In this guide15 sections
- How botulinum toxin works medically
- Chronic migraine prevention
- Hyperhidrosis (excessive sweating)
- TMJ disorder and bruxism
- Bell’s palsy and facial asymmetry
- Muscle spasticity
- Bladder dysfunction
- Strabismus and blepharospasm
- Platysmal banding and “tech neck”
- Other therapeutic applications
- Combining medical and cosmetic applications
- Who is a suitable candidate?
- Risks and considerations
- Cost
- Common questions
Botulinum toxin is best known as a cosmetic treatment for facial lines and wrinkles, but its therapeutic applications span a substantial portion of clinical medicine. The same active ingredient used in anti-wrinkle injections is licensed for chronic migraine prevention, excessive sweating, muscle spasticity, bladder dysfunction, certain types of strabismus, jaw tension, and several other conditions where temporary muscle or gland relaxation produces meaningful clinical benefit.
This guide covers the medical (non-cosmetic) applications of botulinum toxin available at Centre for Surgery, what each treatment involves, who it suits, what to expect from the procedure and recovery, and how the therapeutic effect compares with cosmetic use. If chronic migraine is your main concern, our page on migraine injections explains the treatment in detail.
How botulinum toxin works medically
Botulinum toxin temporarily interrupts the signal between nerve and muscle (or nerve and gland), preventing the target tissue from contracting or secreting as it normally would. The effect is local, dose-dependent, and reversible — the body gradually regenerates the affected nerve endings over 3-9 months depending on the dose and site, after which the muscle or gland resumes normal function.
In medical applications, the doses used are typically higher than in cosmetic treatment and are placed in larger muscle groups or across broader anatomical regions. At Centre for Surgery, treatment is given only by our GMC-registered surgeons, who are familiar with both the relevant anatomy and the specific protocols for each condition.
Chronic migraine prevention
For patients with chronic migraine (defined as headaches occurring 15 or more days per month, with 8 or more being migrainous), botulinum toxin injection following the PREEMPT protocol can substantially reduce headache frequency and severity. This is one of the most studied therapeutic applications, with substantial evidence supporting its effectiveness.
How it works: the toxin is injected at 31 specific points across the forehead, temples, back of the head, neck, and shoulders. The dose depends on the product and the muscles treated, and your surgeon decides it. The mechanism likely involves reduction in muscle tension, decreased release of pain-related neurotransmitters at nerve endings, and interruption of pain signal pathways. For more on the dedicated migraine treatment, see our migraine injection service page.
What to expect:
- The injections take about 15-20 minutes
- Multiple small injections across head, neck, and shoulders
- Some people notice fewer headache days within 2-4 weeks; others only after the second or third treatment
- Treatment repeated every 12 weeks for sustained effect
Realistic expectations: most patients see meaningful reduction in headache days within the first 1-2 treatment cycles. Complete elimination of migraines is uncommon; substantial reduction is typical. Some patients respond dramatically; others see modest benefit. Your response is judged after two treatments, using your headache diary and the NICE stopping rules.
Suitable candidates: patients with chronic migraine that hasn’t responded adequately to oral preventive medications, or who can’t tolerate the side effects of those medications. If you have been diagnosed with chronic migraine by your GP or a specialist, bring any letters and your headache diary. If you have not, your surgeon takes a full headache history at your consultation and, if the pattern does not fit chronic migraine or another cause needs ruling out, advises you to see your GP first.
Hyperhidrosis (excessive sweating)
For patients with excessive sweating that significantly affects daily life, anti-sweat injections are one of the most effective interventions available. Botulinum toxin blocks the release of acetylcholine — the chemical that activates sweat glands — producing substantial reduction in sweat production for around 6-7 months on average in the underarms, and usually less on the palms and soles.
Common treatment areas:
- Underarms (axillae) — the most common site, with the most predictable results
- Palms (hands) — effective but more uncomfortable to inject; may require digital nerve blocks
- Soles (feet) — similar discomfort considerations
We do not currently offer injections for sweating of the face, scalp or back; your GP can advise on the options for those areas.
What to expect:
- Treatment takes 15-30 minutes depending on area
- Multiple small injections across the treatment area
- Effects begin 2-4 days after treatment
- Full effect at 2-3 weeks
- Result lasts around 6-7 months on average for the underarms; usually shorter for the palms and soles
The compensatory sweating question: a common concern is whether reducing sweat in one area causes increased sweating elsewhere. The evidence for this in patients treated with botulinum toxin is limited — unlike surgical sympathectomy, where compensatory sweating is well documented, injection treatment doesn’t typically produce significant compensation. For more on the comprehensive hyperhidrosis treatment options, see our hyperhidrosis hub.
Combined with other options: for patients seeking longer-term solutions, surgical treatment by suction curettage or Morpheus8 for excessive armpit sweating can give more durable results. Stronger antiperspirants usually come first; injections are a later step when they have not helped enough.
