Everything You Need to Know About Botox

Last updated: July 2026  |  Written and medically reviewed by Dr Ravi Jain, MBBS MRCGP, founder of Riverbanks Clinic

If you’ve been thinking about Botox, here’s the short answer: it’s one specific botulinum toxin type A product, not a catch-all term, and although the licensed UK brands genuinely differ, the practitioner giving you the treatment shapes your result more than the brand name on the vial. I’m Dr Ravi Jain, and I’ve treated this in clinic and trained other doctors in it for years. Below, I’ve answered the questions patients actually ask me, in the order they usually come up.

What is Botox, and how does it actually work?

Botox is a purified form of botulinum toxin type A. What it does, in plain terms, is temporarily turn down the volume on specific nerve signals. For muscles, that means it blocks the release of a chemical called acetylcholine, so the muscle contracts less. For sweat glands, it blocks the signal that tells them to produce sweat.

Think about how often you frown, squint, or raise your brows in an average day. Those repeated folds are what deepen expression lines over time. Botox doesn’t fill those lines in, and it doesn’t add volume back to your face. It simply reduces the muscular pull that’s been carving them in the first place.

Migraine treatment works a bit differently, and it’s worth understanding why. It’s not just about relaxing muscles. Botulinum toxin also dampens activity in sensory nerves and reduces certain pain-signalling chemicals, which is part of why it can prevent migraine days rather than just treating a tense forehead.

How did doctors discover botulinum toxin?

The origin story is more interesting than most patients expect. In the early 1800s, a German doctor named Justinus Kerner studied botulism and, remarkably, was the first to suggest that tiny controlled doses might have a therapeutic use. It took until the 1970s for an American ophthalmologist, Dr Alan Scott, to turn that idea into an actual clinical treatment, initially for eye muscle disorders.

The cosmetic use we know today came almost by accident. Dr Jean Carruthers noticed that patients being treated for eye spasms had noticeably smoother frown lines. She brought that observation to dermatologist Dr Alastair Carruthers, and together they laid the groundwork for aesthetic treatment as we now know it.

You’ll sometimes hear people call it “the most studied medicine in the world.” I can’t verify that specific superlative, but it has genuinely been researched extensively across a wide range of medical specialties for decades.

What can Botox treat?

Most people come to me thinking about frown lines, forehead lines, or crow’s feet, and understandably so, since that’s what most marketing focuses on. But doctors were using botulinum toxin medically long before anyone thought to use it cosmetically.

On the cosmetic side, I treat frown lines, forehead lines, crow’s feet, bunny lines, chin dimpling, gummy smiles, neck bands, jaw clenching from teeth grinding, and facial asymmetry. Some of these applications sit outside a product’s official licence, which simply means I’ll walk you through that clearly before we go anywhere near a needle.

On the NHS side, botulinum toxin is also used for chronic migraine, spasticity, blepharospasm (eyelid spasm), cervical dystonia, overactive bladder, and severe underarm sweating, though local funding and eligibility criteria vary by area. If migraine or sweating is what brought you here, jump straight to the relevant section: Botox for chronic migraine or Botox for excessive sweating.

How does Botox treat chronic migraine?

I want to be precise here, because this gets misunderstood a lot: Botox for migraine isn’t for the occasional headache. It’s a preventive treatment for chronic migraine specifically, which generally means at least 15 headache days a month, with at least eight of those showing migraine features.

There’s a specific injection map for this, called the PREEMPT protocol. It involves 155 units injected across 31 fixed sites spanning the forehead, temples, scalp, neck, and shoulders, and can extend to 195 units across 39 sites for patients whose pain follows a different pattern. Treatment is usually repeated every 12 weeks.

At Riverbanks, I follow the full PREEMPT anatomical map, converting the dose into Speywood units when I’m working with a Speywood-unit product. That conversion matters because products aren’t interchangeable unit for unit, so comparing brands by “number of units” alone is comparing apples to a completely different fruit.

For a deeper dive, see our dedicated guide to Botox for chronic migraine.

How does Botox reduce excessive sweating?

Clinicians call this hyperhidrosis, and the mechanism is the same idea in a different location: the toxin blocks the nerve signal that tells your sweat glands to activate, without damaging the glands themselves.

I treat the underarms most often, along with selected scalp areas. I don’t routinely treat hands, because those injections tend to be significantly more painful and can temporarily weaken your grip, which isn’t a trade-off most patients want. For underarm sweating, I use 125 Speywood units per side, diluted in 2ml of saline so I can cover the area evenly with intradermal injections. Results typically last three to nine months, though this varies from person to person.

Read more in our guide to Botox for excessive sweating.

Which botulinum toxin products are available in the UK?

This is probably the single most common misconception I encounter. People use “Botox” as shorthand for any wrinkle injection, the way some people say “Hoover” for any vacuum cleaner. But it’s genuinely one specific brand among several licensed products.

The UK currently licenses Alluzience, Azzalure, Bocouture, Botox, Letybo, Nuceiva, and Relfydess for cosmetic use, alongside products like Dysport and Xeomin used medically. Each has its own formulation, licence, and dosing system, which is exactly why I don’t chase a specific brand name for you without first understanding what you actually want from treatment.

