Treatment can soften expression lines for a smoother appearance. Lines visible at rest can also improve; their depth and how long they have been present affect the result.
Consultation-led aesthetic medicine · Brighton & Hove · By appointmentConsultation-led · Brighton
MOVEMENT · LINES · EXPRESSION
Expression Lines Anti-Wrinkle Treatment
A softer expression and a more rested appearance.Relaxing the right muscles can soften lines and improve facial balance.
At a glance
Understand the lines you notice.
The aim is to soften the lines while preserving expression. You choose how much movement you would like to keep, with my advice on what is suitable and achievable.
Frown lines, forehead lines and crow’s feet may respond when facial movement contributes to the concern.
The result develops as treated muscles crease the skin less. Some established lines may improve further with appropriately spaced repeat treatment.
Quick overviewYour appointment at a glance
- Consultation
- I strongly recommend booking a separate 60-minute consultation. This gives us dedicated time to discuss your concerns, medical history, potential benefits, risks, alternatives and costs, without fitting that conversation into a treatment appointment. You can ask questions, consider your options and take time to make an informed decision before booking treatment. A consultation-only appointment does not include treatment.
- Treatment appointment
- Usually 45–55 minutes, including assessment, planning, preparation, numbing, treatment and aftercare.
- Preparation & comfort
- Complete the medical form sent to you by email before your treatment, and follow the written preparation instructions, which you will also receive by email. In my practice, numbing cream is a standard part of preparing you for treatment. Remember, you can ask for a break at any point during the procedure.
- After treatment
- You can usually return to daily tasks. In my practice, redness usually settles within 15–20 minutes; bruising can last longer. Avoid vigorous exercise and intense heat for the rest of the day, and leave makeup off until the following day.
- Results & repeat treatment
- Results develop over the first 14 days. Treatments should be at least three months apart for the product cited on this page; your own response guides later appointments.
- Review & correction
- Book your review separately for 10–14 days after treatment; it is not booked automatically. The review and any clinically appropriate adjustment within our agreed treatment plan are complimentary within that window. Reviews after 14 days cost £50.
- Important events
- Plan treatment around 28 days beforehand to allow time for the initial result, review and any clinically appropriate adjustment.
- Fees & booking
- Consultation and treatment prices are on the Fees page. Choose a treatment or consultation appointment in online booking.
The complete conversation
Your questions about
anti-wrinkle treatment
What anti-wrinkle treatment can soften, how it affects expression, and what to expect before and after treatment.
odNOVA guide
- 1Question
- 2Piotr
- 3Clinical
- 4In depth
Choose a question
What is causing the lines I’m noticing?Piotr answers
Piotr
Facial muscles move the skin when, for example, you frown, smile or raise your eyebrows. Lines that appear or deepen with this movement and soften as your face relaxes are called dynamic lines. Over time, some lines can remain visible even when your face is relaxed — these are called static lines.
I assess your face while it is relaxed and while you make expressions. This shows how much muscle movement contributes to each line, whether reducing that movement is likely to help and what improvement you can realistically expect.
Why can a line become visible even when my face is relaxed?
Think of folding a piece of paper. If you fold it in exactly the same place every day, eventually the crease remains even when the paper is laid flat. Skin is living tissue and can repair itself. But when it folds in the same places over many years, lines can become visible even when your face is relaxed.
When the muscles contract less strongly, they crease the skin less. This can soften both dynamic and static lines. The degree of improvement depends on factors including the depth of the lines, how long they have been present, muscle strength, injection technique and the amount of product used. Some lines may not disappear completely. During your consultation, I assess your facial movement and the lines visible at rest, then explain which factors are likely to influence your result.
How does this treatment work?
Think of an old landline telephone unplugged from its socket. The phone is the muscle and the cable is the nerve. Unplugging the phone does not damage the phone or the cable — it simply stops the message getting through.
Treatment works in a similar way by temporarily reducing the signals passing from the nerve to the treated muscle. The muscle contracts less strongly, so the skin creases less. As the effect wears off, communication gradually recovers and muscle activity returns.[12]
Which lines can this treatment help?
It can soften lines caused by facial movement, including frown lines between the eyebrows, horizontal forehead lines and crow’s feet around the eyes.[12] Other areas can also be considered. During your consultation, I assess which muscles contribute to the lines that bother you and explain where treatment could help.
Why might a similar-looking line need a different treatment?
Muscle movementMuscle contractions repeatedly crease the skin. Reducing those contractions can soften the lines they cause.
SkinChanges in skin texture and elasticity can leave lines visible at rest.
VolumeLoss of fullness can create a fold or shadow.
SupportChanges in the tissues supporting the face can affect its shape and contours.
Similar-looking lines can have different causes, and sometimes more than one cause contributes to the same line. If muscle movement is the main cause, relaxing that muscle can help. If the line is mainly due to changes in the skin or the tissues beneath it, a different treatment may be more suitable.
Will I still look like myself?Piotr answers
Piotr
Softening expression lines does not have to mean losing your expression. My aim is for you to look like yourself, just less tired or tense. I plan the treatment to soften lines while keeping the movement that feels natural to you.
Will I look frozen or expressionless?
A frozen appearance means there is very little movement in the treated area. Some patients prefer this, while others want to retain more expression. Your preferences guide the result I plan for: you should feel comfortable in your own skin. I will explain what I recommend and what is realistically achievable, but you decide what you would like to change and whether to go ahead. The exact response cannot be guaranteed.
