Anti-wrinkle injections (Botulinum toxin injections)
Injections of a prescription-only muscle-relaxing medicine that soften lines caused by facial expression, such as frown lines and crow's feet.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It relaxes muscles to soften movement lines such as frown lines and crow's feet; it does not fill lines or improve skin quality.
- The effect is temporary, usually lasting about 3 to 4 months, so repeat treatments are needed to keep the result.
- Botulinum toxin is a prescription-only medicine: it must be prescribed by a doctor, dentist, or prescribing nurse or pharmacist after seeing you in person.
- It is illegal in England to give these injections to anyone under 18 for cosmetic reasons, and the medicine cannot legally be advertised to the public.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can soften frown lines, forehead lines and crow's feet caused by movement
Anyone under 18 seeking it for cosmetic reasons (this is illegal in England).
Tiny raised marks or mild redness at the injection points usually settle quickly. Avoid rubbing or massaging the area, as advised by your practitioner.
Written aftercare advice and a clear explanation of what is normal.
Tiny raised marks or mild redness at the injection points usually settle quickly. Avoid rubbing or massaging the...
Follow any advice about staying upright, avoiding strenuous exercise, and not having facials or heat treatments. A...
The muscle-relaxing effect begins. Lines start to look softer as movement reduces. This is also the window in...
Full effect is usually seen. This is the point at which a review can check the result and top up an uneven or...
What are anti-wrinkle injections?
Anti-wrinkle injections use a tiny dose of botulinum toxin, a prescription-only medicine, to relax specific facial muscles. When a muscle relaxes, the skin over it creases less, so lines made by movement (such as frown lines, forehead lines and crow's feet around the eyes) look softer.
The medicine is given through several small injections with a very fine needle. The practitioner targets the muscles causing the lines, so the injection points are not always where you might expect.
It works best on lines that appear when you move your face. Lines that are still there when your face is relaxed (static lines) may soften but often will not disappear completely. It does not change skin texture, sun damage or volume loss.
Because botulinum toxin is a prescription-only medicine, it must be prescribed for you by a qualified prescriber after a face-to-face assessment. It is not a beauty product that anyone can sell or use freely.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Upper-face treatment
The most common use: softening frown lines between the brows, horizontal forehead lines, and crow's feet at the sides of the eyes.
Brow lift (chemical brow lift)
Careful placement can let the brow sit a little higher by relaxing the muscles that pull it down. The lift is subtle, not dramatic.
Lower-face and neck uses
Sometimes used for a 'gummy' smile, downturned mouth corners, dimpled chin or neck bands. These areas are more technical and carry a higher chance of affecting nearby muscles.
Licensed brands
Three botulinum toxin brands are licensed in the UK for cosmetic facial lines (Azzalure, Bocouture and Botox). Doses are measured differently between brands, so they are not...
Preparing for your injection
- Have a face-to-face consultation with the prescriber who will assess and prescribe for you; remote-only prescribing is not acceptable for this treatment.
- Tell the practitioner about any nerve or muscle conditions, pregnancy or breastfeeding, recent facial treatments, and all medicines you take.
- Be clear about which lines bother you and discuss what the treatment can and cannot change.
- Avoid alcohol and, if advised, medicines or supplements that increase bruising in the days before.
- Ask exactly which product will be used, who is prescribing it, and who you contact if there is a problem.
- Expect a cooling-off period to think it over; you should never feel rushed into booking on the day.
- Do not book or accept treatment for anyone under 18; this is illegal in England for cosmetic purposes.
What happens
After the prescriber has assessed your face and agreed a plan, the area is cleaned and you may be asked to make expressions (frown, raise your brows) so the muscles can be mapped.
A series of small injections is given with a very fine needle. Most people describe a brief sting. The whole appointment usually takes about 10 to 20 minutes and you can normally go straight back to your day.
You will not see a result immediately. The medicine takes a few days to start working and up to about two weeks for the full effect. Many practitioners offer a review at around two weeks to check the result and adjust if needed.
Is this injection right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Anyone under 18 seeking it for cosmetic reasons (this is illegal in England).
- People who are pregnant or breastfeeding, where it is generally avoided.
- People with certain nerve or muscle conditions (for example myasthenia gravis) where toxin can be unsafe.
- People mainly bothered by static lines, sun damage, skin texture or volume loss, which this does not treat.
- Anyone who cannot have a proper face-to-face assessment with a prescriber.
Delay or rearrange if…
- You have an active skin infection or inflammation at the treatment site.
- You are unwell or have a flare of a nerve or muscle condition.
- You are pregnant, breastfeeding or trying to conceive.
- You have had recent facial surgery or another facial treatment and the area has not settled.
- You feel rushed or pressured and have not had a cooling-off period to decide.
Alternatives to discuss
- Doing nothing, or using good skincare and sun protection.
- Dermal fillers for static lines or volume loss (a different treatment with its own risks).
