is assessed individually at the consultation.

It describes the extent of the planning, not a superior technique. Facial muscles work in opposing pairs — some lift and others pull down the same structure — so reducing the force of one group changes the balance of the whole region; full face planning maps the dose per muscle group with that opposition in mind, and may include the upper third, the nose, the perioral region and the masseter. Two limits: full face does not replace surgery, volume restoration or skin treatment — it does not correct laxity, does not restore volume and does not treat pigmentation, pores or texture; and a higher total dose is associated with a greater risk of an unnatural expression and of losing response to the toxin over a lifetime.

Botox is the registered trade name of one botulinum toxin product — the first approved for aesthetic use — and over time the name came to be used colloquially as if it were the name of the procedure itself. What is injected is botulinum toxin type A, available in Brazil under several brands registered with Anvisa, the national health surveillance agency. Under the rules of the Federal Council of Medicine (CFM Resolution 2,336/2023), physicians do not advertise commercial brands or manufacturers; the product used in each case is presented to the patient at the consultation.

There is no single brand indicated for every case. The botulinum toxin products registered with Anvisa differ technically — in how the product diffuses through tissue, how quickly it takes effect and how long it lasts on average — and the choice is a technical decision made case by case, according to the area treated, the strength of the musculature and the patient's response to previous sessions.

No. The toxin does not change the shape of the nose at rest and does not replace rhinoplasty: it does not reduce a dorsal hump, does not narrow the nose, does not correct a deviation or structural asymmetry and does not act on bone or cartilage. What is described is dynamic: in patients whose tip drops when they smile, pulled down by the depressor septi nasi muscle, injection into that muscle can reduce how far the tip drops during animation — something seen in a smiling photograph, not in a still frontal one. In dissection studies, 16% of people lack that muscle or have only a rudimentary one, and in those cases there is nothing to relax. The same injection can also reduce gum display and lengthen the upper lip, effects that may be unwanted and are therefore discussed beforehand.

In some cases it can be paired with other treatments, such as dermal fillers; whether to combine them and the ideal timing are assessed individually during the consultation.

Botulinum toxin type A acts at the junction between nerve and muscle fiber: it blocks the release of acetylcholine, the chemical signal that tells the muscle to contract. The muscle is not removed or permanently paralyzed — it simply contracts with less force, so the skin fold that movement created tends to become less marked. That also explains the limits: in expression lines the target is muscle, and the toxin does not act directly on skin, on bone or on the central nervous system. It does not restore volume, does not treat pigmentation, does not correct skin texture and does not erase a line already etched into the skin at rest. Because the nerve endings recover progressively, the effect is temporary: it starts within a few days, usually completes at around two weeks and fades over the following months.

Botulinum toxin type A is produced in the laboratory: it is a protein obtained through controlled fermentation of the bacterium Clostridium botulinum, then purified and standardized in biological units. It belongs to the same family as the toxin behind food-borne botulism — what separates the two situations is dose, purity and route: medical use involves minute quantities placed in specific muscles, with a product registered with Anvisa, the Brazilian health surveillance agency. There is no natural, organic or home-made version. The molecule is sensitive to heat, and each product has its own storage conditions, described in its label — some require refrigeration and some allow room temperature while the vial is unopened. Reconstitution is done in the office, shortly before treatment, and the injection is a medical act.

Assessment comes before the needle: the musculature is observed at rest and in maximum contraction — you are asked to frown, close your eyes tightly and smile — to identify which muscles produce each line and how strongly they pull. The points are then defined by muscle group — frontalis, glabella, orbicularis oculi — and the injections are intramuscular, with a fine needle. The session usually takes ten to twenty minutes, with no incision and no hospital stay. A review at around two weeks, when the effect is complete, allows symmetry to be assessed and any touch-up to be decided.

Discomfort is usually minimal — these are precise injections with fine needles.

Anesthesia usually isn't needed; for more sensitive skin, a topical numbing cream may be applied beforehand.

Headache in the days after treatment is among the described possible effects — usually mild, transient and self-limiting, attributed to the injection itself and to the response of the treated muscle. A severe or persistent headache, double vision or difficulty swallowing are not expected and should be reported to the medical team promptly. As the effect fades, the muscles regain movement gradually, over weeks: rebound pain and worsening compared with the previous state are not described, although some patients report a feeling of heaviness or tension in the forehead as movement returns. During the session the discomfort lasts seconds per point; the glabella, the base of the nose and the lip area tend to be more sensitive than the forehead.

In most cases, yes — daily activities can usually be resumed right away, with no need for time off.

It's generally recommended to avoid lying down, massaging the treated area, or engaging in intense physical exercise in the hours following the injections.

It is a non-surgical, minimally invasive procedure: precise injections with fine needles, performed in the office, with no incision, no hospital stay and no time away from daily activities. Botulinum toxin has been used in medicine since the 1980s, initially in ophthalmological and neurological indications, and is registered with Anvisa for aesthetic use as well. As with any medical procedure there are risks — the most relevant ones are described in the questions below — and they are lower when the indication, dose and technique are defined by a qualified physician after individual assessment.