Dayan et al. (2024): study details
Research · detailed evidence
- How the study was done and who took part
- This analysis used data from two phase III trials. It included 458 adults who were new to botulinum toxin treatment and had achieved a clear improvement in forehead lines. Of this group, 455 answered the question about a natural-looking result at day 30.
- Treatment and follow-up
- OnabotulinumtoxinA, 40 U for forehead and frown lines, with or without 24 U for crow’s feet. Up to three treatment cycles over 12 months.
- What patients reported
- At day 30, 90.5% of the 455 respondents were mostly or very satisfied that treatment gave them a natural look.
- What this means
- This percentage shows how many patients were satisfied that their result looked natural. It does not tell us how much facial movement they retained. Selecting treatment responders means the percentage cannot be applied to everyone who receives treatment.
- Who funded the research
- Manufacturer-sponsored research.
How do you plan my first treatment at odNOVA?
If you are new to odNOVA, I assess your muscle strength and movement before choosing the injection sites and amount of product. Your first treatment and review within 14 days show how you respond and help refine future treatments.
At odNOVA, I choose the amount of product according to your clinical needs and the result we agree on. The amount used is not limited by a treatment package.
Can the effect be reversed if I do not like it?
It cannot be immediately reversed. Muscle activity returns gradually as the effect wears off.[12]
That is why, at odNOVA, I start cautiously and adjust the dose from one treatment session to the next according to your response. We can consider adding more if needed, but we cannot take the effect away if movement has been reduced too much.
Is perfect facial symmetry a realistic goal?
No face is perfectly symmetrical. Small differences between the two sides are a natural part of facial anatomy and expression. Treatment may improve particular differences and create a more balanced appearance, but making both sides exact mirror images is not a realistic goal.
Why can treating the forehead affect my brow?
Your forehead muscle lifts your eyebrows as well as creating forehead lines. Relaxing it too much can lower the brows and make the eyes look or feel heavier. Treatment therefore needs to balance smoother forehead lines with enough muscle activity to maintain a comfortable brow position.[6]
What if I already have heavy lids or hooding?
If your eyelids already feel heavy, you may be using your forehead muscle to keep your brows raised without realising it. That lift may be helping your eyes feel more open. This is why the consultation is especially important. Before treating forehead lines, I check whether you rely on that lift and whether relaxing the muscle could make your eyelids feel heavier or the hooding more noticeable. If that is likely, I may recommend leaving the forehead untreated and explain what other options may be suitable.
When will I see a change, and how long does it last?Piotr answers
Piotr
You usually begin to notice a change during the first week, often around day 3 or 4. The result develops over the first 14 days. The effect usually lasts around three to four months. In my practice, I generally recommend repeating treatment around every 100 days. We adjust the timing according to your response.[12]
The result can continue to develop beyond two weeks; the product information cited here reports the greatest effect at around 30 days.
I’ve just left the practice and there’s no difference — is that normal?
Yes. The treatment needs time to reduce muscle activity, so seeing no change during the first 2–3 days is normal. You will usually begin to notice a difference around day 3 or 4.
How long does the effect last?
The effect usually lasts around three to four months. The duration varies from person to person. Movement returns gradually rather than switching back on one day. Your response to previous treatments, including how long the effect lasted and when movement and lines returned, helps us plan when another appointment may be worthwhile.[12]
Why does it wear off?
The effect wears off as your body gradually restores communication between the nerves and the treated muscle. Nerve endings can grow new branches, a process called nerve sprouting. The original nerve endings can also regain their function. As these signals recover, muscle movement returns and expression lines may become more noticeable again.[12] [15]
How soon can I have it again?
For the product cited here, treatments should be at least three months apart. Your next appointment may be later, depending on how much movement has returned, how your lines look and whether you want further treatment.
Your previous response helps determine when another treatment is worthwhile; there is no need to repeat it while you are still happy with the result.
[12]Does repeated treatment become less effective?
Not usually. Repeated treatment can remain effective, and some lines visible at rest may improve further over successive treatments. The response varies between patients.
A study of 225 people found progressive improvement in frown lines visible at rest across three treatments, four months apart. The results and percentages are explained in the evidence section.[14]
If a result is weaker than expected, I assess the dose, treatment plan and time between treatments before assuming resistance. Antibodies can also reduce the effect; if this is a concern, we can discuss it during your consultation. Treatments should not be brought closer together to try to build a stronger effect: the recommended minimum intervals still apply.[12]
Do I have to keep having treatment?
No. You can stop whenever you choose. It is a little like exercise: maintaining the benefit usually takes ongoing treatment, but starting does not commit you to continuing.
As the effect wears off, muscle movement gradually returns and expression lines become more visible again. The usual change is a gradual loss of the treatment benefit. Your skin has spent time folding less strongly, but natural ageing has continued throughout. Whether you want another treatment remains your decision.
[12]Does the treatment work? What does research show?Piotr answers
Piotr
Yes. Controlled trials show that treatment reduces line severity more than placebo injections.[11]
For example, in one controlled study of moderate to severe lines between the eyebrows, 51.5% of treated participants had no lines or only mild lines at maximum frown after four weeks, compared with 0% receiving placebo. (This counts people who reached that result. It does not mean wrinkle depth fell by 51.5%.)[12]
Other studies ask how patients feel about the result; their satisfaction figures describe a different aspect of the change.[13]
How much improvement has research found?
A 2021 Cochrane review assessed 65 trials involving 14,919 participants, mostly women. It found that several botulinum toxin type A preparations reduced facial lines more than placebo at four weeks. Results varied by treatment, area and measurement.
