Botulinum toxin temporarily blocks the signal travelling from the nerve ending to the muscle. Because the muscle cannot contract, the line it creates softens, or an involuntary spasm stops. The effect is not permanent; nerve endings re-establish their connections over time and the muscle returns to its former function.
Around the eyes it serves two distinct purposes: softening expression lines, and treating medical conditions in which the periocular muscles contract excessively. The two uses share the same substance, but the planning, the injection sites and the follow-up intervals are entirely different.
The amount and the injection points are determined individually. No dosing information is given on this page; treatment is planned only through clinical assessment.
Suitable candidates:
I do not treat when:
Almost all of these are temporary, because the effect of the substance itself is temporary. Any unexpected finding should be reported to the physician who performed the treatment.
These are not alternatives to one another. They answer different problems.
How these are planned together is set out on the periocular rejuvenation page.
In the short video below I explain whether botulinum toxin should be avoided before eyelid surgery.
I am an ophthalmologist working in oculoplastic surgery in Kadıköy, Istanbul. I hold the FEBO diploma of the European Board of Ophthalmology and am an active member of ESOPRS and of the Oculoplastic Surgery Unit of the Turkish Ophthalmological Association.
For patients travelling from abroad, the timing matters: the full effect is not visible until day 10-14, so a review before that date tells us little. For medical indications such as blepharospasm, treatment is an ongoing relationship rather than a single visit, and I discuss how follow-up will be arranged before starting.
Eyelid twitching is most often a self-limiting problem related to fatigue and caffeine. Contractions that persist for weeks, become severe enough to close the eye, or spread to other parts of the face should always be assessed.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
What is popularly called Botox is, in medical terms, a botulinum toxin injection. The substance temporarily blocks the signal travelling from the nerve ending to the muscle; because the muscle cannot contract, the line it creates softens or an involuntary spasm stops. The effect is not permanent.
The effect usually becomes noticeable within 3-7 days and reaches its full extent at day 10-14. The result should not be judged before then. Any fine-tuning is done at the two-week review.
In aesthetic use the effect lasts on average 3-6 months. In medical use such as blepharospasm, the retreatment interval is set individually and is usually a matter of months. A shorter than expected effect after the first treatment often becomes more consistent with repeated sessions.
Temporary eyelid ptosis can develop if the substance spreads to the neighbouring muscle. It is not permanent but may last several weeks. Brow drop from over-weakening the forehead muscle is similarly temporary, which is why I am cautious about treating the forehead in patients whose brow is already low.
When the amount and the injection sites are appropriate, no direct harm to the eye is expected. If the orbicularis muscle is weakened excessively, however, lid closure can become difficult and dryness may follow. This is why periocular treatment should be performed by a physician who knows the anatomy of the lids.
Blepharospasm is the involuntary, repetitive contraction of the eyelids, which can become severe enough to prevent the eyes being kept open. Botulinum toxin is the most established treatment; it is applied to the muscles responsible and repeated at intervals as the effect wears off. Treatment is an ongoing follow-up relationship rather than a single session.
It is not used during pregnancy or breastfeeding, where there is active skin infection at the site, in neuromuscular junction disorders such as myasthenia gravis, or where there is known hypersensitivity to botulinum toxin. In patients on blood thinners, treatment is not planned without consulting the prescribing physician.
Do not bend forward or lie down for the first four hours, and do not massage the treated area. Avoid strenuous exercise, sauna and steam rooms for 24 hours, and limit alcohol on the first day. Wait two weeks before judging the result.
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