George · The Biohack Diaries
Botulinum Toxin Nabota
"You'll look like yourself, only with less noticeable frown lines and crow's feet." That is the aim of every botulinum toxin treatment we do. Botulinum toxin is a purified protein that relaxes selected muscles to soften lines, and in skilled hands it can do much more: slim a square jaw, ease teeth clenching, smooth vertical neck bands and lift the contour of the jawline and neck.
Botulinum toxin is one of the doctors' favorite treatments because of its safety and effectiveness. Unlike fillers, which can carry risks such as blindness, botulinum toxin, when administered correctly, can remarkably reduce the signs of aging and contribute to overall skin rejuvenation. We use Nabota, a premium Korean botulinum toxin, and we treat four areas: the upper face, the jawline (masseter), the neck, and the Nefertiti lift.
Numbing cream is included with every treatment, and for the upper face a touch-up within 1 month is included at no extra charge.
What it is and how it works
Botulinum toxin is a drug made from a neurotoxin produced by the bacterium Clostridium botulinum. It is used medically to treat certain muscular conditions, and cosmetically to soften wrinkles by temporarily relaxing muscles.
Many wrinkles are "dynamic" wrinkles. They are formed by thinning of the deeper skin layer (dermal atrophy) together with the repeated contraction of the facial muscles underneath. Every time a muscle contracts to form an expression, the skin attached to it scrunches up. Repeated over years, this movement leaves a permanent line that eventually becomes a deeper wrinkle. This is why people with very animated or expressive faces, who look extremely happy or angry much of the time, tend to have more wrinkles in those areas.
Botulinum toxin acts at the neuromuscular junction, where the nerve signals the muscle to contract. Injecting small quantities into specific overactive muscles causes localized muscle relaxation, which smooths the overlying skin and reduces wrinkles. The same principle is used to reshape the face: when a large muscle such as the masseter is relaxed, it becomes smaller over time; and when muscles that pull the lower face downwards are relaxed, the muscles that lift the face win, giving a lifted jawline and neck.
The treatment is temporary and its effects are fully reversible. It usually starts to work within 3 to 5 days and reaches its maximum effect at about 2 weeks after injection.
Administering botulinum toxin is an art
Administering botulinum toxin is an art: a careful conversation between you and your doctor aimed at achieving the result you want. Each person has different muscle tone, skin laxity and facial characteristics, so each treatment is different. Our approach puts your preferences first, whether you want a natural look or a more sculpted appearance. Beauty is subjective, and our goal is to deliver a result that matches your vision while keeping you safe. We tailor each treatment to your preferences, your career and your lifestyle.
Equally important is knowing when not to treat. It is not about the number of units; more does not mean better. Understanding the right timing and the right areas is crucial, especially for people over 50. For example, we may avoid heavy injections on the forehead to prevent a droopy look, or choose not to perform masseter reduction after the age of 40, to preserve the masseter muscle that supports the structure of the face.
An essential rule: if too much is used, you must wait for it to wear off. If the first dose is conservative, it can always be adjusted to achieve the best result.
What it is for
Reducing facial wrinkles: forehead lines, frown lines between the eyebrows, crow's feet and bunny lines on the nose
Preventing lines from becoming permanent wrinkles
Restoring the skin and lifting the shape of the face
Shaping the eyebrows, including lifting the outer part of the brow
Slimming a square jaw for a softer, V-shaped lower face
Easing teeth clenching and grinding
Softening vertical neck bands
Defining the jawline and lifting the neck contour (Nefertiti lift)
Who it is for
Botulinum toxin suits adults who want softer lines or a more refined facial contour without surgery. The right area and dose depend on your muscle strength, skin laxity, bone structure and age, which your doctor assesses in person. Each treatment area below describes who it suits best.
If you are visiting Thailand for a short time, have your treatment early in your trip rather than just before you fly home. In some cases it can take up to 2 weeks for botulinum toxin to become fully effective, and you may want a touch-up to fine-tune the result.