Botox contains onabotulinumtoxinA and has the longest clinical track record of the group, alongside several licensed medical uses.

Azzalure and Dysport both contain abobotulinumtoxinA and use Speywood units. Azzalure is the cosmetic sibling, Dysport carries the medical indications. This is the toxin family I have the most hands-on experience with, and I find Azzalure particularly reliable for frown lines and crow’s feet.

Alluzience is a ready-to-use liquid version of abobotulinumtoxinA, so there’s no reconstituting with saline before treatment.

Bocouture and Xeomin contain incobotulinumtoxinA without the accessory proteins the other products carry. In my experience, Xeomin tends to give the shortest duration of the group, though individual response varies.

Letybo and Nuceiva contain letibotulinumtoxinA and prabotulinumtoxinA respectively. I reach for these when I want precise control in a smaller area, like fine perioral work, occasionally off-label.

Relfydess contains relabotulinumtoxinA and comes ready to use. In trials, the median onset was two to three days, with some participants noticing changes within a single day, and effects still measurable at six months in many participants. Of everything I use, this is the one I find gives the longest duration overall, and I favour it particularly for frown lines and crow’s feet.

Disclosure: Dr Jain provides professional training on behalf of the manufacturers of Azzalure, Relfydess, and Letybo. This training relationship is separate from, and does not influence, individual patient treatment recommendations.

If you’re weighing Relfydess against Botox specifically, read our detailed Relfydess vs Botox comparison.

Will you actually feel or look different depending on the brand?
Some patients notice differences in how quickly it kicks in or how long it lasts. But no brand automatically gives you a “natural” look versus a “frozen” one. That distinction comes down to dose, injection pattern, and the judgement behind both, not the label on the vial. You’ll also hear claims that one toxin “spreads more” than another. That’s an oversimplification. Dose, dilution, volume, placement, and your own anatomy all play into how a treatment behaves.

Why does botulinum toxin type A matter?

There are several botulinum toxin serotypes, but type A is what almost all aesthetic and most medical practice relies on. It targets a nerve protein called SNAP-25, which stops the nerve from releasing acetylcholine. It has the deepest evidence base and a duration that works well clinically. Type B exists and targets a different nerve protein, with more autonomic effects, and is reserved for select neurological conditions rather than routine aesthetic use.

What happens during a Botox appointment?

A proper consultation starts with listening, not with a needle. When you come in, I want to understand what’s actually bothering you, what you’ve tried before, your medical history, any medicines or allergies, recent surgery, and anything that might rule out treatment altogether.

I’ll photograph your face at rest and while you’re moving it, note your natural brow position and any pre-existing asymmetry (nearly everyone has some), and score your lines using a recognised severity scale. That baseline matters for two reasons: it keeps us both honest about what changed, and it helps you recognise which asymmetries were already there before we started.

I don’t always mark every injection point on your skin beforehand. I work from anatomical landmarks, how your muscles move, and clinical judgement, using fine 32-gauge needles to keep things as comfortable as possible. For anyone I’m treating for the first time, I’ll see you again a month later, because although you’ll notice changes sooner, the full result keeps settling for a few weeks, and I want to assess you once it’s actually finished developing.

As I tell my training delegates: the product matters, but the practitioner matters more. Assessment, dose, and placement are what actually create your result.
— Dr Ravi Jain

Are there any side effects?

Most patients sail through without any real problems. Some get temporary redness, tenderness, swelling, bruising, or a headache, which settle on their own. Occasionally, treatment affects a muscle next door to the one intended, causing a heavy brow, a drooping eyelid, or a slightly altered smile. These are frustrating, but they resolve as the toxin wears off.

There’s a rarer, more serious risk worth being direct about. In very rare cases, the toxin’s effect can spread beyond the treated area and cause botulism. On 15 July 2026, the MHRA strengthened its warnings across all UK-licensed type A products. If you ever experience difficulty swallowing, slurred speech, trouble breathing, or generalised weakness after treatment, seek medical help immediately. These symptoms can appear within days, or as late as four weeks afterwards.

The MHRA has also flagged that high doses, injecting outside approved sites, certain neurological conditions, and counterfeit or unlicensed products all raise this risk. This is precisely why choosing a properly qualified practitioner using a licensed UK medicine isn’t a nice-to-have, it’s the thing that actually protects you.

Do you need traditional Botox aftercare?

You’ve probably heard the classic list: no lying down, no bending over, no exercise, no alcohol, no flying, no facial treatments. Here’s the thing: strong evidence never really backed most of these rules.

A 2025 Italian multicentre study looked at over 5,000 upper-face treatments. Patients were simply observed for ten minutes after injection, then went back to normal life with no restrictions. Among the 4,000 who returned for follow-up, there were zero cases of upper eyelid droop, and overall adverse effects turned up in under 6% of those reviewed.

