Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Botox and Dysport

Botox and Dysport (both Botulinum toxin Type A) are neurotoxins useful especially to treat and prevent wrinkles mainly in the upper face. They can take the tension out of a face and make a face look more relaxed and youthful.

They work by weakening muscles which are responsible for wrinkles. By removing the cause, the wrinkle fades and becomes less noticeable.

The products act only locally and highly selectively on the treated muscle. They do not freeze the face or the expression. I like to use them to selectively weaken muscles, not to paralyse your face so that you cannot express emotion. It is important that your face remains expressive, but that the product is effective in helping the wrinkles to fade. Areas which can be treated and the Botox doses required for treatment (Dsyport units required are different, but costs for the equivalent amount are the same) are as follows:

Frown line 20 units
Horizontal forehead lines 15 units
Crow’s feet 7.5-10 units per side, 15-20 units
Upper lip 5 units for the whole lip
Chin to improve wrinkling 10 units
To improve the mouth posture from unhappy to happy 10-15 units
Neck bands 20 units

Men usually require about 5 more units per area.

Treatment involves simple and relatively painless injection (said to feel like an ant bite sting). Injection tends to be a little more painful when you are pre-menstrual or menstrual. Treatment is performed in the rooms at the time of consultation and requires no anaesthesia. Small bumps and a slight redness due to the injection last about half an hour. Muscle weakness starts only 1-2 days after injection and takes about a week to reach full effect. Muscle function will begin to return after about 3-6 months, but this is often slightly weaker than before.

The injection should be repeated regularly for best effect. These products are very safe. Used properly, complications are extremely rare. Despite widespread use, toxicity has not been reported.

Occasionally the effect can be excessive and problems such as eyelid droop or tearing can occur, but always this is only temporary. Some bruising and occasional headache may be experienced for a few days after injection.

First used in 1973 for the treatment of squints, Botox has recently been licensed by the FDA for the cosmetic treatment of certain wrinkles. Botox and Dysport work by inhibiting the release of acetylcholine, a neurotransmitter, at the junction of the nerve with the muscle.

Frown lines: 20 units of Botox

Frown lines: 20 units of Botox needed.

Crow's feet: 15-20 units of Botox needed for both sides.

Crow’s feet: 15-20 units of Botox needed for both sides.

Horizontal forehead lines: 15-20 units of Botox needed for both sides.

Horizontal forehead lines: 15-20 units of Botox needed for both sides.


This email comes late as I have purposed to do this since the beginning of the year. I came to you in January 2009 to have reconstructive surgery for a scar on my face. For many people it did not seem a big deal but somehow, I had failed to accept as I could not even look at my face because of it.

You did an excellent job. With the limitations you explained to me, the scar has now healed with a year of plaster/ tape. I still see where the scar originally was but it is now almost unnoticeable that I hardly take notice of it.

I now go about confidently, never hiding my face with my hand as I used to do in the past.

Also, you were so gracious to let me use the coach house at only a fraction of the price. You will never know how truly grateful I am. I will always have fond memories of Cape Town.

Thank you so much. Please extend my thanks to your team also.

God bless you,