What to Expect: BTX —
Examined In Motion, Then Dosed

The first question is whether a muscle is causing the line at all. A line that remains when your face is completely at rest will not be removed by relaxing the muscle, and may need skin treatment or filler instead; forehead and frown lines explains the difference.

Dr SY then takes a history. Tell him about:

• medicines or conditions that affect the signal from nerve to muscle;
• a tendency to bleed or bruise, and any blood thinner, aspirin or fish oil;
• pregnancy or breastfeeding;
• earlier BTX: the product, the areas and the dates, with records if you have them.

Do not stop a prescribed medicine before treatment unless the doctor who prescribed it agrees. Photographs are taken with your consent, for your medical record only, and are never published. You leave with a written plan naming the zones, the product and the two-week visit, and no treatment is always one of the options.

1. Muscles watched in motion. Dr SY examines your face at rest, with your brows fully raised, in a frown, and with your eyes closed and then reopened. For jaw slimming he feels the masseter while you clench.
2. Brows and lids checked. He judges where the brows sit relative to the bone of the eye socket, and looks at the upper lids for loose skin that could settle onto the lashes once the forehead relaxes. If your forehead is working to hold heavy lids open, it is dosed lightly, or the plan turns to the lids instead.
3. Balance planned. Forehead and frown are normally treated as a pair, which helps keep the brows from being drawn downwards. Each side is mapped separately rather than averaged, and the two doses can differ.
4. Points marked. The injection points are marked on the skin.
5. Skin cleaned and comfort agreed. The skin is cleaned, and a cool pack or a topical anaesthetic is used where a zone is sensitive.
6. Injections. Small volumes go into each point with a fine needle: superficial at the corner of the eye, deeper in the frown muscles and the masseter.
7. Before you go. A small bump forms at each point and flattens, usually within the hour. You leave with written aftercare.

Each point brings a brief sting. Over the frown muscles you may also feel pressure, and over the crow's feet very little. Injections into the masseter feel more like deep pressure.

A cool pack or topical anaesthetic takes the edge off a sensitive zone, but you may still feel the needle, so say if any point is uncomfortable.

Nothing changes while you are in the chair, and that is expected: the muscles quieten over the following days. After jaw slimming the change is slower still, as the jaw BTX page explains.

What to do in the first hours and days, and the signs to report, are in BTX aftercare.

How you are likely to look, and when to plan work and events, is in BTX downtime.