- Skin resurfacing such as peels or laser for surface lines and texture.
- Make-up and non-treatment options for a softer appearance.
- For medical problems such as sweating or migraine, an NHS or specialist referral.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can soften frown lines, forehead lines and crow's feet caused by movement
- Gives a smoother, sometimes fresher or more rested look
- Quick appointment with usually no time off
- Effect is temporary and wears off, so an unwanted result is not permanent
- Can be adjusted at a follow-up if the result is uneven or too strong
Risks & complications
- Small bruises, redness or swelling at the injection points
- Mild headache for a day or two
- A heavy or tight feeling in the forehead while it settles
- Result that is not fully even between the two sides
- Drooping of an eyebrow or eyelid if the medicine affects a nearby muscle
- A 'frozen' or surprised look if too much is used
- Difficulty with some expressions, such as smiling naturally, when the lower face is treated
- Result wearing off sooner than expected, or not working as well as hoped
- Spread of the medicine beyond the treated area, causing muscle weakness elsewhere. Very rarely this leads to a botulism-like illness (called iatrogenic botulism) with symptoms such as a severe drooping eyelid, slurred speech, generalised weakness, and difficulty swallowing or breathing. These usually start about 4 to 8 days after treatment but can appear up to 4 weeks later, and are a medical emergency.
- Allergic reaction to the product
- Serious illness from unlicensed or counterfeit toxin bought or used outside proper medical channels
Most side effects are minor and wear off as the medicine does. The biggest avoidable risks come from who treats you and what they use: an untrained, non-prescribing practitioner, no proper assessment, or unlicensed or counterfeit product. Drooping eyelids or brows usually recover within weeks. Very rarely, the medicine can spread and cause a botulism-like illness, with a severe drooping eyelid, slurred speech, generalised weakness, or difficulty swallowing or breathing. These signs most often appear 4 to 8 days after treatment but can occur any time up to 4 weeks later, and are a medical emergency — get help immediately.
Published figures to discuss
Published cosmetic botulinum-toxin rates vary by product, dose, site, injector skill and how minor effects are counted. Most adverse effects are mild and temporary, but droop, asymmetry and counterfeit or poorly prescribed toxin are important consent issues.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Any mostly minor adverse effect after upper-face botulinum toxin | Systematic reviews report roughly 12–16% when minor effects are counted | Includes headache, injection-site reactions and temporary facial muscle effects. | Botulinum toxin facial injection complications review — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Eyelid or brow droop | Often quoted around 1–5% for glabellar/forehead treatment | Technique, dose and anatomy matter; it usually improves as the toxin wears off. | Botulinum toxin facial injection complications review — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Bruising or injection-site swelling | Common but usually short-lived | More likely with blood-thinning medicines, alcohol around treatment and difficult injection sites. | Guide sourcesClinical context |
| Spread causing swallowing or breathing symptoms | Very rare in cosmetic facial dosing | A medical emergency if it occurs, and a reason to avoid unlicensed or counterfeit products. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no real downtime. Most people return to normal activities straight away, but the result is not instant and takes up to two weeks to appear fully.
- Small bruises or pinpoint marks that fade over a few days
- A mild headache in the first day or two
- A slightly tight or heavy feeling as the muscles relax
- No visible change for several days before the effect appears
- Slight unevenness early on that often settles or can be adjusted at review
Aftercare
- Avoid rubbing or massaging the treated area for the rest of the day, or as advised.
- Stay upright for a few hours and avoid lying flat or bending over for long periods if advised.
- Avoid strenuous exercise, saunas, sunbeds and very hot environments for the first 24 hours.
- Avoid facials, other facial treatments or pressure on the area in the first days.
- Take simple pain relief for a mild headache if needed and you normally can.
- Attend any two-week review so the result can be checked and adjusted.
- Contact your practitioner if you notice drooping, and seek urgent care for any swallowing or breathing difficulty.
- Name and registration of the prescriber confirmed
- Product name and that it is UK-licensed confirmed
- Written aftercare advice and what is normal
- Date for a two-week review if offered
- A direct contact for problems or questions
- Clear plan for what happens if the result is uneven
Scars and how they heal
These are injections with a very fine needle, so there are no surgical cuts or scars. You may get small pinpoint marks or bruises where the needle went in, which usually fade within a few days.
⚠ Get urgent help if…
- Difficulty swallowing, slurred speech, trouble breathing, a severe drooping eyelid, or muscle weakness that spreads away from the face and through the body — get emergency help straight away (call 999 or go to A&E). Very rarely these can be signs that the medicine has spread, a serious condition called iatrogenic botulism.
- Be aware of the timing: these serious warning signs most often appear about 4 to 8 days after treatment, but can develop at any time up to 4 weeks later. Stay alert during this whole period and do not assume all is well just because the day of treatment went fine.