Who should not have it
Botulinum toxin is safe and effective, but it is not suitable for:
Pregnant women
Breastfeeding mothers
Anyone allergic to botulinum toxin
People with neurological problems
People with myasthenia gravis or other neuromuscular diseases
Some area-specific limits also apply. Masseter reduction is not recommended for people over 40 with skin laxity along the jawline, and people with more advanced aging of the jawline and neck may be better suited to a surgical neck or chin lift than to a Nefertiti lift. Your doctor will explain this at your consultation.
The treatment
Each area takes 30 to 60 minutes, including your consultation, numbing and injection.
Consultation and assessment. We do not rush. We take the time for a thorough consultation so that you get the result you want most. Your doctor examines the area at rest and while you make different expressions, to find the position, strength and insertion points of the muscles and to make sure there is little to no chance of complications.
Numbing. Numbing cream is applied and left to take effect before the injection. There is no additional charge for it. If you are short on time, ice compression can be used instead.
Marking. Your doctor marks the injection points with a pencil.
Injection. We use the smallest needle available on the market, imported from Korea, so the injections are comfortable and almost painless. The injection itself takes no more than 10 to 15 minutes, depending on the area.
After the injection. You can return to most normal activities straight away, following the aftercare advice below.
Your doctor sets the number and timing of repeat treatments after an in-person assessment. We generally recommend repeating treatment every 4 to 6 months. Several treatments can be combined on the same day, as your doctor advises.
Treatment areas
Upper face
What it treats. Forehead lines, frown lines between the eyebrows (the glabella) and crow's feet around the eyes. Bunny lines on the side of the nose are treated as part of the same area.
We treat the upper face as a whole rather than as separate small areas. This avoids "compensatory" movement: when only some muscles are relaxed, the untreated muscles nearby can work harder, deepening their wrinkles over time. Treating the area together keeps the result natural.
Frown lines. Glabella lines are the short vertical lines between the eyebrows that can extend up the central forehead. They make a person look older, and a little angry or worried, all the time. Remember the serious, intimidating old man in your neighborhood when you were a child? Odds are he was not angry at all; he simply had deep glabella lines. People with these lines are often asked "What's wrong?" The lines are created by three muscles, the corrugator supercilii, the procerus and the depressor supercilii. When these muscles become well developed, they pull the inner ends of the eyebrows inwards and downwards, forming furrows. Relaxing them smooths the lines and makes you look younger and happier.
Forehead lines. Removing worry lines from the forehead is as much an art as a science. Your doctor assesses the forehead muscles both at rest and in motion (a static and dynamic assessment of muscle position, mass and function). The aim is to eliminate lines when your face is at rest while keeping the ability to move freely, with minimal wrinkling when you express emotion.
Eyebrow shape. Forehead treatment affects the shape of the eyebrows, which is often overlooked. You can choose to keep your current brow shape or to lift the outer (lateral) part of the brow, which can help if you have heavy upper eyelids. We also discuss whether you prefer a more feminine eyebrow (a high arch) or a more masculine one (horizontal and straight).
Bunny lines. Horizontal lines on the nose have two main causes. The first is an overactive transverse nasalis muscle, which is common in people who gesture a lot, wear heavy glasses, have chronic rhinitis, or have light-colored eyes and squint in response to sun or light. The second is muscle compensation after incomplete treatment around the glabella, which is another reason we treat the upper face as a whole.
What to expect. You will start to see the result within about two weeks, and it can continue to improve over the following weeks. For frown lines, the effect usually begins to decrease gradually after 4 or 5 months and typically wears off entirely by six months, when most people choose to repeat the treatment. We generally recommend repeat treatment every 4 to 6 months. A touch-up within 1 month is included for the upper face; it is usually done once the full effect can be seen at around 2 weeks.
Specific aftercare. For the next hour, gently use the treated muscles by frowning, raising your eyebrows and smiling. Do not rub or press on the injection sites, which can spread the product towards the eyelid and cause a droop. Wash your face gently.
Jawline (masseter)
What it treats. The masseter is one of the chewing muscles and sits at the angle of the jaw. When it is enlarged (masseter hypertrophy), it gives a harsh, square look to the lower face. Relaxing the muscle with botulinum toxin softens the lower face in a safe and effective way, creating a more refined, feminine, V-shaped look. It also reduces teeth clenching and grinding, which can damage your teeth and disturb your sleep.