That study wasn’t perfect. It looked backwards rather than forwards, had no comparison group, and not everyone came back for follow-up, so it can’t prove restrictions never matter in any circumstance. But it does meaningfully challenge the idea that you need weeks of caution. At Riverbanks, once you’ve sat with me for the first ten minutes, you’re free to exercise, lie down, fly, or get on with your day as normal.

Does exercise make Botox wear off faster?

I hear this a lot from patients who exercise regularly, and honestly, there isn’t much high-quality research to answer it definitively. One 2023 study followed 60 women with varying activity levels and found the most active group lost their aesthetic result sooner, possibly because more active muscles reinnervate faster. But one small study can’t establish a firm rule, so I don’t tell active patients to scale back healthy exercise on the strength of it. What I do instead is simply track how long your results last and adjust your future treatment accordingly.

Can patients develop resistance to Botox?

True resistance, where your immune system builds antibodies that neutralise the toxin, does exist, but it’s genuinely rare at the doses used aesthetically. In my own career, I’ve almost never seen a case of genuine resistance. Far more often, something else explains a disappointing result: the dose wasn’t quite enough, the placement was slightly off, the wrong muscle was targeted, or you were assessed too early before the full effect had settled in.

Before anyone reaches for “resistance” as the explanation, it’s worth ruling out these more mundane, more common causes first. It’s also part of why I’m cautious about unnecessary top-ups and very short intervals between treatments, since higher cumulative exposure is one of the few things that can genuinely raise the odds of true resistance over time.

Is long-term treatment safe?

This medicine has been used clinically for decades, often at higher doses for medical patients than for cosmetic ones, and the long-term safety profile is genuinely reassuring when a licensed product is used correctly. That said, no prescription medicine is entirely without risk, and repeated treatment can change how your muscles move and their size over time, which is exactly why I reassess you at each visit rather than repeating the same template by default.

A 2025 study followed patients who’d received onabotulinumtoxinA for an average of 15 years and found no evidence that it stopped working or that duration declined over that time.

Does the product or the practitioner create the result?

Honestly, no, the product doesn’t decide it, and I’ll happily disagree with anyone who tells you otherwise. Product choice can shift onset, handling, and how long results last, but no premium product can rescue a poor assessment or inaccurate placement. Your anatomy, the dose, the depth, the dilution, all of it matters more than the name on the box.

One patient might need a strong dose for frown lines but a much gentler touch on the forehead. Another might genuinely need different amounts on each side of their face, because most faces aren’t perfectly symmetrical to begin with. This is really the heart of why I’d always encourage you to choose your practitioner first and the brand second. A skilled practitioner can get you a natural result with several different licensed products.

Why does pricing vary between clinics?

This one frustrates patients more than almost anything else, and fairly so. Different clinics run genuinely different clinical and commercial models, so prices can vary a lot for reasons that aren’t always obvious from the price list alone.

What you’re paying for isn’t just liquid in a syringe. It’s the practitioner’s experience, the dose actually prescribed, the product chosen, plus consultation time, photography, follow-up care, insurance, and clinical governance behind the scenes. Some clinics quote “by area,” but that word alone doesn’t tell you the actual dose you’re getting, so two clinics both offering “three areas” might be giving you very different amounts of product. A lower price might reflect a high-volume, shorter-appointment model. A higher one might reflect more time spent on assessment and ongoing care. Neither is automatically wrong, but it’s worth knowing what you’re actually comparing.

You can view our current Riverbanks Clinic prices.

Summary: should you consider Botox?

Botox, and botulinum toxin more broadly, can genuinely help with expression lines, chronic migraine, excessive sweating, and a handful of neurological conditions. But none of that works well without proper assessment and accurate technique behind it. Different brands offer different onset times and durations, but honestly, the practitioner in front of you will shape your outcome more than any brand name on the packaging.

At Riverbanks Clinic near Harpenden, we also see patients from St Albans, Luton, and the surrounding areas. Every patient gets an individual medical assessment before treatment, using licensed, traceable products and evidence-based protocols.

If you’d like to talk it through, you can book a Riverbanks consultation, call 01582 762877, or download the Riverbanks app.

Related reading

• Relfydess vs Botox: a full comparison
• Botox for chronic migraine: what to expect
• Botox for excessive sweating
• Riverbanks Clinic treatment prices

Selected scientific references

1. Santorelli A, et al. Are Post-Care Recommendations Following Upper-Face Botulinum Toxin Treatment Scientifically Necessary? Toxins, 2025.
2. Dodick DW, et al. OnabotulinumtoxinA for Treatment of Chronic Migraine. Headache, 2010. (PREEMPT study)
3. Morhy ON, et al. High Levels of Physical Activity Reduce the Esthetic Durability of Botulinum Toxin Type A. Toxins, 2023.
4. Kroumpouzos G, et al. Exploring Nonresponse to Botulinum Toxin in Aesthetics. JMIR Dermatology, 2025.
5. Ayoub N, et al. Botulinum Toxin Therapy: A Comprehensive Review on Clinical and Pharmacological Insights. 2025.
6. Medicines and Healthcare products Regulatory Agency. Updated Warnings Regarding Iatrogenic Botulism. July 2026.