- Drooping of an eyelid or eyebrow that is getting worse
- Signs of infection at injection sites: increasing redness, heat, swelling or pus
- A severe or spreading rash, facial swelling or difficulty breathing (possible allergic reaction)
- Any new or unexpected symptom after treatment, especially if you cannot confirm the product used was UK-licensed
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result looks natural: movement lines are softer but your face still expresses emotion. The full effect appears by about two weeks, which is why judging the outcome (and any adjustment) is best done then rather than on the day.
The effect is temporary. It typically lasts around three to four months before muscle movement returns and lines reappear. No treatment can stop your face ageing, and over-treatment that removes all expression is a sign of poor technique rather than a better result.
The effect usually lasts about three to four months, though this varies between people and treatment areas. To maintain the look, treatment needs repeating. There is no good evidence that you must keep having it, and you can simply stop, at which point movement and lines gradually return to how they were.
Related tests, treatments or support
Anti-wrinkle injections are sometimes combined with dermal fillers (which add volume or fill static lines) or with skin treatments such as peels or laser. They treat different things: toxin relaxes muscles, fillers add volume, and resurfacing improves skin surface. A responsible practitioner explains what each does rather than selling a package you did not ask for.
Follow-up & long-term care
Many practitioners offer a review at around two weeks to check the result and top up if an area is uneven or under-treated. After that, there is no fixed schedule; people return when the effect wears off, usually after a few months, if they choose to.
- Repeat treatment roughly every 3–4 months if you want to maintain the effect.
- Have a fresh assessment each time rather than assuming the same plan always applies.
- Tell your prescriber about any new medicines or health changes before each treatment.
- Avoid having more areas or higher doses than you feel comfortable with.
Repeat, follow-on and what comes next
- Uneven or under-treated areas are usually adjusted with a small top-up at a two-week review, not 'undone'.
- An over-treated, frozen or drooped result cannot be reversed; it must wear off over weeks to months.
- Because the effect is temporary, an unwanted result is not permanent, but you may live with it for some time.
- Repeat treatment is needed roughly every few months to maintain the look.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Written aftercare advice and a clear explanation of what is normal.
- A two-week review to check the result and adjust if needed.
- A named contact and quick route to be seen if a side effect occurs.
- Clear guidance on warning signs that need urgent medical help, such as swallowing or breathing difficulty.
- Honest advice that repeat treatment is optional, not obligatory.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Who prescribes and administers it, and their training and experience
- Number of areas treated and the dose of product needed
- Which licensed brand is used
- Whether a two-week review and any adjustment are included
- Clinic location and setting
- Whether the price covers a proper face-to-face assessment with the prescriber
- The prescriber's fee and confirmation they are a registered prescriber
- Which UK-licensed product will be used
- Number of areas and whether dose top-ups are included
- Whether a two-week review is included and what it costs if not
- What happens, and what it costs, if the result is uneven
- A named contact and plan if you have a side effect or concern
On the NHS? Cosmetic anti-wrinkle injections are private only and not funded by the NHS; some medical uses of botulinum toxin can be available on the NHS when clinical criteria are met.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- No face-to-face assessment by the actual prescriber before treatment.
- Not being told the product is a prescription-only medicine or which licensed brand is used.
- No discussion of what the treatment cannot change (static lines, texture, volume).
- No clear plan or contact route if drooping or another side effect occurs.
- Pressure to book on the day, with no cooling-off period.
Marketing red flags
- Adverts naming 'Botox' or botulinum toxin to the public, which is illegal.
- Offers, vouchers, 'parties' or group events, or treatment alongside alcohol.
- Treatment in homes, hotels or salons with no prescriber involved.
- Claims of a 'without risks', 'lunchtime' or 'natural-looking guaranteed' result.
- No mention of who prescribes, what product is used, or aftercare.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Are you the prescriber, and what are your qualifications and registration?
- Which UK-licensed product will you use, and how is the dose decided for me?
- What result is realistic for my lines, and what will it not change?
- What happens, and what does it cost, if the result is uneven and needs adjusting?
- What are the signs of a problem, and exactly how do I contact you if one happens?
- Are you on an accredited register such as the JCCP or Save Face?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my injection, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this injection not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is it available on the NHS?
Does it hurt?
How long until I see a result, and how long does it last?
Will my face look frozen?
Who is legally allowed to prescribe and give it?
Can under-18s have it?
Why can't I find it advertised by name?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Advice about cosmetic procedures JCCP — Botulinum toxins (prescription-only medicines) information sheet ASA/CAP — Rules for advertising Botox and non-surgical cosmetic interventions DHSC — Botulinum toxin and cosmetic fillers for under 18s (guidance) Save Face — Government-approved register of accredited practitioners Botulinum toxin review — PMC Botulinum toxin facial injection complications review — PMC Botulinum toxin blepharoptosis review — PMC MHRA — Botulinum toxin type A: updated warnings on risk of iatrogenic botulism (July 2026)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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