Say goodbye to surgery. Traditional jaw reduction is invasive surgery that removes bone and carries potentially significant complications. It is more painful and needs a much longer recovery. Botulinum toxin jaw reduction is non-invasive, quick and virtually painless.
Teeth clenching and grinding. For clenching, botulinum toxin is injected into the muscles that move the jaw, mainly the masseter. Depending on your needs, the frontalis and temporalis muscles may also be treated. It reduces clenching, relieves tension and aches, and helps protect your teeth from wearing down.
Who it suits. A good candidate is usually under 40, with firm skin along the jawline, good lower-face support from the bone structure, no severe skin laxity and a large masseter muscle. Your doctor evaluates the shape and size of your masseter, your skin laxity and your bone structure, and feels the muscle at the corner of your jaw while you clench to judge the likely result. We do not recommend this treatment for people over 40 with skin laxity along the jawline, because reducing muscle volume at the corner of the jaw can weaken the support of the lower face. For people in this group who want a more defined jawline, a Nefertiti lift and/or ultrasound lifting are better alternatives.
What to expect. After the consultation, the injection takes no more than 10 minutes, with numbing cream or ice compression to reduce discomfort and the chance of bruising. Botulinum toxin works by weakening the muscle, which then becomes smaller. For clenching, it usually starts to work 3 to 5 days after injection (though it can take up to two weeks), and the effect on clenching may last 3 to 6 months. The slimming result generally lasts around 5 to 6 months, depending on the size of the muscle, the dose and how much you chew after the injection.
Specific aftercare. Immediately after the injection, chew the air 10 to 15 times to help distribute the product within the target muscle. Do not massage the masseter muscles. To make the result last longer, avoid chewing hard or sticky food such as nuts and sticky rice: if you keep exercising the muscle, it can regain its strength and size.
Neck
What it treats. Softens vertical neck bands. We often care for our face but overlook the neck. Your face may keep a youthful appearance while your neck quietly reveals your true age, so it is worth extending your care routine to the neck.
With age, the skin of the neck shows fine lines, wrinkles and sagging. The vertical muscles of the neck, the platysma muscles, pull downwards on the skin. This leads to loose, sagging skin, visible neck bands, sagging along the jawline and jowls, and the loose "turkey neck" that develops as the neck skin sags. Frequently looking down at a phone or computer ("tech neck") adds horizontal lines.
Botulinum toxin is often associated with the face, but it is also an effective treatment for the neck. Relaxing the platysma bands reduces dynamic wrinkles, tightens the skin, improves the contour of the jaw and reduces the appearance of jowls.
What to expect. The injection itself takes less than 15 minutes after numbing. The neck bruises more easily than the face, so we take extra care: our technique is gentle and we stop any minor bleeding promptly to minimize bruising. If a bruise does appear, it usually resolves on its own within 1 to 2 weeks. We recommend repeating treatment every 4 to 6 months.
Specific aftercare. Follow the general aftercare below. Avoiding alcohol, aspirin, ibuprofen and other strong painkillers may reduce the extent of bruising.
Nefertiti lift
What it treats. Defines the jawline and lifts the neck contour. A well-defined jawline with a long neck has been a sign of beauty since the time of the ancient Egyptians. This technique, which creates a well-toned, smooth neck and a lifted jawline, is named after Queen Nefertiti, whose bone structure is still admired today. It has become a popular beauty treatment, with the idea that it is often not your wrinkles but your jaw that ages you.
In a Nefertiti lift, botulinum toxin is placed along the lower jawline and down the side of the neck along the platysma muscle. This improves the definition of the jawline, rebalances the underlying muscles and gives a "lifting" effect in the neck and jaw area. Once the muscles that pull the lower face down are relaxed, the net effect is an upward pull from the facial muscles, creating a younger-looking jawline, neck and face. The lift returns a contoured appearance to the jawline, improves prominent neck bands and, as a non-surgical treatment delivered by injection, also reduces lines and wrinkles, in a short treatment time.
