Botox! All Your Questions Answered

Posted on by Anouschka in Ask The Experts

Having received several questions regarding Botox, I decided to group them all together so that they could be answered in one go.


A big THANK YOU to Dr Alek Nikolic, for taking the time to answer these for us:


I want to have Botox but I’m scared of all the side effect I read about on-line? How do I know who to go to?

This is a great question but also a difficult one to answer. Upfront Botox® and dermal fillers should only be administered by a qualified medical doctor registered with the HPCSA. Ideally you also need to see someone who is not only experienced (minimum 3 years of treating patients) but who have also been trained according to worldwide accepted consensus recommendations. Unfortunately, there is no way to verify this 100% as any physician who practices cosmetic injectables in their practice will consider they are experienced and that they are treating according to the most current consensus recommendations.


Following this your best option is to get a direct word of mouth referral. If your friends are seeing someone for their Botox® treatments and they look great with no side effects and they look natural, then that is the doctor I would recommend seeing. If you can’t get a direct referral, then I would do a Google search and make a consultation with 3 or 4 doctors and ask specifically for before and after photographs of patients they have treated and I would also ask for references of patients they have treated and their contact details. Phone them and ask their opinion on their Botox® treatment, experience, results, etc.

Following this I would also listen to your inner voice and go with the doctor you get the best feeling and where you feel the safest. I would also look at their receptionists and staff as more often than not they are treated by the doctor they work for so this will also give you an insight on the end treatment results.

I hope the above has helped in guiding you in choosing the best doctor for your cosmetic treatment.


My friend told me that some people are allergic to Botox. Is this true?

Yes, some people may be allergic to Botox® but this is extremely rare. I have been treating patients for over 12 years and I have performed over 20 000 cosmetic procedures and so far, I have not (touch wood) come across a patient who is allergic to Botox®. More commonly is the possibility of being allergic to the carrier protein which is albumin and this is often seen with people who have an allergy to eggs. So in a nutshell an allergy to Botox® when I see a patient for the first time is the furthest thing from my mind. My advice would not to worry about this potential side effect.


Can Botox help with drooping eyelids?

Botox® may help drooping eyelids and only to an extent. It gets a little more complicated than a yes or no answer. We can lift eyebrows with Botox® and with that the upper eyelid skin also lifts. About 2% of the population we cannot lift their brows so not much change will take place with the dropping of the eyelid skin. Also we are limited by how much we can lift as at the end of the day there is a natural arch and height a female brow should be to suite their face.


How many units would you expect to use on the frown lines, and around the eyes?

Another great question and again not a straight forward answer. The amount of Botox® units used will differ from person to person as it is dependent on the final results the patient would like to see (presenters on stage or TV are treated differently to a lay person), the strength of the muscle and the size of the muscle. So units will vary between:

Frown Lines: 10 to 40 units (in total and divided between 1 to 5 injection points)

Crow’s Feet: 20 to 40 units (10 to 20 units per side and 3 injection points per side)


Can Botox fix an upside down smile?

Yes, to a point. Some of us excessively use the muscle responsible for pulling the corners of the mouth down. This muscle is known as Depressor anguli oris (DAO) and when treated with Botox® the downward pull is stopped and the smile muscles which natural pull up will lift the corner of the mouth. However most of us have a slight downward turn of the mouth corners due to fat pad support loss and in these instances your best option is to consider dermal fillers to bring back support and lift the corners of the mouth at the same time.


How long does a treatment last?

Botox® treatments tend to last between 3 to 4 months. I would say this is about 90% of patients I treat and what has been reported worldwide. Some people are unlucky and get a 2-month duration while others are lucky and get a 5-month to 6-month duration. The main reason for this variance is dosage used (units) as the lower the dose the less the duration and secondly the length of time it takes for nerve sprouting to take place. Nerve sprouts develop after the main nerve has been blocked by the initial Botox® treatment and the time it takes for the nerve sprout to connect with the muscle is the length of time before the muscle becomes active again.


Dr Alek Nikolic


MBBCh (WITS) 1992, ATLS (ACS) 1998, MBA (UCT) 2000, BLS (ACS) 2016

Dr Alek Nikolic is a well-known aesthetic medical practitioner with practices in Chelsea London and in Chelsea Village Cape Town. He has been appointed as an Allergan Local Country Mentor for Facial Aesthetics and has extensively lectured and presented live demo techniques both locally and internationally. Dr Alek has performed over 20 000 cosmetic dermatology procedures and as such has been responsible for training numerous doctors in the art of cosmetic treatments.


He currently holds advisory positions with numerous aesthetic supplier companies and is an Associate of the American Society for Laser Medicine and Surgery and a member of the prestigious International Allergan Medical Institute.



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Tel: +27 21 797 0960


If you have any questions, please email them to and I’ll get an expert to answer them.

About Anouschka

Anouschka is a full time mom and part time Spa addict and pamper fanatic. After taking a 'mommy break' from working in the advertising industry, she started managing facebook fanpages for businesses and fell in love with social media. She divides her time writing for PamperMeNow!, managing the ‘ILoveBeingPampered’ fanpage, and running after her two young boys, with a little bit of Spa action in between.

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