Wrinkles / Botulinum Toxin

Q: How long is the downtime?

Please refer to " Questions after injection ".

TOC

Botulinum toxin injection for wrinkles

When we smile, close our eyes, or furrow our brows, the muscles in our face contract, creating wrinkles. These types of wrinkles are often called ‘dynamic wrinkles’ or ‘expression lines’.

Repeatedly making dynamic wrinkles day after day can gradually etch them deeper into our skin, giving the impression of fatigue or aging.

Additionally, as we age, the amount of collagen in our skin decreases, making dynamic wrinkles more prominent and noticeable.

Botulinum toxin temporarily blocks nerve signals to the facial muscles. This causes the muscles to relax. Even when we move our facial muscles, it’s less likely to create expression lines, which helps improve wrinkles.

Recommended for：

Those concerned about wrinkles that appear when smiling or frowning.
Those with fine lines around the mouth and chin.
Those bothered by exposed gums when smiling.
Those who are concerned about drooping corners of the mouth.

Wrinkles that can be treated with botulinum toxin injections

Coretox (botulinum toxin) injections are effective for wrinkles caused by facial expressions such as smiling and frowning. Coretox injections are very effective, especially if the wrinkles are still shallow.

For deep nasolabial lines, hyaluronic acid injecitons is recommended over Coretox.

For forehead wrinkles that have not yet formed, Coretox is sufficient, but for forehead wrinkles that have already formed, it is necessary to use Coretox and hyaluronic acid injections together.

By relaxing the muscles that cause wrinkles with Coretox and then lifting the wrinkles with hyaluronic acid, deep wrinkles become shallower and less noticeable. Additionally, this helps prevent further creasing.

While it is possible to receive Coretox and hyaluronic acid injections on the same day, the ideal approach is to have the Coretox injection first. Then, two weeks later, when the muscles are in a relaxed state, receiving the hyaluronic acid injection leads to a more natural result.

For fine wrinkles on the neck, we recommend Micro Coretox injection or Snekos + Coretox injection.

Flow of treatment

The actual treatment process is as follows. For more information on the formulation and needles used, see the Botulinum toxin treatment page.

STEP

Examination / injections / records

During your examination, we will ask you to move the muscles of your face, determine how wrinkles are formed and which muscles are working, and then administer the injection.

All information such as the injection site, depth, and number of units will be recorded in the medical record along with photos, so you can receive treatment with confidence from the second time onwards.

STEP

Consultation after 2 weeks (free touch-up)

The effectiveness of botulinum toxin is maximal after two weeks. Muscle movement and wrinkle formation are examined to determine the effectiveness of treatment.

If the effect is insufficient, additional injections (touch-ups) will be given free of charge. Additionally, if the effects are too strong, injections of acetylcholine chloride, a relief preparation, may be given.

The size and movement of muscles vary greatly from person to person, and the effects also vary from person to person, so the area and number of units will be recorded in the medical record for the next treatment.

Touch-up is only applicable to wrinkle and philtrum shortening treatments, and is not applicable to treatments for masseter muscles, hyperhidrosis, and hay fever. Free for one injection at the same site (up to three injections of acetylcholine chloride, a botulinum toxin reliever). Please note that a separate re-examination fee will be charged each time. A fee will be charged if it is more than 3 weeks (or the day before if 3 weeks fall on a holiday) after treatment.
We are very busy with reservations, so if you are making a last minute reservation, you may not be able to get a reservation. If you are unable to make a reservation for more than 3 weeks, you will still be charged a fee, so we recommend that you make a reservation for 2 weeks later on the day of your treatment.

STEP

3-4 months later

Since the effectiveness of botulinum toxin wears off, you will be asked to make an appointment for a follow-up visit after a period of at least 3 months, and the injection will be performed again.

Even injections once every six months are effective in preventing wrinkles.

Case photos of wrinkle treatment with botulinum toxin injection

We are presenting cases where Coretox injections were performed at our clinic. Each photo was taken while the facial muscles were engaged.

While wrinkles may not completely disappear even with maximal effort, attaining a state where wrinkles are less likely to form during everyday expressions (such as smiling, frowning, or raising eyebrows) is often sufficient for wrinkle prevention.

