Medical Botulinum Toxin Treatment

​What is Botulinum Toxin?

Botulinum toxin is a naturally occurring purified protein derived from the bacterium Clostridium botulinum. It works by temporarily blocking the release of the chemical messenger that allows muscles to contract. As a result, overactive muscles relax, helping to reduce pain, muscle spasms and unwanted movements.

​

The effects of treatment are temporary, typically lasting around three months, before gradually wearing off. Muscle function then returns naturally, making the treatment fully reversible.

​

At Midlands Jaw Physiotherapy, botulinum toxin is used as part of a comprehensive treatment programme for a range of medical conditions, including facial palsy, hemifacial spasm, cervical dystonia and temporomandibular disorders (TMD). Treatment is always combined with specialist physiotherapy to optimise your recovery and achieve the best possible long-term outcomes.

​

Who Can Benefit?

Most people are familiar with botulinum toxin as a cosmetic treatment for reducing the appearance of fine lines and wrinkles. However, the same medication has been used safely in medicine for many years to treat a wide range of neurological and musculoskeletal conditions.

​

The medication itself is the same; the difference lies in the muscles selected for treatment, the dose administered and the clinical goals.

At Midlands Jaw Physiotherapy, Harriette has extensive experience using botulinum toxin to manage facial palsy, hemifacial spasm, cervical dystonia and jaw disorders. Her advanced anatomical knowledge and specialist training allow every treatment plan to be tailored to your individual needs.

​

Conditions We Treat

Facial Palsy

Facial palsy is weakness or paralysis of the facial muscles caused by temporary or permanent damage to the facial nerve.

Botulinum toxin is commonly considered once facial recovery has plateaued and synkinesis (unwanted facial movements) or hyperkinesis (overactive muscles) have developed, typically from around six months after the onset of facial palsy.

​

Treatment aims to:

• Improve facial symmetry

• Reduce synkinesis

• Relax overactive muscles

• Improve facial function

• ​

Botulinum toxin works best when combined with specialist physiotherapy, including stretching, movement retraining and exercises designed to improve facial control.

​

Temporomandibular Disorders (TMD)

Temporomandibular disorders (TMD) describe a group of conditions affecting the jaw joints, jaw muscles and surrounding structures. Symptoms commonly include jaw pain, headaches, clicking, locking and difficulty opening the mouth.

​

Botulinum toxin is rarely a first-line treatment for TMD. Conservative management, including specialist physiotherapy, education and habit modification, should always be optimised first.

​

Where symptoms remain persistent despite appropriate treatment, botulinum toxin may help reduce excessive muscle activity, allowing the muscles to relax and helping to break the cycle of pain.

​

Treatment is always individualised. Although the masseter and temporalis muscles are commonly injected, other muscles may also be considered depending on your symptoms and clinical presentation.

​

Our aim is never to keep patients reliant on repeated injections. Ideally, one or two treatment cycles alongside physiotherapy are sufficient to reduce symptoms and restore normal jaw function.

​

Hemifacial Spasm

Hemifacial spasm is a neurological condition that causes involuntary muscle contractions affecting one side of the face. It is usually caused by compression of the facial nerve by a blood vessel.

​

​

Symptoms often begin with painless twitching around the eye before gradually spreading to other facial muscles. Many people find symptoms worsen with fatigue, stress or anxiety.

​

Botulinum toxin is considered the gold standard treatment for hemifacial spasm and provides excellent symptom control for most patients.

​

Treatment requires careful assessment and precise muscle selection to reduce unwanted movements whilst maintaining natural facial expression and symmetry.

​

Cervical Dystonia

Cervical dystonia is a neurological movement disorder that causes involuntary contractions of the neck muscles, resulting in abnormal head posture, muscle spasms and pain.The exact cause is often unknown, although investigations may occasionally be required to exclude other neurological conditions.

​

Botulinum toxin is considered the gold standard treatment for cervical dystonia. Treatment aims to reduce muscle overactivity, improve head position, reduce pain and improve quality of life.

​

Every case of cervical dystonia is unique, making careful assessment, accurate muscle selection and appropriate dosing essential for achieving the best results.

​

What Happens During Your Appointment?

Every patient begins with a comprehensive assessment by our specialist physiotherapist. We will discuss your symptoms, examine the affected muscles and determine whether botulinum toxin is an appropriate treatment option.

​

If treatment is suitable, the risks, benefits and expected outcomes will be discussed before obtaining informed consent. Your prescription is then completed, and an injection appointment is arranged, usually around one week later.

