Ask the Expert: Botox Myths and Truths

Botox combats signs of aging and has other medical benefits as well, but misinformation abounds. Here, we dispel common myths of Botox and give you the facts.

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Botulinum toxin - in particular, Botulinum type A (BTA) - is an injectable neurotoxin, better known under various brand names in the market. In 1987, ophthalmologists Dr Alistar and Jean Carruthers discovered that patients who had their squint treated with BTA, had miraculous improvement of the tiny irritating wrinkles at the corner of their eyes, and so this miracle potion was used to treat wrinkles ever since. But the magic doesn’t stop at crow’s feet, in addition to combating the signs of aging, BTA has other medical uses to offer as well, which we will share with you in this article. But before we get to that, let’s examine why wrinkles occur and which areas are usually affected most.

Well, it is rather evident that the first signs of aging for many women are often around the eyes. We typically blink 28,000 times per day and it is little wonder that wrinkles appear around the eyes first, in the form of crow’s feet. Furthermore, fine lines may also appear on your forehead, cheeks and lips from frowning and smiling. But of course, we don’t want you to stop smiling, so here we give you the full rundown of wrinkles and how to get rid of them with ease.

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There are two types of wrinkles: dynamic and static wrinkles. Dynamic wrinkles appear when you animate your face such as winking your eyes, smiling or frowning. Static wrinkles, however, remain on the face even after our facial muscles relax and tend to deepen with age. Eventually with time, the decrease in collagen production and skin laxity can cause dynamic wrinkles to become static wrinkles - permanently etched on your face. This could make you look tired or older than your actual age. However, it’s worth noting that wrinkles are not just caused by aging. Wrinkles can be contributed by external factors such as squinting too much when you go out under the hot Singapore sun, contributing to the development of crow’s feet. Besides that, pursing your lips from smoking too much could also cause fine lines to form around your lips like barcodes on a label.

No matter what the cause, there are definitely safe options to remove these pesky lines and one of them is to have injections of BTA.

At iCare Medical And Wellness Clinic, Dr Larry Wu and his team understand how wrinkles and fine lines can impact your self-confidence and they are dedicated to quality, service and image enhancement with a focus on making clients feel comfortable in their own skin. It is also worth noting, that Dr Wu only uses a specific brand of BTA, backed by extensive scientific evidence.

On that note, despite being one of the commonly requested nonsurgical aesthetic procedures in Singapore, we understand that there are a lot of false rumors circulating in regards to Botox type A. Read on to unpack prevalent BTA myths and discover what this injectable can do for your appearance and your self-confidence.

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How is Botox type A used to remove wrinkles and what’s its other benefits?

Botulinum Toxintype A (BTA) is a neurotoxin typically used to treat muscle spasms. Basically, it relaxes the muscles in the face so as to erase wrinkles, in turn restoring your youthful appearance. This has a smoothening effect on the face, as well as a numbing one, preventing the muscles from contracting.

Besides erasing these unwanted facial scribbles, BTA can also be used to medically treat conditions like:

  • Eye twitching
  • Chronic migraine
  • Bladder dysfunction
  • Hyperhidrosis (abnormally excessive sweating)
  • Cervical dystonia (abnormal contraction of neck muscles)

So, what are the common fallacies of Botox type A and what is fact over fiction?

Myth #1: My face will look frozen

Many women are under the impression that BTA will freeze their facial muscles and leave them looking expressionless. This is a misconception that has carried forth throughout the years because we have seen many celebrities that have a very plastic-looking face after they claim they have received this treatment. However, this procedure has improved over the years and a trained physician will always advise you against overdoing it.

Fact #1: Botox type A gently relaxes - not freezes - your facial muscles

A proper consultation with a trained physician will ensure you leave with natural-looking results. During the consultation, Dr Wu would examine the severity of your aging lines as well as your dynamic facial muscle movements to pinpoint what may lead to dynamic wrinkles formation over the years. This provides the basis of how much BTA injections you may need to ensure you get the right amount required.

Dr Wu’s Advice: “Less is more with BTA, especially if you’re looking for a natural result. Think of it like adding salt to your cooking - add too much - and the entire dish becomes unpalatable. In the same way, if you start with minimal treatments, you can always add more if you want a more dramatic result, but too much BTA can’t be undone; you’ll need to wait 3 to 4 months for it to dissipate.”

