What each one does
Botulinum toxin softens the lines made by movement — the frown between the brows, the horizontal forehead lines, the crow’s feet at the outer eye. It works by relaxing the muscle that creases the skin, so the line stops deepening and the existing crease has a chance to settle.
Dermal filler replaces volume. Under the eye, in the cheek, along the jaw or in the lips, it restores what time has taken rather than relaxing what movement has made. Used on a line that is caused by muscle, it does not work; used on a hollow, it works immediately.
The aim in both is a face that still moves. A forehead that cannot move is a dosing error, not a style.
What to expect
Treatment takes fifteen to thirty minutes in the clinic, with no anaesthetic beyond topical cream for filler. You go straight back to your day.
Toxin begins to work at three to five days and is fully settled at two weeks, which is when a result is judged and, if needed, topped up. It lasts three to four months at first and often longer with repeated treatment.
Filler is visible immediately, though swelling for the first few days exaggerates it. Depending on the product and the area it lasts from six months to around eighteen.
Why it matters who injects
These are medical treatments with anatomy behind them. Filler placed in the wrong plane near the eye or the nose can occlude a vessel, and that is the complication that matters. A plastic surgeon injects with the same anatomy in mind that they operate with, and can manage the rare problem rather than refer it on.
Recovery
What actually happens, week by week
Recovery is part of the treatment rather than an afterthought, so it is described here in the same detail as the operation.
Same day
Back to workSmall pinpoint marks, occasionally a small bruise.
Day 3–5
Toxin beginsThe muscle starts to relax; the line softens.
Week 2
JudgedToxin fully settled. This is when the result is assessed and topped up if needed.
Month 3–4
Toxin fadesMovement returns gradually. Repeat treatment is planned before it is fully gone.
Month 6–18
FillerDepending on product and area, filler softens gradually rather than disappearing.
Honesty
Risks, and what can go wrong
Every operation has them. They are listed here because a patient who has read them and still wants to proceed is a patient who will be content afterwards.
- Bruising at the injection point — common, brief, and easily covered.
- A temporary heaviness or asymmetry of the brow after toxin, which settles as the dose wears off.
- Swelling and lumpiness after filler in the first week; nodules that persist can be dissolved.
- Rarely, vascular occlusion with filler — the reason injections should be done by someone who knows the anatomy and holds the reversal agent.
Results
His own patients
Every photograph here is of Dr. ElKhoury’s own patients, taken at the same distance under the same light, before and after, and published unretouched apart from the masking that protects identity.
Results vary between patients. Shared with consent. More cases →
Questions
What patients ask
How long does botulinum toxin last?
Three to four months at first, and often longer once you have had it repeatedly, because the muscle gradually weakens with disuse. It is planned before it wears off entirely rather than after.
Will my face look frozen?
Not if it is dosed properly. The aim is a face that still moves and still shows what you feel. A forehead that cannot move is a dosing error.
What is the difference between toxin and filler?
Toxin relaxes muscles that fold the skin. Filler replaces lost volume. They treat different problems, and using one where the other is needed does not work.
Is there any downtime?
Essentially none. Fifteen to thirty minutes in the clinic and straight back to your day. A small bruise is possible and is easily covered.
Can it replace eyelid surgery?
No. Toxin and filler treat lines and volume. Excess eyelid skin has to be removed surgically. They are often used together, but one does not substitute for the other.