Concrete results from individual trials on this page, assessed at day 30:
- Crow’s feet: 54.9% vs 3.3% with placebo had no or mild lines at full smile, according to the clinician. Study details — 917 participants.
- Forehead lines: 45.6% vs 0.6% with placebo improved by at least two grades, agreed by both patient and clinician. Study details — 787 participants.
These figures come from separate trials. They are not a combined Cochrane estimate. Their different measures explain why the percentages should not be compared as if one treatment performed better.
What does a study’s success rate actually mean?
A success rate tells you how many people reached a defined result at a particular time. It does not tell you how much each person’s lines improved.
For example, at day 30, clinicians rated crow’s feet at full smile as absent or mild in 54.9% of the treatment group, compared with 3.3% with placebo. That does not mean everyone’s wrinkles became 54.9% shallower.
These findings help us discuss what treatment might achieve for you. We also look at your starting lines, the area you want treated and how much movement you would like to keep.
Review details: 65 trials and 14,919 participants
Research · detailed evidence
- Studies included
- Cochrane systematic review published in 2021. Search completed in May 2020; 65 randomised trials, 14,919 participants, mostly women.
- Comparisons and timing
- Different botulinum toxin type A preparations, doses and comparators. Several placebo comparisons showed reduced frown-line severity at four weeks.
- How to read these results
- The review gives separate results for each comparison. It does not give one combined success rate for every treatment and facial area. Each trial percentage shown above uses that trial’s definition of improvement.
- Limitations
- Most trials assessed one treatment cycle. Evidence was strongest for lines between the eyebrows; results cannot automatically be transferred to every area or long-term repeated treatment.
What do five larger studies show?
These studies show that treatment can soften expression lines. The percentages differ because the studies measured different results, in different areas and at different times. Below, I explain what each result means.
The percentages below show how many patients met each study’s measure of improvement. They do not show the percentage reduction in wrinkle depth. The studies used different preparations and doses, whose units are not interchangeable.
Research
SAKURA 3 (2020) · Frown lines · 2,691 participants
At weeks two to four, clinicians rated frown lines as absent or mild in 96.6% of assessed participants in the first treatment cycle. The figures were 96.6% and 97.7% in later cycles; this study had no placebo group.
Study details: SAKURA 3 (2020) · Frown lines · 2,691 participants
Research · detailed evidence
- Result and timing
- In SAKURA 3, clinicians rated frown lines at maximum frown as absent or mild in 96.6%, 96.6% and 97.7% of assessed participants at the peak response in treatment cycles one, two and three. This occurred at weeks two to four.
- Participants, treatment and follow-up
- Adults with moderate or severe frown lines received daxibotulinumtoxinA, 40 units, for up to three cycles. The median time before lines returned to moderate or severe was about 24 weeks. That duration belongs to this particular preparation and study; it is not the expected duration of every anti-wrinkle treatment.
- How to interpret it
- There was no placebo group, and fewer participants reached the later cycles.[16]
Research
Moy et al. (2009) · Repeated treatment · 1,200 participants
Clinicians rated frown lines as absent or mild in 80–91% of assessed participants at day 30 across five treatment cycles. Repeat treatment was followed over 13 months, in an open-label study without placebo.
Study details: Moy et al. (2009) · Repeated treatment · 1,200 participants
Research · detailed evidence
- Result and timing
- At 30 days, 80–91% of assessed participants had no or mild frown lines, as rated by clinicians across five treatment cycles.
- Participants, treatment and follow-up
- Participants received abobotulinumtoxinA, 50 units, with repeat treatment followed over 13 months.
- How to interpret it
- This was an open-label study without placebo: patients and clinicians knew treatment had been given. Not everyone completed all five cycles.[17]
Research
Crow’s-feet trial (2014) · 917 participants
At day 30, clinicians rated crow’s feet at full smile as absent or mild in 54.9% of the crow’s-feet-only group, compared with 3.3% with placebo. This was a randomised trial of onabotulinumtoxinA; the result describes lines during smiling.
Study details: Crow’s-feet trial (2014) · 917 participants
Research · detailed evidence
- Result and timing
- Thirty days after treatment, clinicians assessed crow’s feet while participants smiled fully. The lines were rated as absent or mild in 54.9% of people treated only around the eyes and 59.0% of those who also had their frown lines treated. In the placebo group, 3.3% reached the same result.
- Participants, treatment and follow-up
- This seven-month randomised trial enrolled people with moderate or severe crow’s feet and frown lines. It tested onabotulinumtoxinA: 24 units for crow’s feet, or 44 units including the frown area.
- How to interpret it
- These percentages apply to crow’s feet at full smile. They cannot be used to describe every facial line or how much wrinkle depth fell.[18]
Research
Kane et al. (2009) · Individualised dosing · 816 participants
At day 30, clinicians recorded a response in 85% of treated participants, compared with 3% with placebo. The median duration of clinician-assessed response was 109 days; the abstract does not specify the full response threshold.
Study details: Kane et al. (2009) · Individualised dosing · 816 participants
Research · detailed evidence
- Result and timing
- At 30 days, clinicians recorded a treatment response in 85% of treated participants versus 3% with placebo. Patients’ own ratings were 87% versus 5%. The median duration of response, assessed by clinicians, was 109 days.
- Participants, treatment and follow-up
- This randomised, placebo-controlled trial followed participants for 150 days. It tested abobotulinumtoxinA, 50–80 units, with the amount adjusted according to sex and muscle mass.