​

The injection appointment lasts approximately 30 minutes. Before treatment, the target muscles are reassessed to ensure the treatment plan remains appropriate. Injections are performed using anatomical landmarks and careful palpation to accurately identify the muscles being treated.

​

Following treatment, you will receive comprehensive aftercare advice and a follow-up plan. There is no downtime, and most patients are able to drive home and return to their usual daily activities immediately.

​

When Will I Notice Results?

Most patients begin to notice the effects of treatment within 3–5 days.

​

Maximum benefit is usually reached after approximately 10–14 days, with improvements gradually wearing off after around three months.

​

Treatment timeline

• Day 0: Treatment

• Days 3–5: Early effects begin

• Days 10–14: Maximum effect

• 3–4 months: Effects gradually wear off

​

Benefits of Treatment

The benefits of botulinum toxin vary depending on the condition being treated, but may include:

​

• Reduced pain

• Reduced muscle tightness

• Improved facial symmetry

• Reduced involuntary muscle contractions

• Improved jaw opening

• Easier speaking and eating

• Improved head and neck movement

• Improved quality of life

• ​

Every treatment plan is tailored to your individual goals and symptoms.

​

Risks or Side Effects

As with any medical treatment, botulinum toxin injections carry some potential risks. Every effort is made to minimise these risks through careful assessment, accurate injection technique and appropriate dosing.

​

Common

• Bruising

• Mild discomfort

• Temporary muscle weakness

Less common

• Headache

• Flu-like symptoms

Rare

• Excessive muscle weakness

• Difficulty swallowing (depending on the muscles treated)

• Allergic reaction

​

These risks will be discussed in full during the consent process before treatment.

​

Who May Not Be Suitable for Treatment?

Botulinum toxin is suitable for most healthy adults. However, treatment may not be appropriate if you:

​

• Have certain neuromuscular disorders

• Have an active infection

• Are taking certain medications, including aminoglycoside antibiotics

• Have previously experienced an allergic reaction to botulinum toxin or one of its ingredients

• Are pregnant or breastfeeding

​

If treatment is not appropriate, we will discuss alternative options to help manage your symptoms.

​

Frequently Asked Questions

Does the injection hurt?

Most patients describe the injections as causing only mild discomfort. The sensation is brief, and ongoing pain following treatment is uncommon.

​

How long do the effects last?

The effects typically last around three to four months before gradually wearing off. Combining injections with physiotherapy often helps prolong the overall benefits of treatment.

​

Will I still look natural?

Yes. Medical botulinum toxin aims to reduce unwanted muscle activity while maintaining natural facial movement wherever possible. Our goal is always to improve function and symmetry rather than create an artificial appearance.

​

Can I exercise afterwards?

We recommend avoiding strenuous exercise, prolonged head-down positions (such as yoga) and excessive heat, including saunas, steam rooms and very hot showers, for 24 hours after treatment.

​

Can I drive home afterwards?

Yes. There is no sedation involved, and most patients are able to drive home immediately after their appointment.

​

How often will I need treatment?

Treatment frequency depends on your condition and your response to injections. Some patients benefit from treatment every 12 weeks, while others may only require injections every 12–18 months. Injections should not be given more frequently than every 10–12 weeks to minimise the risk of developing resistance to the medication.

​

Will I still need physiotherapy?

In most cases, yes. Physiotherapy plays an important role in maximising the benefits of treatment and achieving long-term improvements. The exception is often hemifacial spasm, where injections alone may provide effective symptom control.

​

Is this the same as cosmetic Botox?

The medication is the same, but the treatment goals are entirely different. Medical botulinum toxin focuses on improving muscle function, reducing pain and controlling unwanted muscle activity through carefully selected muscles and individualised dosing.

​

Is treatment permanent?

No. The effects are temporary and gradually wear off over approximately three to four months.

​

Why Choose Midlands Jaw Physiotherapy?

Harriette is a specialist physiotherapist with extensive experience treating patients with facial palsy, jaw disorders, hemifacial spasm and cervical dystonia.

​

She has completed Master's-level training in the administration of botulinum toxin and is an Independent Prescriber, having completed her prescribing qualification at the University of Birmingham.

​

Unlike many injection clinics, every treatment at Midlands Jaw Physiotherapy combines expert injection therapy with specialist physiotherapy. This integrated approach allows treatment to be tailored to your individual goals, helping to reduce symptoms, restore function and achieve the best possible long-term outcomes.

​​​