The Solution for Wrinkle Reduction – Botulinum Toxin Type A

In the pursuit of smoother, more youthful skin, botulinum toxin treatments have been long used as a simple and minimally invasive, yet effective way to prevent the formation of new wrinkles and diminish the appearance of existing ones.

These anti-wrinkle injections contain the botulinum toxin type A (BoNT/A), a potent neurotoxin that reduces the movement of facial muscles. When administered correctly and at the right doses, BoNT/A is safe and has the ability to smoothen the appearance of wrinkles. But how exactly does it work?

The science behind botulinum toxin type A injections

To move any part of the body, the brain sends electrical impulses through the nerves to the muscles which then are triggered to contract, stimulating movement. BoNT/A acts by interrupting this communication between nerves and muscles, temporarily reducing movement, and relaxing the facial muscles. The relaxation of these muscles causes the overlying skin to smoothen, reducing the prominence of wrinkles.

Common questions about BoNT/A treatments

Before getting BoNT/A injections, there are a few common questions that people wish to have addressed. These include:

  • How much do BoNT/A injections cost?
    The cost of BoNT/A injections varies depending on a few factors, such as the brand being used, the area being treated, and the dose being injected. Prospective patients should consult their healthcare professional for specific pricing details.
  • How long do the effects last?
    The muscle relaxation effect of BoNT/A is temporary and generally lasts for around 3–4 months. However, this varies depending on the individual and the specific area being treated. Follow-up treatments are required to maintain the results.
  • What can I expect during treatment?
    Treatment is quick and convenient, usually taking between 10–20 minutes, but can take longer if several areas are being treated at the same visit. No local anaesthesia is required as discomfort during injections is typically minimal. However, the physician may use a topical anaesthetic (numbing cream) or cold pack to reduce any potential discomfort.

The importance of toxin purity

Depending on the manufacturing process, unnecessary bacterial components such as complexing proteins, inactive or denatured neurotoxin, flagellin and contaminant DNA may be present together with the active neurotoxin1. These impurities * increase the risk of triggering an immune response leading to neutralising antibody formation1,2. These antibodies bind to and neutralise BoNT/A, reducing its effectiveness over time.2 As a result, patients may experience inconsistent results, require more frequent treatments or higher doses to achieve their desired results, or even experience complete treatment failure.1,2

Hence while cost and efficacy duration are common considerations before getting the treatment, the purity of BoNT/A formulation is also an important consideration factor. This is because the purity of BoNT/A formulation may have a significant impact on how well the treatment works and how long the effect will last in the future, especially among patients who get repeated treatments and may experience declining treatment effects over time. Diminishing treatment efficacy is a growing concern among patients and healthcare professionals alike. In fact, one survey found that 8 out of 10 patients surveyed experienced diminishing efficacy with botulinum toxin injections, particularly among those who received 3 or more BoNT/A treatment cycles.3

A pure+ BoNT/A formulation lowers the risk of declining treatment effect that arises due to neutralising antibody formation4, and hence offers consistent results with the same dosage with repeated treatments over time. Aside from less effective aesthetic treatments to reduce the appearance of wrinkles, BoNT/A resistance may also restrict its therapeutic use for neuromuscular conditions such as post-stroke spasticity if required later in life.2,4

Patients should thus consider purity when deciding on their botulinum toxin injection treatment and discuss this with their healthcare provider to make an informed decision.

In summary, botulinum toxin is a great treatment option for reducing fine lines and wrinkles, helping individuals to achieve smoother and more youthful-looking skin. However, not all BoNT/A formulations are the same. Before considering treatment, speak with a qualified healthcare professional to ensure you receive a high-quality and pure+ BoNT/A formulation. This minimises the risk of developing resistance while maximising effectiveness and overall satisfaction of your treatment in the long run.

To learn more about botulinum toxin resistance, visit

* Impurities refers to the presence of complexing proteins, inactive neurotoxin, flagellin and bacterial DNA1

+ Pure refers to the absence of complexing proteins, inactive neurotoxin, flagellin and bacterial DNA1


1 Park JY, et al. Neurotoxin impurities: A Review of Threats to Efficacy. Plast Reconstr Surg Glob Open. 2020;8(1):e2627.

2 Dingley M. Potential implications of cosmetic BoNT-A use on future treatment options for neuromuscular disorders and pain. Open Access Government. 2023;146-147. Available at (Accessed Oct 2023).

3 Merz Aesthetics. Consumer experience with diminishing efficacy of BoTH treatment in Asia Pacific. 2021.

4 Kerscher M, et al. lncobotulinumtoxinA: A highly purified and precisely manufactured botulinum neurotoxin type A. J Drugs Dermatol. 2019;18(1):723-728.