- What the abstract leaves unclear
- These figures show how many people met the study’s definition of a response. The abstract does not explain that definition fully. We therefore cannot read them as the percentage whose lines disappeared.[19]
Research
De Boulle et al. (2018) · Forehead lines · 787 participants
At day 30, 45.6% of the forehead-and-frown group achieved at least a two-grade improvement in forehead lines, compared with 0.6% with placebo. Both the patient and clinician had to agree on that improvement.
Study details: De Boulle et al. (2018) · Forehead lines · 787 participants
Research · detailed evidence
- Result and timing
- At day 30, 45.6% of participants treated for forehead and frown lines had at least a two-grade improvement in forehead lines. Among those also treated for crow’s feet, 53.0% reached that result. With placebo, the figure was 0.6%.
- What counted as improvement
- A two-grade improvement means, for example, moving from severe lines to mild lines. Both the patient and clinician had to agree on the improvement.
- Participants, treatment and follow-up
- The trial compared onabotulinumtoxinA, 40 units for forehead and frown lines, or 64 units also including crow’s feet, with placebo. The controlled phase lasted six months, followed by up to two further treatment cycles.
- How to interpret it
- This was a stricter measure than “absent or mild” judged by one observer. It does not mean that other trials with higher percentages produced better results.[20]
What do we know about repeated treatment over time?
Repeat-treatment studies show that benefit can be maintained. In the study described below, frown lines visible at rest improved over successive treatments.
Among people whose resting frown lines had not disappeared after the first treatment, 25–52% achieved that result during the second or third cycle, depending on starting severity. Study details and original results ↓
The Cochrane review identified gaps in evidence about long-term repeated treatment. Continued treatment should therefore include checks on your response and any side effects, rather than assuming that the same plan remains right indefinitely.[11]
Carruthers et al. (2016): study details
Research · detailed evidence
- Participants and treatment
- Analysis of 225 people treated with onabotulinumtoxinA, 20 U, across three cycles four months apart.
- Result and definition
- Among those whose resting frown lines had not disappeared after the first treatment, 25–52% achieved that result after the second or third treatment, depending on their starting line severity. In this study, a line counted as “disappeared” if it was no longer visible with the face relaxed at one or more checks during that treatment cycle. This did not mean it had been permanently removed.[14]
- How to read this result
- The 25–52% range comes from groups with different line severity at the start. It should not be read as a single result for all 225 participants. The outcome was recorded during at least one assessment in the cycle; it does not mean permanent removal or improvement for every patient.
- Who funded the research
- Manufacturer-supported research.
Were patients satisfied, and how long did that satisfaction last?
Patient-reported results
Satisfaction after treatment
- 30 days
- 95% reported overall satisfaction.
- 120 days
- 86% reported overall satisfaction.
These percentages show how many patients were satisfied. They do not tell us how much muscle movement remained or whether the effect stayed unchanged for four months.[13]
Study details and original results ↓
Stotland et al. (2007): study details
Research · detailed evidence
- How the study was done and who took part
- Prospective open-label study of 58 women with moderate or severe frown lines between the eyebrows. There was no placebo group, and participants knew they had received treatment.
- Result and timing
- Overall satisfaction was reported by 95% at day 30 and 86% at day 120.
- What was measured
- Patients reported their overall satisfaction after treatment. These figures do not show how much wrinkle depth fell or how many people’s lines disappeared.
- Limitations
- This is a small uncontrolled study in women with frown lines. The total study sample may differ from the number who answered at each follow-up. The available summary does not state how many answered at each visit or give the full dosing details. We cannot fill in those gaps.
When should I consider treatment?Piotr answers
Piotr
Consider an assessment when expression lines bother you and you would like to explore options for softening them. There is no single age at which everyone should start, and having a line does not mean you need treatment.
An assessment can be useful both when lines appear only with expression and when they remain at rest. The decision is about what bothers you and what treatment could improve.
Do I need to wait until lines are visible at rest?
No. If expression lines bother you, you can discuss treatment before a crease stays visible at rest. Reducing repeated folding at this stage may help soften the line. Some patients prefer this earlier approach. An established line can still improve, but its depth and how long it has been present affect what treatment can achieve.
I’ve got an event coming up — how far ahead?
For an important event, I recommend planning treatment 28 days beforehand. This allows around 14 days for the initial result to develop and for your review. A further 14 days allows any clinically appropriate adjustment made at that review to take effect.
Booking closer to the event leaves less time to assess and adjust the result. This is especially important before your first treatment, when your individual response is not yet known.
Do I need to plan the review appointment too?
Yes. When booking your treatment, make sure you can return for your review within 14 days. If you have a holiday or other plans, let me know so we can choose dates that work for both appointments. If anything worries you after treatment, contact me rather than waiting for the review.
Is this treatment suitable for me?Piotr answers
Piotr
Suitability depends on your health, the medicines you take and the changes you want to address. At odNOVA, elective treatment is postponed during pregnancy and breastfeeding. A relevant allergy, certain neuromuscular conditions, infection at the injection site, or some medicines and health conditions may also rule it out or change the plan.
Please provide your full medical history. Do not stop or change your prescribed medication to prepare for this appointment. Your health comes before an elective aesthetic treatment.
Do the medicines I take matter?
Yes. Before treatment, you will receive an online medical form. Please list all prescribed medicines, over-the-counter products and supplements, and tell me if anything changes after you submit it. Some medicines and health conditions affect whether, or how, treatment can be considered; I review that information alongside your assessment.
What if I take blood thinners or supplements?
