Botox / Filler Injection

Botox and filler injections are minimally invasive cosmetic treatments that reduce the appearance of wrinkles and restore lost volume in the face without surgery. They are two distinct products used for different purposes, though they are often performed together in the same appointment.

Botox works by using a purified protein to temporarily relax the muscles beneath the skin that cause expression lines — such as frown lines between the eyebrows and crow's feet around the eyes. Dermal fillers, on the other hand, are gel-like substances (most commonly made from hyaluronic acid, a sugar that occurs naturally in the body) that are injected directly under the skin to plump up hollows, smooth deep folds, and add shape to areas like the lips and cheeks. The effects of both are temporary and gradually wear off over months.

These injections are used primarily for aesthetic (cosmetic appearance) concerns, though Botox also has several approved medical uses. A dermatologist or trained aesthetic doctor will assess whether the treatment matches the patient's specific concerns and anatomy.

• Botox: forehead lines and frown lines (the '11' lines between the eyebrows)
• Botox: crow's feet (lines at the outer corners of the eyes)
• Botox: a 'gummy smile' (where too much gum shows when smiling)
• Botox: excessive sweating (hyperhidrosis) in the armpits, palms, or feet
• Botox: teeth grinding (bruxism) and jaw-clenching, by relaxing the masseter (jaw) muscle
• Botox: chronic migraine (severe recurring headaches) — a medical, not cosmetic, use
• Filler: loss of volume in cheeks or temples that makes the face look hollow
• Filler: nasolabial folds (the deep lines running from the nose to the corners of the mouth)
• Filler: thin or asymmetric lips
• Filler: under-eye hollows (tear troughs)
• Filler: non-surgical nose reshaping (rhinoplasty)

These injections are generally not suitable for everyone. Doctors typically advise against them in the following situations:

• Pregnancy or breastfeeding
• Known allergy to any ingredient in the product being used
• Active skin infection, open wounds, or severe acne in the treatment area
• Certain neuromuscular conditions (diseases affecting nerve-muscle communication) such as myasthenia gravis
• Patients on blood thinners who cannot temporarily pause them — increased bruising risk
• Unrealistic expectations or body dysmorphic disorder (a condition where a person is excessively preoccupied with perceived flaws)

Botox and filler injections are generally considered low-risk when performed by a trained medical professional, but like all procedures that break the skin, they carry possible side effects and, rarely, more serious complications.

• Redness, swelling, and tenderness at the injection site — very common and usually settles within a day or two
• Bruising at the injection point — common, especially with filler; typically fades within one to two weeks
• Headache after Botox, usually mild and short-lived
• Asymmetry (one side looking different from the other) if the product spreads unevenly
• Botox spreading to nearby muscles, causing temporary drooping of an eyelid or eyebrow
• Filler lumps or uneven texture under the skin, which may need massaging or dissolving
• Delayed allergic reaction (skin redness, itching, or swelling appearing days later)
• Infection at the injection site — uncommon but possible if aftercare instructions are not followed
• Vascular occlusion (filler accidentally injected into or pressing on a blood vessel, blocking blood flow) — rare but serious; can potentially affect vision or cause skin tissue damage if not treated quickly
• Filler migration (filler slowly moving away from the original injection site over time)

Botox and filler injections do not require general anaesthesia (being fully asleep), so there is no need to fast beforehand. However, there are several steps patients are typically asked to take in the days leading up to the appointment.

Before the procedure, doctors usually advise:

• Avoid blood-thinning medications and supplements — such as aspirin, anti-inflammatory painkillers (like ibuprofen), fish oil, vitamin E, and ginkgo — for around one week before, to reduce bruising risk. Always check with your prescribing doctor before pausing any medication.
• Avoid alcohol for at least 24 hours before the appointment, as it thins the blood and increases bruising.
• Avoid smoking in the days before, as it can slow healing.
• Come to the appointment with clean skin — no heavy makeup, moisturiser, or sunscreen on the treatment area.
• Inform the doctor of any herpes (cold sore) history if the lips or face are being treated, as filler can sometimes trigger an outbreak; preventive treatment may be recommended.

Pre-procedure tests are not usually required for standard cosmetic injections in healthy adults. The doctor will conduct a face-to-face consultation to assess the areas of concern, review medical history, check for contraindications (reasons not to proceed), and take photographs for comparison.

The procedure itself typically follows these steps:

• 1. The skin is cleaned thoroughly with an antiseptic solution.
• 2. A topical anaesthetic cream (numbing cream applied to the skin surface) may be applied and left for a short time to reduce discomfort — this is more common for filler than Botox.
• 3. The doctor marks the injection points on the face with a skin-safe pencil, using the patient's facial movements and anatomy as a guide.
• 4. Very fine needles or blunt-tipped cannulas (thin hollow tubes) are used to inject the product at precise depths and locations.
• 5. The doctor gently massages or moulds the treated area to distribute the product evenly where needed.
• 6. Ice or a cold pack may be applied to reduce immediate swelling and discomfort.
• 7. The patient is given a mirror to review the initial result and ask questions before leaving.

Recovery from Botox and filler injections is usually quick — most people return to their normal daily activities on the same day. However, the treated skin needs some care in the first few days, and the final result may take time to fully appear. Botox typically takes several days to show its full effect, while swelling from filler can temporarily make the result look overdone before settling.

• Stay upright for at least four hours after Botox injections — do not lie down, bend forward, or do inverted exercises, as this may cause the product to drift to unintended muscles.
• Avoid touching, rubbing, or pressing on the injected areas for at least 24 hours.
• Avoid strenuous exercise, saunas, steam rooms, and hot baths for 24 to 48 hours, as heat and increased blood flow can worsen swelling and bruising.
• Avoid alcohol for 24 hours after the procedure.
• Do not apply makeup directly over injection points for at least a few hours, or as advised by the doctor.
• Sleep on your back if possible for the first night, to avoid pressure on the treated areas.
• Avoid dental procedures or facial massages for at least two weeks after filler injections, as pressure can shift the product.
• Protect the treated skin from strong sun exposure and use sunscreen regularly during healing.
• Attend any scheduled follow-up appointment — usually two to four weeks later — so the doctor can assess the result and make any small touch-up adjustments if needed.
• Report any unusual pain, sudden vision changes, skin discolouration (colour change), or signs of infection to the treating doctor promptly, as these may indicate a rare but serious complication requiring urgent attention.
• Plan for repeat treatments in advance: Botox effects typically last several months, and filler effects can last from several months to over a year depending on the product used and the area treated.