TMJ disorder and bruxism
The temporomandibular joint (TMJ) connects the jaw to the skull. For patients with TMJ dysfunction — characterised by jaw pain, clicking, limited movement, and often associated with bruxism (teeth grinding) — botulinum toxin injection into the masseter muscle reduces the force of clenching and grinding. It should not be seen as a treatment for jaw joint pain itself: a 2024 meta-analysis of randomised trials found it was not clearly better than placebo for TMD pain.
How it works: the masseter is one of the strongest muscles in the body. Chronic clenching and grinding produce hypertrophy (muscle enlargement) that increases force on the joint and contributes to pain. Reducing masseter activity aims to ease:
- Joint loading and inflammation
- Nighttime grinding and tooth wear
- Tension-related headaches associated with jaw clenching
- Subjective jaw tightness and discomfort
A secondary effect: the masseter gradually shrinks over weeks, producing a slimmer lower face appearance. For patients with both medical TMJ symptoms and cosmetic concerns about jaw width, the combined benefit is often welcome. See our dedicated guide on non-surgical jaw reduction for the cosmetic-focused version of this treatment, and our broader jaw slimming injections service page.
What to expect:
- Treatment takes 5-10 minutes
- 3-5 injection points per side
- Effects begin within 1-2 weeks
- Symptom improvement typically over 2-4 weeks
- Result lasts 3-6 months for symptom control; muscle slimming effect about 4-6 months
Dental wear protection: for patients with documented bruxism causing tooth wear, the treatment combined with a custom night guard from the dentist provides comprehensive protection. Many dentists now refer patients for botulinum toxin treatment as part of bruxism management.
Bell’s palsy and facial asymmetry
Bell’s palsy is a sudden weakness or paralysis of the facial muscles on one side, caused by inflammation or damage to the facial nerve. Most patients recover spontaneously over weeks to months, but some are left with persistent asymmetry — the unaffected side overcontracts while the affected side remains weak, producing visible imbalance during expression, speech, eating, and drinking.
Botulinum toxin placed strategically into the overactive muscles on the unaffected side can rebalance the face. By reducing the contraction on the strong side, the visual difference between the two sides decreases, producing:
- More symmetric appearance at rest and during expression
- Easier eating, drinking, and lip closure
- Improved articulation during speech
- Significant psychological benefit from reduced visible asymmetry
What to expect:
- Treatment takes 10-15 minutes
- Small doses placed precisely into specific muscles (depressor anguli oris, mentalis, orbicularis oris, others)
- Effects develop over 1-2 weeks
- Result lasts 3-4 months
- Maintenance every 3-4 months
This is highly specialised treatment requiring detailed understanding of facial nerve anatomy. Patients should be assessed by a practitioner experienced with Bell’s palsy rebalancing rather than treated with the same protocol as cosmetic patients. We may offer this, subject to consultation with one of our surgeons.
Muscle spasticity
For patients with spasticity from neurological conditions — stroke, cerebral palsy, multiple sclerosis, spinal cord injury — botulinum toxin can reduce muscle tone in specific overactive muscles, improving function, comfort, and care:
Common indications:
- Upper limb spasticity following stroke (flexor patterns in the arm and hand)
- Lower limb spasticity affecting walking
- Cerebral palsy in children and adults
- Spasticity-related pain and contracture prevention
This is highly specialised treatment performed in coordination with neurologists, physiotherapists, and occupational therapists. The treatment is typically NHS-provided rather than private; we mention it here for completeness in describing the full therapeutic spectrum of botulinum toxin.
Bladder dysfunction
For patients with overactive bladder symptoms (urinary frequency, urgency, urge incontinence) that haven’t responded to oral medications, botulinum toxin injected into the bladder wall via cystoscopy reduces detrusor muscle contractions and substantially improves symptoms. This treatment is performed by urologists in specialist centres, typically NHS-provided, rather than at our clinic — we mention it for completeness.
For more on the related topic of urinary symptoms in women, see our guide on what causes urinary incontinence in women.
Strabismus and blepharospasm
For patients with certain types of strabismus (eye misalignment) or blepharospasm (involuntary eye closure), small doses of botulinum toxin placed into specific extraocular or eyelid muscles can correct alignment or reduce involuntary contractions. This is highly specialised ophthalmic treatment performed by oculoplastic surgeons or ophthalmologists with appropriate training — outside the scope of standard cosmetic practice.
Platysmal banding and “tech neck”
The platysma muscle in the front of the neck can become visible as vertical cords with age. Botulinum toxin placed into the platysmal bands reduces their contraction and softens the appearance of the cords. This sits at the boundary between medical and cosmetic indication — patients with bothersome platysmal banding can be treated regardless of whether their concern is primarily aesthetic. We may offer this, subject to consultation with one of our surgeons. For the broader neck treatment context, see our guide on how to tighten neck skin without surgery and our non-surgical neck lift hub.