Although it’s possible to administer a higher dosage initially, overdosing unnecessarily heightens the risk of unnatural facial expressions. We recommend starting with an injection level that preserves a natural look, and then making any necessary touch-ups or adjustments later on.

Wrinkles between eyebrows before treatment

Wrinkles between eyebrows after treatment

Wrinkles between the eyebrows and nose before treatment

Wrinkles between the eyebrows and nose after treatment

Side effects and precautions

For information on side effects and post-treatment precautions, see Potential side effects of botulinum toxin injections.

Price for wrinkle treatment with botulinum toxin injection

At our clinic, we use “Coretox” as a botulinum toxin preparation.

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
Touch-up	Free
Forehead / Glabella / Corners of the eyes / Nose / Gummy smile / Cheeks / Around lips (Philitrum shortening) / Corners of the mouth (Marionette lines) / Chin	¥18,700
Plastymal bands	¥37,400

Each injection requires a consultation every time. Please be aware that a separate consultation fee will apply.
For wrinkle treatment with Botulinum Toxin, a complimentary touch-up is available for the same area and limited to one time, two weeks after the initial treatment. A consultation is also required for the touch-up, and a separate consultation fee will apply. If you wish to maintain a natural expression, it is possible to start with a conservative amount in the initial treatment and make additional adjustments during the touch-up.
Any touch-up after three weeks (or the day before if 3 weeks fall on a holiday) from the initial treatment will incur a fee. Even if it exceeds three weeks due to difficulty in booking an appointment, it will still be considered a paid touch-up. Therefore, we recommend making your appointment as early as possible.

Micro-Coretox injection (micro-botulinum toxin injection)

Micro-Coretox injection is a method of injecting small units of Botulinum Toxin into the skin in a finely distributed manner. When using Botox, it is also referred to as “Micro Botox” or “Meso Botox.”

It is recommended for skin with fine lines, concerns about sebum, sweat, and enlarged pores.

By injecting a low concentration formulation in a fine manner, it is possible to expect effects such as improvement of fine lines, improvement of skin texture, sebum suppression, and pore improvement while avoiding direct action on the facial expression muscles.

It is suitable for those who prefer a more natural appearance by mildly suppressing muscle movement.

Price for Micro-Coretox Injections

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
5 units	¥19,800
10 units	¥24,200
20 units	¥31,350
30 units	¥38,500

Each injection requires a consultation every time. Please be aware that a separate consultation fee will apply.
Micro-Coretox does not include a complimentary touch-up.
While individual variations exist, for the neck, injections are administered at 30-60 units
For those desiring anesthesia, a numbing cream (additional cost of 3,300 yen) can be applied.

Sunekos + Coretox Injection

This injection combines the non-crosslinked hyaluronic acid “Sunekos 200” with Coretox. The collagen-stimulating effect of Sunekos enhances the treatment’s effectiveness for fine wrinkles and texture improvement, particularly in areas like the neck.

For the neck, treatments are performed every two weeks, typically 3-4 times. In the case of the face, the treatment plan may be adjusted based on the impact on facial muscles, and there may be a switch to Sunekos monotherapy midway.

After achieving a satisfactory result, it’s advisable to repeat the treatment with a roughly six-month interval.

Price for Sunekos + Coretox Injection

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
Sunekos + Coretox	¥48,400

Both consent forms for Sunekos and Coretox are required for the procedure.
Each injection requires a consultation every time. Please be aware that a separate consultation fee will apply.
For those desiring anesthesia, a numbing cream (additional cost of 3,300 yen) can be applied.

Frequently Asked Questions About Botulinum Toxin Injections for Wrinkles

For general inquiries about Botulinum Toxin injections and post-injection questions, please refer to the “Frequently Asked Questions about Botulinum Toxin Injections.”

How long is the downtime?

Please refer to “Questions after injection“.

Is the treatment painful?

The pain during needle insertion is not intense due to the use of the finest 34G needle. However, there may be a slightly stronger sensation during the injection of the solution. It lasts for a short duration, so anesthesia is not usually necessary.

How soon will the effects be noticeable?

In Coretox injections for wrinkles, the effects gradually start to appear within 3 to 4 days, reaching their peak around 2 weeks later.

Can I get as much injected as possible?

It is possible to inject a higher number of units based on your preference. However, increasing the quantity raises the risk of having an unnatural appearance.

