Treatment of Expression lines - Botox

Botulinum toxin marketed under the name of Vistabel by the laboratory Allergan, has been used in France since 2003 where it received authorization to be marketed by the Ministry of Health.

Its official indication is the treatment of frown lines between the eyebrows.


The treatment involves injecting very small doses of active ingredient purified botulinum toxin into the muscles responsible for wrinkles to relax them.


The effectiveness appears within the first week, with results at a peak from the period from 1 to 4 months. The return to the initial state is progressive from the 4th or 6th month, normal muscle movement returns to normal and wrinkles gradually reappear. A new session of botulinum toxin can be then proposed.


As always in aesthetic medicine, the patient is guaranteed the safety of treatments and the reversibility of effects.


In general, you should plan a second session after respecting the 3 month minimum period. The reinjection will take place from the time the wrinkle reappears.


Contraindications are infrequent, but it is important to tell the aesthetician of pregnancy, myasthenia gravis, neuromuscular diseases, concomitant therapy with aminoglycosides, people with an allergy to botulinum toxin, inflammatory dermatosis in between the eyebrows, any anti-coagulant treatment .

Botox or Frotox?

These two treatments aim to smooth the skin by acting on the muscle contraction that causes wrinkles. What are their common points and their differences?

The technique:

Botulinum Toxin or Botox is a purified toxin injected in very small quantities directly into specific muscles. The objective is to relax certain muscles whose contraction wrinkles the skin and is therefore the cause of wrinkles. This smoothing of the skin provides a lifting effect. This product has been used in aesthetic medicine since 1989.


Frotox is a new aesthetic medicine technique developed in California which has just obtained CE marking in Europe. The Frotox aims to paralyze the muscles of the forehead thanks to the phenomenon of Cryoneurmodulation. It is a mechanical destruction by the cold of the "electric cable" which transmits the information to the muscle to contract. The injection of purified botulinum toxin is replaced by the application of cold using a handpiece like a large pen, the end of which consists of 3 needles refrigerated at -80°C. The needles placed in contact with the frontal nerve, branch of the facial nerve, freeze it thanks to rapid applications, repeated for a few seconds, under local anesthesia.

The areas treated:

Botox allows multiple treatment areas:



The Frotox only treats forehead wrinkles.

Time to appearance of the result

The effect of Botox begins after the 2nd or 3rd day. The full effect is obtained in 15 days. Between 15 days and a maximum of 30 days after the injection session, a check-up visit allows for possible touch-ups if necessary.

The effect of Frotox is immediate.

Result persistence time

The effect of Botox gradually fades over 4 to 6 months, and muscle action reappears. This reversible effect is systematic. You can sometimes see a lengthening of the duration of the effect after several injections. The muscles gradually lose the automatisms of contraction which tends to lengthen the time between 2 injections. Conversely, very rarely there may also appear resistance to the product by creation of anti-botulinum toxin antibodies. This resistance disappears after a period of 24 to 30 months without Botox injection. The injections can then be resumed.

The effect of Frotox lasts about four months, the time for the nerve to regenerate.

The side effects

Botox can cause:

A small superficial hematoma at the injection site. Discomfort in the form of a bar at the level of the forehead is felt especially during the first treatment but the effect is transient of the order of a few days.

A transient lowering of the upper eyelid linked to a possible diffusion of the product.

All the effects of Botox are transient and therefore always reversible.

Frotox can cause:

The frozen nerve could be permanently damaged due to repeated large temperature differences. This would lead to permanent paralysis of the frontalis muscle.

Other noted side effects are headaches, bruising and redness.

In conclusion

Botox has remained a real revolution in aesthetic medicine since 1989 and is the most frequently practiced aesthetic medicine treatment in the world. Its efficacy and safety make it a reference treatment for non-surgical facial rejuvenation.


Frotox is a new practice to fight against wrinkles, which presents itself as an alternative to Botox. It seems to have neither its harmlessness for the patient, nor its ease of use for the doctor. With a cost equivalent to that of Botox and a result of a similar duration, however, it is beginning to spread gradually in the United States, the Middle East and lately in Europe, whose use is still marginal.

Summary table

Chemical mode of action by injection of an active substanceMechanical mode of action by transcutaneous application of cold
No local anesthesiaLocal anesthesia
Ease of injection directly into the targeted musclesNeed to locate the nerve before freezing it
Duration of action of 4 to 6 monthsDuration of action of 4 months
Multiple treatment areasSingle indication
Time to appearance of the result in 15 daysImmediate effect
Reversibility of effectsRisk of permanent damage
Equivalent costEquivalent cost
Botox in Monaco for the treatment of wrinkles - Dr Antoni