Botox and Bocouture

Botox® and Bocouture®

Botox® is a brand known to the general public as a cosmetic means to create a more beautiful appearance. It has become so popular that it's now even a verb: "let's Botox!" But what is Botox and what does it do?


In the Netherlands Botox® and Bocouture® are drugs that are to be administered strictly by physicians. These drugs fall into the group of neuromodulators and provide decreased muscle activity at the site of injection. In cosmetic medicine this is used at certain muscles with increased pulling power on the skin. The result is that skin gets much less pulled in and gets the chance to recover and renew, thereby fading away your facial wrinkles and furrows.

Both of these drugs belong to the group of Botulinum-A toxins. It is produced by various bacteria of which Clostridium botulinum is the best known. The bacterium produces a toxic protein (toxin). This technically means it is a poison. Just as with many other drugs, the poison is an active drug made by dilution and by altering its chemistry. These new drugs are tested and, when approved, they provide a safe medical solution. Botulinum is traditionally used by ophthalmologists to correct certain eye muscle problems. It is used by neurologists to treat certain neurological disorders (i.e. spasticity in children). Furthermore it is used by urologists to address muscle related problems.

From 1987 onward, US physicians family Carruthers, experimented with the drug and discovered by accident that it had a nice cosmetic effect on the skin around the eyelids. Wrinkles around the eyes disappeared, after being injected with Botox by the ophthalmologist. Since the first scientific publications a warm interest was generated in what was called "Carruthers Botox" (botulinum toxin). This resulted in a considerable influx of people who also wanted to use this drug.

From the year 2000 several brands came on the market that had produced a Botulinum-A toxin from different bacterial strains. The best-known brands at the moment in the Netherlands are:

  • Botox / Vistabel produced by United States firm Allergan
  • Bocouture / Xeomin produced by German firm Merz
  • Disport produced by French firm Ipsen
  • Azzalure produced by Galderma (Nestlé Skin Health)

Good to know:
When considering a treatment with Botox or Bocouture, it is important that you choose genuine medicines. At Pasman Esthetics you get to see both the packaging and the bottle to make sure you receive the correct product. Unfortunately, there are several derivatives on the market with a less predictable effect, often a whole lot cheaper and often originating from the Asian region. It is also possible that you are being treated with a diluted product, which means the results will end up disappointing surely. For medical safety, Pasman Esthetics only uses the best products from reputable suppliers. This enables us to ensure and verify the end-results, the duration of the effect and above all your safety.

How does a Botulinum-A-Neuromodulator (BAN) work?

Once the injection has been administered the liquid will spread over and between the muscles. Here, it will find its way to the transition between the small nerves and muscles. In the three days following injection, it will be absorbed into the ends of the many small nerves and it binds to the small "beads" that form the nerve stimulators. Now, the beads may not transfer this content to the muscle so that the muscle can contract much less easily. The muscle becomes weakened and its pulling force on the skin is reduced. The effect is temporary. The visual effect lasts for three to four months, after which it gets degraded by the body.

Botox / Bocouture treatment of the face

Botulinum-A Neuromodulators (BAN) have its effect especially on muscles with a lot of activity. For example the muscles providing you with a frown (looking angry), the muscles of the forehead (looking surprised) or pinching eye muscles (from looking at the sun). This strong pulling force on the skin results in deep wrinkles in your face. When we age, other muscles in the surrounding area are going to affect the pulling forces of the skin as well; the muscle that pulls down the corner of the mouth, the chin muscle that causes a "golf ball" effect of the skin, the neck muscles are contracted more prominently and several more. When the facial proportions between muscles that push upwards and muscles that push downwards is disturbed it is possible to restore balance with a BAN treatment.

When can I expect results and for how long does the effect last?

Prior to the procedure photographs are taken and become a part of your medical file. When using these pictures we can easily see the result of your treatment. On average it takes between 4-5 days before the first effects can be felt and become apparent. After approximately 10 days the cosmetic effect reaches its optimal state, after which it takes between 3 to 4 months before the effect gradually reduces. After having received treatment more often, the results remain visible for longer, sometimes up to 6 months.

The result

You can see the result when the muscles can pull no more wrinkles and when existing wrinkles fade. Your facial expression softens with a more relaxed appearance. This is why these resources can be used preventively in younger people also. Especially frown lines, forehead wrinkles and crow's feet are easy to deal with. After three to six months (when the Botox has faded) the treatment can be repeated without any problems. Photos are made during the final inspection in the clinic to ensure the intended result was achieved.

However, the end-result can never be guaranteed 100% because not all individuals respond the same way to the treatment. On average, there will be a marked improvement for 90% of all cases, but in 8% of the cases observed, the result is slightly below optimal. Occasionally the result improves by switching for the next treatment to another neuromodulator. In 1-2% of cases, there are antibodies present in the body against Botulinum-A Neuromodulators. In these individuals the treatment has unfortunately no effect.

Risks and complications

People with nerve or muscle conditions, pregnant women or nursing women should not be treated. This is done as a precaution. There are generally no complications, risks or drawbacks when receiving a Botulinum-A Neuromodulator (BAN) treatment in the cosmetic field. Allergic reactions are not present due to the low concentration and low dose of the botulinum-A toxin. In exceptional cases, an injection with a BAN can have a strange effect temporarily persists. Such is the case when having been injected too close to the eyebrow (a drooping eyelid results), or a person over 65 years of age where the muscle structure of the face has become less dense so that the injected liquid moves through and around the muscle to underlying regions with a weakening of unintended muscles as a result.

At Pasman Esthetics we will therefore always carefully consider what areas are deemed safe for treatment.