It's a possible risk, generally temporary and uncommon, related to the technique used and how the product spreads in the treated area; it should be discussed during the consultation.

It is not a risk-free procedure. The most frequent events are local and temporary: pain at the moment of injection, small bruising, swelling, headache and mild flu-like symptoms in the following days. Asymmetry between sides, eyelid drooping or a sense of heaviness in the brow can occur and — when the total dose is high and spread across many areas — an unnatural expression with loss of animation. In the lower third, an asymmetric smile and difficulty whistling or pronouncing lip sounds are described. The label of the product used carries a warning about the possibility of the effect spreading beyond the injected site: it is rare, but generalized weakness, double vision or difficulty swallowing, speaking or breathing require immediate care. Because the effect is temporary, most of these changes are too.

The effect starts to show within a few days, with the full result at about two weeks.

The masseter is the muscle that closes the jaw — the one that hardens under your fingers when you clench your teeth. The toxin reduces the force of its contraction and, over weeks of working with less force, the muscle tends to lose volume through disuse; that loss of volume is what can reduce the width of the lower third. The effect on force begins within days, but the change in volume usually appears between the fourth and the twelfth week. The limit is anatomical and it decides the outcome: when the width comes from the bony mandibular angle or from fat rather than from muscle, the toxin does not change the contour — a distinction made on examination, with the muscle palpated in contraction. In thinner faces, reducing muscle volume can make existing skin laxity more apparent. It is use outside the labeled indications, supported by specialty literature.

Those are the nasal dorsum lines, popularly called bunny lines, produced by contraction of the nasalis and neighboring muscles — procerus, orbicularis oculi and the levator labii superioris alaeque nasi. Low doses are used, over the nasalis muscle on both sides. One anatomical detail explains results that fall short: a study with dissection of 39 cadavers plus ultrasound showed that the area between the inner corner of the eye and the nasal dorsum is, in most people, a triangle without muscle — the line you see in the mirror does not necessarily sit over the muscle producing it. The toxin acts on movement, so a line already etched into the skin at rest is not resolved this way. Evidence specific to the nasal region is still limited. It is use outside the labeled indications, supported by specialty literature.

No — pregnancy and breastfeeding are among the situations in which the injections are not indicated, because safety in those settings has not been established in studies, not because harm has been demonstrated. There is no standardized interval in the literature between a last session and a pregnancy; if you are planning to conceive, that is discussed at the consultation. If a pregnancy is discovered after a recent session, the step is to inform your obstetrician and the medical team, and the course is defined with whoever is following the pregnancy. Other situations in which the injections are not indicated include certain neuromuscular conditions, known hypersensitivity to the toxin or to albumin, active infection at the site, and medications that interfere with neuromuscular transmission.

Pregnant or breastfeeding women and people with certain neuromuscular conditions are generally not candidates; suitability is always confirmed through an individual evaluation.

There's no fixed age; the indication depends on each person's muscle characteristics and expression lines, which are assessed individually during the consultation.

Assessing and managing bruxism belongs to the dentist; in patients already diagnosed and followed by one, masseter injection is discussed jointly, and what is described here is the injection into the muscle, not treatment of the condition. The literature delimits what changes. In the trial that counted episodes by polysomnography, the electrical amplitude of the masseter fell — measured four weeks after injection, which was the limit of that study's follow-up — but the frequency, the number of bursts and the duration of the episodes did not fall; trials that counted episodes by electromyography recorded a drop in their number, probably because that count depends on the amplitude of the signal. Treated participants reported less morning jaw stiffness, with a caveat that belongs alongside it: in the randomized trial that had a placebo group, reported symptoms improved in both groups. What the two methods suggest is that the injection reduces the intensity of the contraction rather than the command that generates it — a command that comes from the central nervous system during sleep. It also does not restore tooth wear already present and does not replace an occlusal splint or dental follow-up.

There is no minimum or recommended age: what defines the indication is muscular marking, not age. A line starts out dynamic and, with the same fold repeated over years, part of them becomes marked at rest, so reducing that repetition has been associated with less marking. The evidence, though, is limited — the long-term argument rests on case reports about a single pair of identical twins followed for thirteen and then nineteen years, with no controlled trial. A young patient with no relevant dynamic marking generally has nothing to treat, and the course is to wait. Higher doses, more areas and an earlier start are also what an expert panel links to a greater chance of no longer responding to the toxin later on. Sun protection and skin care remain the basis.

Yes. Planning takes male proportions into account, and they differ: frontalis and glabellar muscle mass tends to be greater, which usually calls for a higher dose in the same area, and the male brow sits lower and more horizontally — lifting it can change the expression in unwanted ways, so the aim is to soften movement while preserving brow position and horizontality. As with any patient, the indication, dose and points come out of individual assessment, and the goal remains a natural result.

Repeat sessions are typically spaced a few months apart, varying with the muscle group treated and individual response; the ideal interval is defined at follow-up visits.

The muscles gradually regain their usual movement, and expression lines return to behaving as they did before treatment.

