Dr David Loh
Dr David Loh
Dr David Loh is one of the earliest B*tox trainer for new doctors in Singapore.

B*tox, Dysp*rt, Xe*min are the trade names of the more commonly used and medically approved Botulinum toxin type A

Botulinum toxins work by blocking the release of Acetylcholine (a chemical neurotransmitter) from nerve endings. The lack of which the target muscles would not contract in reaction to signals sent from our brain. The muscles into which Botulinum Toxins were injected become “relaxed”, thus reducing the appearance of wrinkles. These wrinkles are termed dynamic wrinkles because they come on only with muscle action.


Static wrinkles are those already etched onto the skin, even without any muscle action. Treatment options for static wrinkles include Fillers, Ulthera or Thermage, Lasers or any of these in combination with Botulinum Toxins.


Botulinum Toxins was primarily used to eliminate the wrinkles in the forehead, brow area and crow’s feet around the eyes. Nowadays, the main objective – and we cannot emphasize more – when we use Botulinum Toxins and Fillers is to lessen shadows on one’s face and maintain a smooth taut outline of the jaw and cheeks from all directions. And we preemptively prevent the appearance of these line and shadows in otherwise young and beautiful people.


The healing properties of Botulinum Toxins are well known. And I am not exaggerating here. Patients who’ve had Botulinum Toxins even just once will find that the lines that were etched into the skin over the years heal. They would almost always lament that they should have started earlier. In fact skin looks better than before.


Areas that are good to have preventive botulinum toxin are the crow’s feet and glabellar areas. Start in your 20s or 30s and you will delay getting crow’s feet or frown lines. This is the essence of preventive botulinum toxin.

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It is now commonly believed that starting young with Botulinum Toxins can delay the onset of lines and prevent the sagging of the face.



While there are doctors who will remove wrinkles, at David Loh Surgery, we use Botulinum Toxins to enhance one’s features. Already beautiful patients will look even more beautiful in our hands. We can lift (yes, LIFT by relaxing muscles) various parts of the face and neck, lessen shadows along the jaw and chin as well as to reshape faces with Botulinum Toxins alone!



Another common approach is to use Botulinum Toxins in synergy with collagen building treatments like Ulthera, Fillers and Lasers. With Botulinum Toxins used concurrently, skin is able to lay down more collagen than if such procedures were done alone. This little appreciated fact has been documented in clinical trials from the early 2000s.



Botulinum Toxin's Onset and Duration of Action

Action of the drug begins in 2 days, peaking at 10 days and lasts for 4 months. We generally advise a follow-up at one week and four months, for top-ups.


  • Are the effects of Botulinum Toxins lasting?
    In theory, it is not lasting. But in practice some effects linger.It has been shown that with Botulinum Toxins done back to back, the target muscles “forget” to contract. Thereafter, much less Botulinum Toxins would be needed each time or the periods between follow-ups lengthen somewhat. Most people will need Botulinum Toxins 2-3 times a year.
  • Are the wrinkles going to come back with a vengeance once Botulinum Toxins has faded?
    Absolutely NOT! They go back to the original state or perhaps slightly improved after 4 months when the Botulinum Toxins has worn off. There is evidence to suggest long term improvements after even one Botulinum Toxins treatment. There are long term improvements to fine lines and skin texture that cannot be explained by the muscle blocking action alone. Perhaps without the background muscle tone on the face, some degree of healing takes place, such that fine lines disappear.

Precaution to Note

We have revised our list of precautions with years of experience behind us. Now, there is only one precaution. Wash your face gently on the day after Botulinum Toxins. Do not rub too hard. Use general common sense for everything else and nothing will go wrong.


With a lot of common sense, complication are very rare… the reported complication rates vary from 0.1 to 1% in published medical literature. Ptosis being the commonest, making up 50%-75% of serious complications. It usually recovers fully, but nobody is happy during the 3 month duration. The complications luckily do not last as long as the desired effects. No doctor in his/her right mind injects in the wrong position. It is always another event like a vigorous facial massage that causes the toxins to track to other muscles. Hence we are dealing with a small amount; possibly even just a few molecules. Which is why complications often last weeks only, instead of months.


Botulinum Toxins is unsuitable for those suffering from myasthenia gravis, certain motor neuron conditions and those who are allergic to Botulinum Toxins (obviously!) previously used.

While aspirins usage and mild hypertension or diabetes are not absolute contraindications, those with serious bleeding conditions should not have any kind of injections (all Botulinum Toxins included) unless in life-saving circumstance.


Speak with us at (+65) 6733 5300
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