List all medicines and supplements in your online medical form, including the dose and how long you have been taking them. This helps me check whether they could affect treatment or increase bleeding or bruising. Do not stop or change prescribed medication on your own. If you are unsure what to take before your appointment, contact me first. If a change needs to be considered, I can advise whether you should speak to the clinician who prescribed it.
Can someone under 18 have cosmetic treatment?
For cosmetic treatment in England, you must be at least 18. Parental permission does not override this age restriction.[8]
Is treatment considered during pregnancy or breastfeeding?
Cosmetic treatment is postponed during pregnancy and breastfeeding at odNOVA because there is not enough safety evidence to justify it in these circumstances.
What if I have a condition affecting my nerves or muscles?
Some conditions affecting the nerves or muscles can make treatment unsuitable; others may still allow it after assessment. Your diagnosis, current symptoms and medicines need to be reviewed before booking.
What if I get cold sores?
Tell me before your appointment if you get cold sores, especially if one is developing or already present. Depending on your history and the area being treated, preventive antiviral treatment or postponement may be appropriate.
Is treatment safe, and what are the risks?Piotr answers
Piotr
In my practice, small injection marks and redness usually fade within 15–20 minutes. Swelling and tenderness are rare; any swelling generally settles within the same period. Most of my patients do not bruise, although individual responses vary. A temporary headache is something I mainly see after a first treatment.
Other risks include unwanted changes in expression or a lower brow or eyelid. Assessment, appropriate dosing and careful placement help reduce these risks, alongside consideration of your anatomy and medical history. This is why choosing a suitably qualified, experienced practitioner matters. Serious complications are rare, but possible.[12]
Before treatment, I discuss the risks relevant to you, including those listed in your consent form, and explain how to get help if a problem develops.
Small injection marks, redness, mild swelling or tenderness can occur after injections; not everyone experiences them. They usually settle, although bruising or a headache can last longer. Contact me if symptoms worsen or concern you.
If you notice an unwanted side effect, please contact me. I will assess what has changed and talk you through the next steps.
Serious effects from toxin spreading beyond the treated area are very rare. If you have difficulty breathing, swallowing or speaking, or widespread weakness, call 999 immediately. Let the clinic know once emergency help is arranged; do not wait for a clinic reply.[22]
When should I call the clinic?
Your care at odNOVA continues after your appointment. If you have a question, notice something unexpected or simply feel unsure about your recovery, you are welcome to contact me. This is especially helpful when treatment is new to you: you do not need to wait until your review to ask.
You can email me, send a WhatsApp message or call. Contact details are on the Contact page and in your written aftercare.
For emergency symptoms, seek immediate medical help.
How common are headache or drooping brows and eyelids?
These are selected side effects from the UK product information cited here.[12]
Reported frequencies for treatment of lines between the eyebrows:
- Headache
- Common: 1% to less than 10%.
- Eyelid drooping; brow drooping
- Uncommon: 0.1% to less than 1%.
Injection technique matters. A brow can drop if treatment weakens the forehead muscle more than it can comfortably tolerate; an eyelid can droop if the effect reaches the nearby muscle that lifts it. Careful placement, appropriate dosing and assessment of your anatomy help reduce these risks, but cannot eliminate them.[12]
These are frequency bands, not an exact personal probability or a complete side-effect list. They do not describe every product or facial area. I discuss the information for the medicine actually proposed for you before treatment.
If you notice a concerning change, follow the warning signs and contact routes above. A frequency label is not a reason to wait.
What are the alternatives to this treatment?Piotr answers
Piotr
Leaving the lines untreated is also an option. The alternative depends on what is causing the change. Skincare or a procedure such as a chemical peel may help uneven texture and signs of sun damage. Dermal fillers may be an option for lost fullness, while mild skin laxity may be assessed for skin-tightening treatments such as radiofrequency or ultrasound. More pronounced sagging may need a surgical assessment.
If excess eyelid skin is causing significant hooding, a specialist may recommend blepharoplasty — surgery to remove excess eyelid skin.
During your consultation, I explain which options could address your concern and whether a referral would be appropriate.
What if the concern is skin quality rather than movement?
Rough texture, uneven pigmentation, dryness and scarring are skin concerns. They may need skincare or a treatment directed at the skin rather than the muscles. The choice depends on the particular concern and its cause.
What if the concern is volume or structural support?
A hollow area or a fold caused by a loss of fullness will not necessarily improve by relaxing a muscle. Depending on the cause, options may include dermal fillers or other specialist treatments. The Face & Structure guide explains how facial shape and support differ from skin quality.
Which other approaches might help my concern?
Other approaches to consider
Depending on the concern and your assessment, options may include:
- Static lines & sun damage — retinoids and medical skincare, peels and resurfacing, microneedling or laser.
- Skin quality, dryness or crepiness — skin boosters, polynucleotides, PRP/PRF or a suitable skincare routine.
- Volume loss or deep folds — dermal fillers or collagen biostimulators, where appropriate. Hollowing in the temples or forehead needs an individual assessment before considering filler in these areas.
- Loose or descended skin — energy-based devices or a surgical opinion.
- Pigmentation — targeted skincare or chemical peels, depending on the type and cause of the pigmentation.
- Skin lesions — I assess the lesion first. Suitable benign lesions can be removed at odNOVA; a lesion that is suspicious or unclear needs specialist assessment before removal.
- Drooping lids or excess eyelid skin — assessment by an eyelid specialist or surgeon. Blepharoplasty removes excess eyelid skin; a low brow or a drooping eyelid itself may need a different procedure.
- Mild, accepted lines — no treatment, and good skin care.