Other therapeutic applications
Less commonly performed but established uses of botulinum toxin include:
- Anal fissure (sphincter relaxation to allow healing)
- Achalasia and other oesophageal motility disorders
- Tension headache (distinct from migraine)
- Hypersalivation in neurological conditions
- Crocodile tears syndrome (gustatory lacrimation after Bell’s palsy)
These specialist applications are typically performed in dedicated NHS or hospital settings rather than aesthetic clinics.
Combining medical and cosmetic applications
Many patients receiving botulinum toxin for medical indications also have some cosmetic concern that can be addressed in the same treatment session. For example:
- Migraine treatment naturally includes injection of frontal and glabellar muscles that also produce forehead lines — cosmetic benefit comes alongside the medical effect
- TMJ/bruxism treatment of the masseter produces both symptom relief and lower-face slimming
- Platysmal band treatment improves both functional and cosmetic concerns
A consultation establishes whether your medical treatment can incorporate any cosmetic considerations you’d want addressed. We don’t perform additional cosmetic treatment beyond what was discussed and agreed; the consultation simply identifies opportunities where the treatment plan can serve multiple purposes.
Who is a suitable candidate?
General considerations across all medical applications:
- A diagnosis of the condition being treated, confirmed at your consultation
- An inadequate response to first-line treatments (where applicable)
- No known allergy to botulinum toxin or its excipients
- Not pregnant or breastfeeding
- No active infection at injection sites
- No neuromuscular disorder (myasthenia gravis, Lambert-Eaton syndrome, motor neurone disease) that would contraindicate treatment
- Realistic expectations about the temporary nature of the treatment
Each medical application has additional specific considerations discussed at consultation.
Risks and considerations
Common (mild and self-limiting):
- Mild discomfort at injection sites
- Small bruise occasionally
- Temporary mild weakness in adjacent muscles if product diffuses (rare with proper technique)
- Mild flu-like symptoms for 24 hours after treatment (uncommon)
Less common:
- Local muscle weakness beyond the intended target if dosing is too high or placement imprecise
- For migraine treatment: temporary neck weakness if too much product is placed in neck muscles
- For TMJ treatment: temporary chewing weakness if dose is excessive
- For Bell’s palsy treatment: asymmetric correction requiring adjustment
Rare:
- Allergic reaction (very uncommon)
- Antibody formation reducing future treatment effectiveness
- Spread of effect beyond the treatment area (very uncommon with appropriate dosing and technique)
Experienced practitioners with detailed anatomical knowledge significantly reduce these risks. A thorough consultation discusses your specific risk profile and the treatment plan.
Cost
Prices for migraine, anti-sweat and jaw slimming injections are listed in our Skin & Aesthetics price list; for other uses, your surgeon confirms the price at your consultation.
Finance options through Chrysalis Finance are available, subject to status, across all treatments.
Migraine and anti-sweat injections at Centre for Surgery are self-pay; we are not able to bill health insurers.
Common questions
Is this the same product used for cosmetic treatment?
Yes — botulinum toxin type A is the same active ingredient. The brand may vary by clinical indication (some brands have specific licences for medical uses), but the underlying mechanism is identical.
How does medical treatment differ from cosmetic treatment?
The dose is typically higher, the injection points are determined by clinical protocols rather than aesthetic considerations, and the goal is symptom relief rather than appearance change.
Will I notice cosmetic changes from medical treatment?
Often yes — particularly for migraine treatment (forehead lines reduced) and TMJ treatment (jaw slimming over weeks). These are usually welcome but should be discussed at consultation if you’d prefer to avoid cosmetic effects.
How long does the medical effect last?
Varies by indication — typically 3-6 months for most uses, occasionally longer for hyperhidrosis and TMJ. The effect gradually fades; maintenance treatment sustains the result.
Can I have multiple medical indications treated in one session?
Yes — for example, migraine treatment and hyperhidrosis can be performed in the same session. The treatment plan is structured to address both efficiently.
Is botulinum toxin safe for long-term use?
The safety profile is excellent across decades of clinical use for both medical and cosmetic purposes. The main practical issue is antibody formation in a small minority of patients, which can reduce effectiveness over time. Even with antibody formation, the medication remains safe — just less effective.
How do I know if my condition would benefit from this treatment?
A consultation establishes whether your specific symptoms are likely to respond to botulinum toxin. For migraine, bring any letters and your headache diary if you have been diagnosed; if not, your surgeon takes a full headache history at your consultation. For hyperhidrosis, the severity and pattern of sweating determine appropriateness. For TMJ, a dental or maxillofacial assessment can inform the decision.
What if the treatment doesn’t work for me?
Some patients don’t respond to botulinum toxin. The pattern is usually clear after one or two treatments; for migraine, the response is judged after two. If the treatment isn’t working, alternative approaches are discussed — for migraine, different preventive medications; for hyperhidrosis, surgical or laser alternatives; for TMJ, dental approaches and physical therapy.
Centre for Surgery · CQC-regulated · GMC-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 020 7993 4849 · Book a consultation · Finance available, subject to status
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