What is upper nose botulinum toxin?
Upper nose botulinum toxin is a procedure directed at the appearance of the oblique lines that form at the root of the nose and on the upper part of the nasal dorsum when smiling or wrinkling the nose. Whether any change in appearance is possible is assessed at the examination.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces contraction of the muscle into which it is administered. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
The muscle in this area is directly adjacent to the area between the eyebrows. For this reason, the upper nose is not assessed on its own but together with Eyebrow Botulinum Toxin. Administering the product to only one of them may leave a difference in movement between the two areas.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The factors that determine the assessment in this area are:
- Whether the lines appear only when smiling, or whether they also remain when the face is at rest
- The condition of the area between the eyebrows, and whether a procedure will also be performed there
- How the nose and upper lip move during smiling
- Procedures previously performed on the area, and any history of nasal surgery
In those who have had nasal surgery, the movement and sensation in the area may be different; this is assessed at the consultation.
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Active infection, an acne lesion or an open wound
In these situations, the procedure is planned subject to the physician’s assessment:
- Asymmetry of the smile (the possibility that it may increase is discussed beforehand)
- Eyelid drooping (the area is adjacent to the area between the eyebrows)
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
If nasal surgery has been carried out and healing is still ongoing, the procedure is postponed.
How is the procedure performed?
- Assessment. The muscle movement in the area and the type of the lines are assessed; the movement of the nose and upper lip during smiling is observed. The condition of the area between the eyebrows is considered alongside it. The physician asks about any history of nasal surgery or neuromuscular disease, current medication, allergies and previous procedures. Blood pressure and pulse are measured.
- Product check. The authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The procedure, the fact that the effect is temporary, the possibility of asymmetry of the smile and the possible side effects are explained in writing and verbally; the form is signed.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Administration. The product is administered to the determined points with a fine needle.
- Observation and follow-up. Vital signs and anything observed are recorded in the file. A follow-up appointment is arranged at which the outcome will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full outcome is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
If you have a history of nasal surgery, please state its type and date.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- If you wear glasses, take care that they do not press on the root of the nose, and follow the advice you are given
- Bending forward, remaining head-down for long periods and lying face down should be avoided for the period specified
- Avoid hot environments, saunas, sunbeds and intense exercise for a while
- Temporary raised bumps, redness and slight bruising may occur at the points of administration
Advice and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
Risks specific to this area
- Asymmetry of the smile
- An unexpected change in upper lip movement
- A difference in movement in and around the nose; a transition line remaining between the two areas
- Drooping of the eyelid (the bridge of the nose is adjacent to the area between the eyebrows)
- A temporary feeling of heaviness in the area
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- A change in facial expression
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Drooping of the eyelid or a change in vision
- Marked asymmetry of the smile
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Does upper nose botulinum toxin change the shape of my nose?
This procedure is not directed at the structure of the nose; what is assessed is the appearance of the lines that form with movement at the root of the nose and on the upper part of its dorsum. Assessment directed at the position of the nasal tip is described on the Nasal Tip Elevation Botulinum Toxin page.
Can I have upper nose botulinum toxin on its own?
The muscle in this area is directly adjacent to the area between the eyebrows. Administering the product to only one of them may leave a difference in movement between the two areas. For this reason, the two areas are assessed together; which of them the product is administered to, and to what extent, is determined at the examination.
I have had nasal surgery; can I have upper nose botulinum toxin?
In those whose healing is still ongoing, the procedure is postponed. In those who have had surgery, the movement and sensation in the area may be different; please state the type and date of your operation at the consultation.
Can I wear glasses after the procedure?
Take care that your glasses do not press on the root of the nose. The time period and advice specific to you are given in writing at the end of the procedure.
Will my smile change after upper nose botulinum toxin?
Asymmetry of the smile and an unexpected change in upper lip movement are among the reported side effects. For this reason, the movement of the nose and upper lip during smiling is observed before the procedure.
How long does the effect of upper nose botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It varies with the individual, muscle strength and the pattern of administration. The timing of any repeat is determined at the follow-up consultation.
Is upper nose botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