These options treat different concerns and are not interchangeable. More than one approach may be considered when several factors contribute to the change you notice.
What about jaw clenching or teeth grinding?
If you have been diagnosed with jaw clenching or teeth grinding, or suspect that you do either, you can book an assessment at odNOVA. Where clinically appropriate, I can offer treatment to reduce activity in the affected jaw muscles.
I assess your symptoms, medical history and any treatment you have already tried before discussing the options. A dental assessment may also be needed, particularly if you have tooth wear, pain, a change in your bite or difficulty opening your mouth. Treatment here does not replace dental care.
Is doing nothing a real option?
Yes. If the lines do not bother you, the likely improvement does not feel worthwhile, or you prefer to keep your full facial movement, you can leave them untreated. You can also take more time before deciding.
What can I book, and where can I find the fees?Piotr answers
Piotr
Choose a consultation if you want an assessment and answers before deciding on treatment. Choose a treatment appointment if you would like to proceed, subject to assessment and your consent.
Consultation and treatment prices are on the Fees page. Any proposed cost is explained before you decide.
Can I book treatment for my first visit?
Yes. You can book a treatment appointment even if you are new to odNOVA or have previously been treated elsewhere. We begin by discussing what you would like to improve and assessing whether treatment would benefit you. I explain the options and my recommendation, then we agree a suitable plan. If I do not think you need treatment, I will tell you honestly. A consultation-only booking does not include treatment.
When will I know which medicine is being considered?
After assessment and before you consent. If a prescription option is appropriate, I explain its name, intended benefit, limitations, risks, alternatives and cost. You will know what is proposed before deciding whether to proceed.
What actually happens on the day?Piotr answers
Piotr
A treatment appointment usually takes 45–55 minutes. It starts with a medical-history check and examination of your face relaxed and moving. The plan, risks, alternatives and cost are explained before you decide whether to proceed.
If you go ahead, I prepare your skin and apply numbing cream as standard preparation, allowing time for it to take effect before the planned injections. Your written aftercare is sent to your email, together with information about your review.
I also send you written instructions before treatment, so you know how to prepare. You can refer back to your pre-treatment and aftercare instructions whenever you need.
What the assessment helps decide
- Lines at rest
- Seeing which lines remain when your face relaxes helps estimate how much they may soften and whether treating muscle activity alone is likely to help.
- Muscle movement
- The same facial muscles can work differently from person to person, and some parts of a muscle may contract more strongly than others. I assess this before choosing your injection sites and dose. The plan accounts for the movement you want to keep, including the lift supporting your brows.
- Health and previous treatment
- Your health and medicines help determine suitability. Previous results and side effects help decide whether the dose or injection sites should change.
- Your preferred result
- Your preference for more or less movement guides the proposed plan. You can compare what you want with what is realistically achievable before deciding.
- Photographs
- With your consent, photographs record your starting appearance. At review, they help distinguish a treatment-related change from a difference that was already present.
Who will actually be treating me?
I assess you, make any prescribing decision and carry out your treatment myself. Your care stays with me from consultation through to review.
My pharmacy, dermatology and aesthetic-medicine training help me understand the medicine, your skin and the change we are planning. You can read about my qualifications and additional facial-anatomy training on Meet Piotr.
How do I prepare?
Complete the medical form with all medicines and supplements, and tell me about any subsequent changes. Arrive without heavy makeup where possible and eat normally. At odNOVA, I recommend avoiding alcohol for 2–3 days before treatment to help reduce the risk of bleeding and bruising. Mention cold sores or signs that one is developing before the appointment. Keep taking prescribed medicines unless the clinician responsible for them advises otherwise.
What’s the questionnaire I get by email?
The questionnaire lets you provide your health history, medicines and previous treatments before the appointment. This gives time to identify anything that needs clarification. Your answers are reviewed with you at the appointment.
What happens at the consultation?
I set aside 60 minutes for your consultation. We discuss what you would like to improve, review your medical history and assess your face. One question often leads to another — that is exactly what this time is for.
I explain how the treatment works, the benefits, risks and limitations, what to expect afterwards, the alternatives and the cost. My aim is for you to understand the treatment and have your questions answered before deciding. If something is unclear, we talk it through. I want you to feel informed and comfortable when you come for treatment.
The consultation also gives you time to meet me and decide whether I am the right practitioner for you. Aesthetic medicine is personal, and you should feel comfortable with the person treating you.
This consultation is booked as a Comprehensive Clinical Assessment in online booking. It is a separate appointment from treatment, so you have time to consider your decision.
What if I am nervous about needles?
If the sensation worries you, numbing cream is applied before treatment to reduce what you feel at the skin. Anti-wrinkle injections at odNOVA use very fine 32G or 33G needles. Treatment can pause whenever you need.
What am I agreeing to?
Your treatment plan and your choice
You are agreeing to the specific treatment plan discussed with you. Before you consent, the treatment is explained by name, including the expected result, limitations, duration, recovery, risks, alternatives and cost. You have time to ask questions. I assess whether treatment is clinically appropriate; you decide whether to proceed.[9]
The plan also records the changes you want and the movement you wish to retain. If the proposed treatment is unlikely to meet your expectations, that is explained before you decide.
What if I decide not to go ahead?
You can decide not to proceed, even after discussing a plan or signing the consent form. You do not have to have treatment because you attended a consultation.
Why do you take photographs?
Clinical photographs are part of your care record and help us assess your results together. Comparing photographs taken before and after treatment, and across later visits, lets us see what has improved, what has remained unchanged and whether the treatment plan needs adjusting. Your feedback helps us interpret these comparisons.