Who it suits. The treatment is suitable for patients of all ages: younger patients who want to prevent the platysma muscle from becoming overactive, and older patients with strong activity in the depressor muscles that pull the face down and cause facial laxity. Ideal candidates are those with the first signs of aging around the jawline and upper neck. People with more advanced aging in this area may not achieve a satisfactory result and may be better suited to a surgical neck and/or chin lift. You should be in good general health and have realistic expectations.
Ideal candidates meet several of these descriptions:
Normal or slim weight
No excess fat along the jawline
Loose or folding skin below the chin or jawline
Neck bands or "turkey neck"
Mild to severe jowls, or cheeks that hang below the jawline
A rippled appearance along the jawline
A very pronounced, square jawline
What to expect. Your doctor first examines your lower face and neck to tailor the treatment to you. After numbing, the skin is prepared and the product is placed gently with a very small needle at the exact location and depth needed. The injection itself takes less than 15 minutes. We recommend repeating treatment every 4 to 6 months to keep the result.
Specific aftercare. Do not lie face down for 4 hours after treatment, and it is better not to bend down, lie down or do strenuous exercise immediately afterwards. Avoiding alcohol, aspirin, ibuprofen and other strong painkillers may reduce bruising. Avoid saunas for 2 weeks, and avoid aggressive skin manipulation such as facial treatments or facial massage. Aftercare is incredibly important with botulinum toxin, and it is something many people overlook.
Before and aftercare
Before your treatment
Stop products containing aspirin, ibuprofen, vitamin E and similar products 10 days before the procedure, to reduce the chance of bruising.
Do not schedule important social events or meetings immediately after the procedure. Most patients have no side effects, but bruising and, rarely, eyelid droop can occur.
Plan ahead. Do not wait until the last minute before an important event such as a wedding; we recommend treatment 2 to 4 weeks before.
Do your daily workout before your appointment rather than after it.
After your treatment
Do not rub or massage the treated area for 3 hours.
Do not lie down for 4 hours.
Avoid straining, heavy lifting or vigorous exercise for 6 hours.
Do not have facial treatments, facial massage or laser treatments for 2 weeks.
If you have swelling or bruising, apply cool compresses.
Follow the specific aftercare for your treatment area above.
If you have any questions about your activities after treatment, please ask us. We are always happy to advise.
Quality and safety
The brand we use: Nabota
Nabota is a premium Korean botulinum toxin produced by Daewoong, a company with more than 30 years of experience in developing innovative pharmaceuticals. It stands out for its purity of 98.7%, known as "Golden Toxin 98.7%", which helps minimize the risk of developing resistance to the treatment over time. Nabota is popular for its fast-acting results and is the only Korean botulinum toxin brand approved by both the U.S. FDA and the Thai FDA. There are more than 20 brands of botulinum toxin worldwide, but only five have passed U.S. FDA approval, and Nabota is one of them.
Genuine, undiluted product
We use only genuine botulinum toxin from the official distributor, certified by the Thai Food and Drug Administration, for safe and long-lasting results. It is always 100% genuine and undiluted. Some clinics dilute their product with saline to cut costs. Cheap or impure products can cause many side effects, including allergic reactions and resistance to future treatment. The possible side effects of fake botulinum toxin include:
Bruising
Lumps
Droopiness
Botulism poisoning
Partial paralysis
Resistance to botulinum toxin treatment in the future
A doctor at every step
Under Thai health regulations, botulinum toxin may only be administered by a licensed, certified doctor. Unfortunately not every clinic follows this rule, and a clinic willing to break one rule about who gives the injection may also break others, such as those on cleanliness or on the products used. Most horror stories about severe complications after botulinum toxin injections in Thailand are the result of injections given by untrained, unlicensed people. If a quoted offer seems too good to be true, it probably is.
At the clinic:
Every case and every step is done by a specialist medical doctor, who prepares and gives the injections personally.
Every treatment is tailor-made to create the best result for you.
The doctors have extensive experience treating international patients, with a wide variety of muscle size, alignment and skin types, and the doctors and staff speak English fluently.
There is no hard selling and there are no sales agents.
Your benefit, your long-term safety and your privacy are our top priorities.
Language can be a barrier when choosing a clinic in Thailand, because most certificates and licenses are written in Thai. One simple safeguard is to make sure the doctor you meet is the clinic's owner, whose own license is at stake if anything goes wrong, and who will therefore take the greatest care to avoid complications.