To maintain a natural expression, it is recommended to start with the standard dosage for the initial treatment. If necessary, a touch-up injection can be performed two weeks later.

Is it possible to have Botox injections for multiple wrinkles on the same day?

It is possible to treat multiple areas where wrinkles are a concern at the same time.

However, it is not possible to treat “vertical wrinkles around the mouth” and “shortening of the philtrum” at the same time. Additionally, if you treat #vertical wrinkles around the lower lip”, “marionette lines”, and “chin wrinkles” all at once, there is a high risk of facial distortion. It is safer to treat each area individually.

How long is the recommended interval between treatments?

Since the effects last for 3-4 months, we recommend treatments at intervals of 3-4 months. However, even receiving treatment once every 6 months can provide sufficient wrinkle prevention.

Is it possible to make adjustments if the effect is insufficient or if it’s too strong?

If it is determined that the botulinum toxin treatment is not sufficiently effective at the re-examination two weeks later, touch-ups (additional injections) will be performed free of charge.

On the other hand, if the effect is too strong, acetylcholine chloride, a botulinum toxin antagonist, may be injected.

Injections of acetylcholine chloride make it easier for muscles loosened by botulinum toxin to move. The effects begin to appear after 24 hours and disappear in a few days. Repeated injections once or twice a week may slightly speed recovery of muscle function. However, the effects are not significant and it is important not to overdo the botulinum toxin injection.

One retouch of the same area is free of charge. Up to three injections of acetylcholine chloride are free.

Please note that a consultation fee will be charged for each visit. Additionally, if the first adjustment injection is given more than 3 weeks after the treatment, there will be a charge.

List of references/websites

Allergan, “BOTOX onabotulinumtoxinA injection” アクセス 2020.10.23
アラガン・ジャパン, “医療用医薬品：ボトックスビスタ” 添付文書情報2020年8月改訂
Medytox, “Coretox“　http://www.medytox.com/page/coretox アクセス 2020.11.21
株式会社エムエムアンドニーク, “UNIEVER注射針・注射筒” https://www.mm-japan.co.jp/product/micro_injection_needle.html アクセス 2020.11.21
Oliver Lange, “Neutralizing antibodies and secondary therapy failure after treatment with botulinum toxin type A: much ado about nothing?” Clin Neuropharmacol. Jul-Aug 2009;32(4):213-8. doi:10.1097/WNF.0b013e3181914d0a. PMID: 19620852
Dirk Dressler, “Antibody-induced failure of botulinum toxin therapy: re-start with low-antigenicity drugs offers a new treatment opportunity” J Neural Transm (Vienna). 2018 Oct;125(10):1481-1486. doi: 10.1007/s00702-018-1911-3. Epub 2018 Jul 31. PMID: 30066275
Margherita Fabbri, “Neutralizing Antibody and Botulinum Toxin Therapy: A Systematic Review and Meta-analysis” Neurotox Res. 2016 Jan;29(1):105-17. doi: 10.1007/s12640-015-9565-5. PMID: 26467676
君浦隆ノ介, “脳卒中後の痙縮に対する治療(1) チーム医療として取り組むボツリヌス治療” 運動と医学の出版社発行年：2017
Markus Naumann, “Meta-analysis of neutralizing antibody conversion with onabotulinumtoxinA (BOTOX®) across multiple indications” Mov Disord. 2010 Oct 15;25(13):2211-8. doi: 10.1002/mds.23254. PMID: 20737546
Hanna E, Xing L, Taylor JH, Bertucci V. Role of botulinum toxin A in improving facial erythema and skin quality. Arch Dermatol Res. 2022 Oct;314(8):729-738. doi: 10.1007/s00403-021-02277-0. Epub 2021 Sep 14. PMID: 34519860.
Shuo L, Ting Y, KeLun W, Rui Z, Rui Z, Hang W. Efficacy and possible mechanisms of botulinum toxin treatment of oily skin. J Cosmet Dermatol. 2019 Apr;18(2):451-457. doi: 10.1111/jocd.12866. Epub 2019 Jan 29. PMID: 30697928.
Ahmed El Attar Y, Nofal A. Microbotox for the treatment of wide facial pores: A promising therapeutic approach. J Cosmet Dermatol. 2021 May;20(5):1361-1366. doi: 10.1111/jocd.13675. Epub 2020 Sep 27. PMID: 32799408.