Can I continue treatment here if I was treated elsewhere?
Yes. If you have been treated elsewhere, you are welcome at odNOVA. I begin with my own assessment and ask what you liked about your previous results and what you would like to change. Together, we use that experience to plan treatment around your preferences and how you have responded before.
You do not need to explain why you changed practices or name your previous practitioner. What matters to me is your experience of the treatment: what worked well, what did not and how you felt about the result. That feedback is invaluable when planning your care.
If you have them, bring the product name, amount used, areas treated and treatment date, along with any details of side effects. These are useful clinical details for your assessment.
Why can’t I compare different medicines by their units?
The units measure biological activity using tests specific to each product. For that reason, the same number of units from two different products does not necessarily have the same effect. I plan the dose for the specific product being used. A dose used for another product cannot simply be copied.
What should I expect afterwards, and when is my review?Piotr answers
Piotr
You can usually return to daily tasks straight away. In my practice, redness usually settles within 15–20 minutes. Bruising may occur and can last longer. It may appear as small spots at the injection sites, although the size and time it takes to fade vary. Follow your written aftercare, including the advice about makeup, exercise and rubbing the treated area.
Book your review separately for 10–14 days after treatment. We assess the result together and discuss whether an adjustment would be appropriate. Your response also helps me refine the dose and plan for future treatments. If you have any questions or concerns before then, please contact me — you do not need to wait for your review.
What should I avoid after treatment, and for how long?
At odNOVA, I recommend avoiding saunas, hot baths, steam rooms and vigorous exercise for the rest of the day after treatment — including gym sessions and other activities that make you hot and sweaty. If you would like to exercise that day, plan your workout before your appointment.
Avoid alcohol and facial massage until the end of the day, and do not rub or manipulate the treated area unless I have specifically advised otherwise. Follow the written aftercare sent to you; your individual instructions may differ.
When can I wear makeup again?
Leave makeup off for the rest of the treatment day; you can apply it again the following day.
When’s the review, and what happens at it?
Please book your complimentary review separately for 10–14 days after treatment. It is not booked automatically. At the review, you tell me how you feel about the result and whether the amount of movement suits you. I assess the change in your lines and muscle activity. We then discuss whether to leave the result as it is, allow more time for it to develop, or consider an adjustment.
The review and any clinically appropriate adjustment within our agreed treatment plan are complimentary within 14 days. Reviews after 14 days cost £50.
How will my treatment change over future visits?
I always record the product, dose, injection sites and your response. At the review, I compare the result with your photographs taken before treatment and discuss your feedback about movement and appearance. This helps me plan future appointments: the dose or areas treated can be adjusted according to your previous response, rather than simply repeating the same treatment each time.
Once your response is familiar and you are happy with the results, we may agree that a separate routine review is not needed after every treatment. A review remains available if you want one or have any concerns; the timing and fees above still apply.
What if I am unhappy with the result?
You are welcome to get in touch and tell me honestly how you feel about your result. Tell me what you are happy with and what you would like to change. Perhaps the effect feels too subtle or too strong, or you have more or less movement than you wanted.
The more clearly I understand your concerns and the result you had in mind, the better I can advise you and plan your care. We assess the result together and discuss what can be improved and what may need time to settle. Adding more treatment will not help every concern.
Question index
All your questions, by topic.
Open a topic and choose a question to go straight to its answer.
Browse all 66 questions
Lines, movement and natural results12 questions
Timing and repeat treatment11 questions
Research and results6 questions
Suitability7 questions
Risks and safety3 questions
Other treatment options6 questions
Booking and consultation8 questions
Your appointment and comfort7 questions
Aftercare and review6 questions
References & sources
The references below support the explanations on this page. Each is labelled so you can distinguish clinical research, product information and professional guidance.
View all 22 references
- Advertising and public information: Committee of Advertising Practice. CAP Code, Section 12: Medicines, medical devices, health-related products and beauty products. Available at: asa.org.uk/type/non_broadcast/code_section/12.html (Accessed: 10 August 2026).
- Clinic websites and prescription-only medicines: Medicines and Healthcare products Regulatory Agency. Blue Guide: advertising and promoting medicines, including Appendix 6. Available at: gov.uk/government/publications/blue-guide-advertising-and-promoting-medicines (Accessed: 10 August 2026).
- Advertising of prescription-only medicines: ASA/CAP. Healthcare: Prescription-only Medicines (websites). Available at: asa.org.uk/advice-online/health-prescription-only-medicines-websites.html (Accessed: 20 September 2026).
- Current licensed information, contraindications, warnings, interactions and adverse effects: Electronic Medicines Compendium. Current UK licensed product information for relevant prescription medicines. Product units, indications, contraindications and safety information are not interchangeable. Available at: medicines.org.uk — current licensed product information (Accessed: 10 August 2026).
- Upper-face adverse events — systematic review and meta-analysis. Zargaran D, et al. (2022), Aesthetic Surgery Journal 42(5):NP327–NP336. PMID: 35178552. PMCID: PMC9005453. Available at: pmc.ncbi.nlm.nih.gov/articles/PMC9005453/ (Accessed: 10 August 2026).
- Forehead and glabellar functional anatomy. Lorenc ZP, et al. (2013), Aesthetic Plastic Surgery 37(5):975–983. PMID: 23846022. Available at: pubmed.ncbi.nlm.nih.gov/23846022/ (Accessed: 10 August 2026).