Dose limits
Botulinum toxin treatments have daily, monthly and even quarterly limits on the amount that can be injected. A trained, licensed doctor knows these limits and makes sure you stay well within them. The general limit per session is 400 units, a dose used only for spastic paralysis; cosmetic doses are far lower.
The science
Types of botulinum toxin
Seven types of botulinum toxin have been identified, known as A, B, C, D, E, F and G. All of them relax muscles by blocking their nerve supply, and with time can make them smaller. The most powerful is type A. Type B is also available for medical use and has a faster but shorter effect.
Botulinum toxin is sold under several names, including:
Botox, Vistabel, Botox Cosmetic (onabotulinumtoxinA, type A)
Dysport (abobotulinumtoxinA, type A)
Bocouture, Xeomin (incobotulinumtoxinA, type A)
Myobloc (rimabotulinumtoxinB, type B)
Safety
Botulinum toxin has become the most popular aesthetic procedure in the world, mainly because of its safety and predictable results. No long-term effects of the toxin have been described. Serious complications after professional injection are rare. The most common side effects reported are eyelid droop after frown-line treatment (about 3%) and eyelid swelling after crow's feet treatment (about 1%), and both resolve within a few weeks. Most side effects come from the toxin spreading to neighboring muscles, which is preventable with correct doses and injection planes. With repeated treatment, the effect can become weaker in some people, probably because of antibodies against the toxin; this is one reason product purity matters.
Complications of masseter treatment
A report by Peng and colleagues on 2,036 masseter treatments listed these possible complications:
Temporary decrease in chewing force (30%)
Bruising (2.5%)
Headaches (0.58%)
Paradoxical bulging (0.49%)
Sunken cheeks (loss of volume below the cheekbone) (0.44%)
Sagging skin (0.20%)
Limitation of the smile (0.15%)
A decrease in chewing power and bruising are expected effects of the medication and of the needle. The other complications can be prevented by careful injection design and by choosing suitable cases. We are proud to report that we have had no cases of any of these complications, because every treatment is tailor-made with close attention to detail.
Frequently asked questions
When will I see the result?
Botulinum toxin starts to work at about day 3 to 5 after injection and reaches its maximum effect at about 2 weeks. The result is reviewed once the full effect can be seen, and for the upper face a touch-up within 1 month is included.
How long does the treatment take?
Each area takes 30 to 60 minutes in total. Most of this time is the consultation and waiting for the numbing cream to work; the injection itself takes about 10 to 15 minutes.
Does it hurt?
Very little. Numbing cream is included, ice compression can be used, and we use the smallest needle available on the market, so almost no pain should be felt.
How can I make my treatment last longer?
Avoid strong sunlight and high temperatures, for example saunas.
Increase your zinc intake.
Make sure your treatment is done with a top-quality, genuine product.
For masseter treatment, avoid chewing hard or sticky food.
Regular follow-up treatments increase the effectiveness of botulinum toxin, so aim for treatment about 3 times a year if possible.
Can I choose a natural look?
Yes. Our goal is a result that looks like you, only fresher. We aim to remove lines at rest while keeping natural movement, and we start conservatively, because more can always be added but too much cannot be removed.
Is it safe to have botulinum toxin in Thailand?
Botulinum toxin is a safe and effective treatment when it is given by experienced, well-trained medical staff. Botulinum toxin injections are among the most common procedures in Bangkok aesthetic clinics, so doctors here are very experienced with them. The key is to choose a properly licensed clinic, where a doctor gives every injection and genuine, undiluted product is used.
I am only in Thailand for a few weeks. When should I have my treatment?
As early in your trip as possible. It can take up to 2 weeks for the full effect, and you may want a touch-up before you leave.
Which areas can I have treated?
We treat the upper face (forehead lines, frown lines, crow's feet and bunny lines), the jawline (masseter) for slimming and teeth clenching, the neck for vertical bands, and the Nefertiti lift for jawline definition and neck contour. Botulinum toxin can also reduce excessive sweating of the underarms, hands and feet, which is a separate treatment.
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