The effect is shorter-lived than in the upper face: in the only study with serial objective measurement, the gain in lip height was significant at fifteen days, no longer significant at thirty and back to baseline at ninety — attributed to the very low dose. Maintaining it means more frequent repeat treatment. Among the temporary effects, numbness of the lip was the most common, in nine of seventeen patients, and difficulty whistling or drinking through a straw, altered articulation of lip sounds and incomplete lip seal are described; all were mild and resolved within thirty days, but every participant reported some discomfort. Anyone who depends on fine lip control — wind instruments, singing, professional voice use — discusses this beforehand.

It is not the same in every area. In the upper third — forehead, glabella, crow's feet — three to four months is the usual figure. In the masseter, part of the reduction in volume was still measurable at six months, already with partial recovery over that interval. In the nasal and perioral regions, with small muscles and low doses, duration tends to be shorter — in the upper lip, the measured effect was already no longer significant at thirty days. For gingival display, something around three to four months is described, with values approaching baseline again by around 24 weeks. Dose, muscle strength and individual metabolism weigh as much as the region treated.

Care is private — Dr. Lorena does not work through health insurance. In addition, procedures performed for aesthetic purposes fall outside the mandatory coverage of Brazilian health plans by law. Botulinum toxin also has non-aesthetic indications; in those situations the team advises on the documentation and on the possibility of reimbursement from the plan, which is always the insurer's decision.

No — the SUS does not cover procedures performed for purely aesthetic purposes. Dr. Lorena is a plastic surgeon appointed by public examination to the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU) and preceptor of its plastic surgery residency, and she operates on SUS patients there, for reconstructive and functional indications. For those, the route is for the patient to register at the primary care unit (Unidade Básica de Saúde) nearest to her home, be assessed by a doctor there and, if there is an indication, be placed in the regulation queue of her municipality. The surgeon cannot choose who is operated on through the SUS — the order follows the queue and the rules of the system strictly.

We do not publish isolated before-and-after pairs. Resolution 2,336/2023 of the Brazilian Federal Council of Medicine allows results to be demonstrated, but only within a set that also includes unsatisfactory outcomes and the complications described in the literature, across different body types, age ranges and stages of healing, and with no editing of the images (art. 14, II). An isolated pair of photos does not meet those requirements and also implies a guaranteed result, which the same resolution prohibits (art. 11, XII). At the consultation the expected outcome is discussed from your own anatomy — what is reasonable to expect, what is not possible, and what the risks are.

The botulinum toxin type A products used in the office are registered with Anvisa, the Brazilian health surveillance agency, but the indications approved in the label are specific and do not cover every area where the toxin is used in clinical practice. Injection into the masseter muscle, the perioral region, the nose and the elevator muscles of the upper lip is not among the indications approved in the label in Brazil — it is off-label use, described in specialty literature and in international consensus statements, lawful under medical responsibility and with individual explanation and consent. Off-label does not mean irregular: it means the support comes from specialty literature rather than from a registration dossier.

This is a real and still open controversy, and it is discussed at the consultation before entering a cycle of repeat treatments. The bone changes described in the masseter literature are secondary to prolonged reduction of muscle function, not to an action of the toxin on bone itself. Animal studies show loss of cortical and subchondral bone after masseter injection. In human data, a meta-analysis found a reduction of about 6% in the thickness of the mandibular cortical bone, with no change in volume or density; conversely, a double-blind, placebo-controlled study with CT imaging over twelve months found no clinically relevant impact on mandibular bone density. What neither answers is precisely the scenario of high-dose injections repeated over many years, which has not been studied. Add to that the temporary drop in bite force in the first weeks and the possibility of the muscle bulging on clenching when the toxin does not reach its whole volume.

In some cases — when the cause is overactivity of the muscles that lift the upper lip. Very low doses are used, over the levator labii superioris alaeque nasi and its neighbors: the lip still rises when you smile, only with less force, and the visible band of gum tends to narrow. In a meta-analysis, gingival display fell by an average of about 3.4 mm at two weeks — pooled from studies mostly without a control group — with values approaching baseline again by around 24 weeks. The limit is the cause: display of skeletal origin, altered passive eruption, excess gum tissue, dental extrusion or a short upper lip are not corrected by toxin, and in those cases the appropriate course is referral to the right professional. Among the possible effects, an asymmetric smile, excessive lengthening of the upper lip and momentary difficulty with fine lip movements are described — usually temporary, and the reason for working with low doses and reassessing before any top-up. Assessment establishes the cause before any injection. It is use outside the labeled indications, supported by specialty literature.

It does not make it bigger. The technique uses a very low dose in the orbicularis oris. It reduces part of the inward pull that curls the lip under, so the lip tends to rotate slightly outward, exposing more of the vermilion you already have. Nothing is added to create volume. Measured by three-dimensional photogrammetry, upper lip height went from an average of 8.31 mm to 8.74 mm at fifteen days, with a shorter white lip, and with no difference in lip volume at any assessment point. Anyone seeking a fuller lip will not obtain that this way. It is use outside the labeled indications, and the literature is still limited.