- Upper facial expression-line evidence and variation: Rahman E, et al. (2023), Aesthetic Surgery Journal 43(2):215–229. DOI: 10.1093/asj/sjac253. PMID: 36099476. Correction: 43(2):256. DOI: 10.1093/asj/sjac294. PMID: 36416878. Available at: pubmed.ncbi.nlm.nih.gov/36099476/ (Accessed: 10 August 2026).
- Under-18 law in England: GOV.UK. Guidance on the under-18 law for specified cosmetic injections in England. Available at: gov.uk/government/publications/botulinum-toxin-and-cosmetic-fillers-for-under-18s (Accessed: 10 August 2026).
- Consent: General Pharmaceutical Council. In practice: guidance on consent. Available at: pharmacyregulation.org — guidance on consent (PDF) (Accessed: 10 August 2026).
- Urgent symptoms: NHS. Botulism. Available at: nhs.uk/conditions/botulism/ (Accessed: 20 September 2026).
- Systematic review of botulinum toxin type A for facial wrinkles. Camargo CP, et al. (2021), Cochrane Database of Systematic Reviews, CD011301. PMID: 34224576. Available at: pubmed.ncbi.nlm.nih.gov/34224576/ (Accessed: 20 September 2026).
- Mechanism, recovery and a product-specific safety example: Merz Aesthetics UK Ltd. Bocouture 50 units: UK Summary of Product Characteristics, sections 4.2, 4.4, 4.8 and 5.1. The safety example uses the glabellar-frown-line table, not other treatment areas. Updated on emc: 22 January 2026. Read the current UK product information (Accessed: 20 September 2026).
- Patient-reported satisfaction after frown-line treatment: Stotland MA, Kowalski JW, Ray BB. (2007). Patient-reported benefit and satisfaction with botulinum toxin type A treatment of moderate to severe glabellar rhytides: results from a prospective open-label study. Plastic and Reconstructive Surgery, 120(5):1386–1393. Read the study abstract (Accessed: 24 September 2026).
- Repeated treatment and resting frown lines: Carruthers A, et al. (2016). Repeated OnabotulinumtoxinA Treatment of Glabellar Lines at Rest Over Three Treatment Cycles. Dermatologic Surgery, 42(9):1094–1101. Analysis of 225 participants across three treatment cycles; manufacturer-supported research. Read the study (Accessed: 28 September 2026).
- Nerve sprouting and recovery of nerve-to-muscle signalling: de Paiva A, et al. (1999). Functional repair of motor endplates after botulinum neurotoxin type A poisoning: Biphasic switch of synaptic activity between nerve sprouts and their parent terminals. PNAS, 96(6):3200–3205. Mechanistic research in mice; not a clinical estimate of treatment duration in patients. Read the study (Accessed: 28 September 2026).
- SAKURA 3: repeat-treatment efficacy in 2,691 adults: DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Efficacy Results From SAKURA 3, a Large, Open-Label, Phase 3 Safety Study (2020). Read the study (Accessed: 28 September 2026).
- Repeated frown-line treatment in 1,200 participants: Moy R, et al. Long-term safety and efficacy of a new botulinum toxin type A in treating glabellar lines (2009). Read the study (Accessed: 28 September 2026).
- Crow’s-feet placebo-controlled trial in 917 participants: Placebo-controlled trial of onabotulinumtoxinA for crow’s feet, with or without simultaneous treatment of glabellar lines (2014). PMID: 25485803. Read the study (Accessed: 28 September 2026).
- Variable-dose frown-line trial in 816 participants: Kane MAC, et al. Evaluation of variable-dose treatment with a new U.S. botulinum toxin type A (Dysport) for correction of moderate to severe glabellar lines (2009). Read the study (Accessed: 28 September 2026).
- Forehead-line placebo-controlled trial in 787 participants: De Boulle K, et al. Phase 3 Study of OnabotulinumtoxinA Distributed Between Frontalis, Glabellar Complex, and Lateral Canthal Areas for Treatment of Upper Facial Lines (2018). Read the study (Accessed: 28 September 2026).
- Research — patient-reported natural-looking results: Dayan S, et al. (2024; first published 2023). Self-perception of natural outcome, appearance, and emotional well-being after OnabotulinumtoxinA treatment for upper facial lines: Post hoc analysis across age and gender. Journal of Cosmetic Dermatology, 23:107–116. Secondary analysis of 458 selected responders from two phase III trials; 455 answered at day 30. OnabotulinumtoxinA 40 U (forehead and glabella), with or without 24 U for crow’s feet; up to three cycles over 12 months. Manufacturer-sponsored. Read the study (Accessed: 28 September 2026).
- Updated UK safety guidance: Medicines and Healthcare products Regulatory Agency (15 July 2026). Botulinum toxin type A products: updated warnings regarding risk of iatrogenic botulism. Read the MHRA safety update (Accessed: 7 October 2026).
Botulinum toxin: updated safety advice.
The MHRA has updated its warnings about rare cases of iatrogenic botulism after therapeutic or cosmetic treatment, when the toxin’s effects spread beyond the treated area.
Symptoms can develop up to four weeks after treatment. Difficulty breathing or swallowing, or slurred speech, requires immediate medical attention through emergency services.
Piotr’s commentThis is why I recommend choosing a suitably qualified healthcare professional with specific training in these treatments. Knowledge of anatomy, careful assessment, appropriate dosing and the use of a UK-licensed product are important safeguards, though they cannot eliminate risk. [12]
This page provides general information about the concern and consultation. It is not individual medical advice or a recommendation. Any prescription option is considered only after a face-to-face assessment.