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Myth #2: Botox type A injections are painful and toxic

BTA is considered safe and is a clinical treatment approved by the FDA for cosmetic use since 2002. A recent study published in the Clinical, Cosmetic, and Investigational Dermatology journal reaffirms this and continues to find BTA to be safe, effective and painless when administered by a skilled professional.

Fact #2: Botox type A is a non-invasive cosmetic treatment

BTA, just like dermal fillers, are considered to be non-invasive aesthetic treatments given through thin needle injections. The procedure does not involve surgery and should be performed by certified and highly skilled aesthetic practitioners, such as Dr Wu.

Dr Wu’s Advice: “When you make an appointment to get BTA injections, you are putting your trust in the physician. In our clinic, we use specially concocted numbing cream from a registered pharmacist to reduce the pinprick to a tiny discomfort.”

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Myth #3: I’m too young for Botox type A

BTA is not just for older women with naturally occuring wrinkles. Approved by the FDA for healthy adults aged between 18-65, you can safely receive this treatment based on the advice of the physician, even at an early age. In other words, there is no ‘perfect’ age to receive BTA. If you have dynamic wrinkles that bother you, even if you're only in your late 20’s, you can opt for this treatment to address your concerns.

Fact #3: Botox type A is for anyone with Dynamic Wrinkles

What this means is that BTA can remove any dynamic wrinkles that show when you squint or smile. Static wrinkles that remain on the face even after your facial muscles are relaxed will not disappear easily with this treatment.

Dr Wu’s Advice: “All faces deflate, descend and wrinkle, as our faces age along an aging curve. If we can intervene early, we can plateau the aging curve so that you age more gracefully. But, if you wait too long to start, like in your 30’s to 40’s, you will need more modalities of treatment than a simple BTA treatment.” “No matter how skilled and qualified the physician is, they may not be able to give you the result you’re looking for - depending on your age and skin type - and they should be upfront about it. They may even gently steer you away from BTA entirely, if it’s not a good fit.”

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Myth #4: Botox type A provides immediate results

BTA results aren’t instantaneous. The effects are gradual - over the days following the treatment. You can expect to see visible changes over the course of three to four days after your appointments. Optimal results show in about one to two weeks and generally last up to three to four months. In some patients, the results may last up to 6 months.

Fact #4: The treatment is quick and easy

Although BTA does not show immediate results, the procedure is quick and can be done during your lunch breaks! It involves an application of anaesthetic cream 20 minutes before the procedure, with the actual procedure taking only 5 to 10 minutes to complete. There’s no time-consuming preparation and you would be able to carry on with your daily activities such as work, shopping or even going to the gym after the treatment. Most patients experience no visible side effects and no one will even know you had it done!

However, with that said, some patients may experience mild side effects such as slight swelling and rare bruising. But this can be minimised by applying an ice pack to the area or a simple touch-up with concealer!

Dr Wu’s Advice: “It’s best to avoid alcohol at least 1 day before and 1 day after the treatment. You should also stop taking Vitamin E supplements, aspirin and anti-inflammatory medications 1 week before treatment to help prevent bruising. In the local Singapore context, it is advisable to stop traditional Chinese medications such as cordyceps and ginseng supplements 5 days before the procedure as they have been known to cause bruising too. Besides that, avoid rubbing the injected site for 24 hours so you don’t spread the BTA to another area.”

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What are the alternatives to Botox type A if it's not recommended for you?

Sometimes there is confusion by the patient of what BTA does and what can be achieved from it. Dr Wu explains that patients can be treated with either BTA alone or in combination with a dermal filler. Aging is a complex interplay of intrinsic and extrinsic factors across multiple layers of the face. In fact, a consensus paper by Carruther et al in 2016, recommends that to effectively address the different aspects of facial aging, a multi-prong approach involving BTA, an energy based device and a dermal filler is required.

If smooth, radiant and youthful skin is what you long for, dermal fillers could be the choice for you. In fact, certain dermal-fillers have dual function of volumising the face as well as collagen stimulation so that the eventual result is a harmonised rejuvenated appearance. This procedure is a non-surgical treatment too, which aims to smoothen the skin by adding volume to it and reducing visibility of wrinkles. Before treatment, we suggest you have a consultation with Dr Wu about BTA and the dermal filler treatments to decide upon which procedure may suit you best.

CTA: Are you ready to turn back the clock and get smooth skin with long-lasting results? call iCare Medical And Wellness Clinic to schedule a consultation with Dr Wu, or book an appointment here.

References for article:


  1. Carruthers, et al, Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices, VL - 42, Dermatologic surgery : official publication for American Society for Dermatologic Surgery