Botulinum Toxin Type A (BTA) Botox®  Is indicated for the temporary improvement of moderate to severe upper facial lines in adults ≥18 and <65 years. Botulinum Toxin Type A (BTA) Bocouture® is indicated for the Temporary improvement in the appearance of moderate to severe upper facial lines (glabellar frown lines, crow’s feet lines, horizontal forehead lines) in adults ≥18 and <65 years.

BTA is prescribed and used to treat areas outside of it’s licensed indications. Both the forms listed above contain the active medicine, Botulinum Toxin Type A.  This medicine is a biologically active medicine made by a process called fermentation.  It is produced by a bacteria (clostridium botulinum) and each company that produces the medicine uses the same strain of the bacteria, meaning the active part is identical between different formulations. 

The differences between them are in the manufacturing process that extracts and purifies the medicine, and in the excipients (other added ingredients) in the finished product.  The amount of the additional proteins can be measured in terms of the weight of a complex, the complex being the active molecule and its associated protiens.  Botox has added Human Albumin and Sodium Chloride, Bocouture contains Human Albumin and Sucrose

For Botox the complex weighs  900 kD (kD stands for kilodalton, which is a measure of weight used for molecules).  Bocouture weighs in at 150 kD, this is the weight of the active component itself meaning that the Bocouture preparation has no additional complexing proteins in the mix, containing only the active compound.  The other difference other than the amount of actual protein, or biological material in the vial is the excipients.  These are other things added to the vial to help maintain the stability of the medicine before it is reconstituted and injected.

For the patient, there is no significant clinical difference between the formulations, they are all good, your practitioner has vast experience using both formulations. Results typically last from 2-4 months before requiring re-treatment, there are no guarantees as to the longevity of treatment and may vary greatly from one person to another.

The treatment takes approximately 4 days to 10 days to take effect, this may be gradual and can sometimes take longer, a free of charge dose adjustment is offered within 2-3weeks of initial treatment.  Further corrective treatment using more product will be charged at a basic rate agreed with the practitioner free of charge treatment cannot be offered under any circumstances. 

You should book your review appointment you are responsible for booking this, it is advisable to do this at the time you book your initial appointment, if you cannot make the appointment with 3 weeks of the initial treatment please ensure that you inform the clinic and every effort will be made to accommodate you, dose adjustment cannot be administered after 4 weeks of initial treatment.


It is important to understand that you may not achieve line free results, the practitioner will make every effort to treat the indicated areas however it may not be possible achieve full results if the adjacent muscles would be affected, this will be explained at your consultation prior to treatment.

Treatment will not eradicate static lines, those lines that you see when you are not using the facial muscles, these lines may reduce over time with sustained and continued treatment.  The effects of Bta are to reduce the dynamic movement lines, minimising the impact upon the skin and preventing lines occurring.

If Ptosis does occur it is impossible to treat, you will wait until the effects of the Botulinum Toxin reduce generally this Ptosis will not last throughout the treatment phase and will start to reduce at around 6 weeks onwards.

  • Pain, stinging or burning sensation
  • Numbness at the site of injection
  • Risk of bruising, swelling, pain and burning sensation
  • Headache & general facial pain
  • Drooping of the eyelid & eyebrow, ptosis
  • Asymmetry of facial expression
  • Allergic reaction or Anaphylactic reaction
  • Dry eye, sensitivity to light and inflammation of the eyelid
  • Period if time to take effectand typical duration of treatment


Immediately after treatment for the first 4 Hours avoid the following;

  • Bending forward for long periods e.g cleaning
  • Laying flat, use an extra pillow if laying down
  • Avoid Exercise

Over the following period before review;

  • Avoid heat including swimming, sauna and steam rooms
  • Do not apply make-up or facial creams to the treated area for at least 8 hours
  • When washing please do not apply too much pressure or rub vigorously
  • Avoid facial treatments and massage for 2 week post treatment / review treatment
  • If you have bruising you can apply ice for 10 minutes per hour maximum, ensure that you do not apply this directly to the skin use a clean tissue or thin cloth around the ice before applying the ice
  • Report any other effects promptly

This treatment is an elective cosmetic procedure and hereby acknowledge the following:

The practice of medicine is not an exact science and different people can react differently to the same procedure.  You should understand that the effects of the treatment can last longer for some patients than others.

This procedure is a cosmetic procedure and so assessment of the results involves a great deal of subjectivity, therefore it is important to understand that while you will be advised as to the probable result, this should be in no way interpreted as a guarantee.

That whilst complications from the procedure are uncommon, they do sometimes occur.

Please report any pain or unusual rash, loss of circulation to the surrounding skin immediately. BTA administration can result in anaphylaxis (a severe allergic reaction) which in itself is life threatening and requires immediate medical attention. Symptoms of a severe allergic reaction can include shortness of breath, wheezing, coughing, difficulty swallowing, swelling of the tongue, eyelids, lips, hoarseness of the voice, stomach pain, nausea or diarrhoea. If you have any of the above symptoms please report to your nearest Accident and Emergency Department or call 999 for an ambulance.

Your Practitioner can be reached 24 hours per day.


I understand that though complications are uncommon, they do sometimes occur. It is possible that side effects not described may occur and indeed that a complication not previously reported may occur for the first time. I understand if I suffer any adverse reactions that are not expected, or concern me, I must contact my practitioner, and book a review appointment.  MD Medical Aesthetics Ltd cannot take responsibility for complications or results that have not been reported, assessed, documented and managed in a timely manner.  Whilst I have been advised of the probable result, this cannot be interpreted as a guarantee. Results vary from one individual to another.

I confirm that the medical health history form has been completed truthfully and I am fully aware that withholding medical information, including history of previous treatment, may be detrimental to the safe and optimal outcome of any treatment administered.  If there are any changes in my medical history, I must inform the practitioner.

I confirm that I have been provided with verbal and written information about this treatment which includes aftercare and follow up advice and I agree to follow the aftercare advice and understand this reduces risk of adverse reactions and helps ensure optimum results.

I understand information about me will be treated as confidential and access to it restricted in accordance with the Data Protection Act, unless specific permissions given.

By consenting to treatment you accept the clinic terms and conditions as outlined:

  • You are satisfied that the treatment has been explained comprehensively
  • That the possible risks and side effects associated with the treatment have been fully discussed and understood
  • That you have taken sufficient time to process and consider the information provided and any questions have been answered to your satisfaction, before making a decision to proceed with the agreed treatment plan.
  • You consent to your medical records being shared with appropriate professional staff
  • You accept emergency intervention treatment if required