Principles of London Botox, and Why Botox Can Create a Lifting Effect

The science of “muscle rebalancing” that relaxes the depressor muscles and shifts the pulling direction of the face upward

💡 At a glance

· London Botox is a commonly used domestic nickname for “lifting Botox,” an injection treatment that selectively relaxes the depressor muscles that pull the face downward, restoring the balance of pull upward.

· The core principles are twofold: ① muscular rebalancing of the elevator and depressor muscles, and ② a microdroplet technique (Microbotox) that injects diluted toxin densely into the superficial skin layer.

· Treatment takes 10~20 minutes with almost no downtime. Results begin to appear after 3~7 days, peak around 2 weeks, and last about 3~4 months (individual differences apply).

· Recommended for: early sagging when the jawline starts to blur, and people in their 30s~40s who want to refine their impression while keeping their expressions natural.

What exactly is London Botox?

London Botox (lifting Botox, Botox lifting, Lifting Botox, Microbotox, Nefertiti Lift) is a non-surgical injection treatment that uses botulinum toxin to readjust the face’s “pulling direction” and refine the jawline and lower facial contour.

Let’s start with the exact definition. “London Botox” is not an official medical term listed in textbooks, but rather a marketing nickname for a Botox injection technique used for lifting purposes. The name may be new, but the principle behind it is close to a combination of two techniques that have already been validated in papers for nearly 20 years: the Nefertiti Lift and Microbotox. So in this article, we will explain it based on the principle rather than the name.

Principle ①: The face is a tug-of-war between elevator and depressor muscles

It is well known that Botox relaxes muscles. Botulinum toxin blocks the release of acetylcholine (the substance that sends the signal to muscles to “contract”) at the nerve ending, temporarily reducing the strength of the injected muscle. But how can an “injection that prevents movement” lift the face?

The answer lies in the structure of the facial muscles. In the face, the elevator muscles that pull tissue upward and the depressor muscles that pull it downward form pairs and engage in a tug-of-war. Representative depressor muscles include the platysma, which broadly covers the front of the neck and pulls the jawline downward, and the depressor anguli oris (DAO), which pulls down the corners of the mouth. As we age, this downward pull becomes relatively dominant, causing the jawline to collapse and the mouth area to appear saggy.

Lifting Botox is a treatment that selectively relaxes only the depressor side in this tug-of-war. When the depressor muscles relax, the elevator muscles become relatively dominant, and the combined force (vector) acting on the facial tissue shifts upward. This is called muscular rebalancing.

A representative study applying this principle to the jawline is the “Nefertiti Lift” published by Levy (2007, Journal of Cosmetic and Laser Therapy). It is a technique that injects toxin along the lower border of the mandible and the upper part of the posterior band of the platysma to release the platysma’s downward pull on the face. In clinical experience with 130 patients, jawline re-contouring effects were observed even with low doses within 20 units, and patient satisfaction was very high while the incidence of side effects was low. However, excessive injection in the neck area has been reported to cause swallowing discomfort or neck weakness, so dose and injection-site design are the key points of this treatment.

Principle ②: Preserve the deep muscles, refine only the surface attached to the skin

The second axis is injection depth. London Botox-type treatments dilute toxin with normal saline and create very small droplets, then inject them densely not into the deep muscle, but into the dermis or just below it.

This technique was systematized as Microbotox by Wu (2015, Plastic and Reconstructive Surgery). It involves diluting toxin to 20~28 units per 1 mL and dividing it into 100~120 points to inject at the boundary between the dermis and the superficial muscle layer; clinical experience in more than 1,867 cases has been reported. This partially relaxes only the superficial muscle fibers attached below the dermis while preserving the function of the deep muscle layer, allowing expression to remain natural while fine lines and pulling on the skin surface are refined. It has also been reported to reduce horizontal neck wrinkles and vertical bands, bring the platysma closer to the jawline, and sharpen the jaw-neck angle. Incidentally, reduced activity of the sebaceous and sweat glands can improve skin texture and reduce shine, which is also a characteristic of this technique.

In summary, the lifting Botox referred to as London Botox is the combination of two design variables: ① depressor rebalancing (where to relax) and ② superficial microinjection (how shallow and how finely to divide the dose). Even with the same drug, the outcome can be completely different depending on this design.

Who it is recommended for, and where its limits should be clearly explained

It is recommended for people in their 30s~40s with early to moderate sagging, where the jawline is starting to blur, the impression is being pulled downward toward the mouth and neck, or the lower face looks especially heavy in photos. It is suitable for those who want to refine their impression without losing their expressions.

On the other hand, its limitations are also clear. Botox lifting is a treatment that changes the pulling direction of muscles; it does not physically lift stretched skin or sagging fat. For moderate to advanced aging accompanied by skin laxity and fat descent, the standalone effect is limited. In such cases, a practical approach is to combine it with ultrasound (HIFU) or radiofrequency (RF) lifting, or thread lifting, which induce collagen remodeling.

Treatment process and post-treatment care

The treatment is completed in 10~20 minutes after evaluating expression patterns and designing the plan, applying anesthetic cream, and then performing microinjections at the designed points with a thin needle. On the day of treatment, you should avoid rubbing or pressing the injected area (such as massage or sleeping face-down), and refrain from sauna, heavy drinking, and intense exercise for a few days. Washing your face and light makeup are possible a few hours after the treatment on the same day.

Dioré clinical principles

At Seoul Dioré Clinic, we approach lifting Botox not as a “dose-based treatment” but as a “design-based treatment.” The chief doctor directly evaluates each patient’s expression pattern and depressor muscle activity to individually design the injection points, depth, and dilution concentration, and uses authentic toxin in measured amounts. In particular, for the neck area, we prioritize minimizing the risk of side effects such as swallowing discomfort by following the principle of low-dose distributed injections. For patients with more advanced sagging, rather than recommending toxin alone, we also plan the sequence of combined treatment with ultrasound and radiofrequency lifting. Multilingual consultations are also available for patients visiting from overseas.

Frequently Asked Questions (Q&A)

Q1. How is London Botox different from regular Botox?

The drug itself is the same botulinum toxin. The difference lies in the purpose and design. While regular wrinkle Botox focuses on deeply relaxing the muscles that create wrinkles, such as those in the forehead and glabella, lifting Botox, called London Botox, selectively relaxes the depressor muscles that pull the face downward and injects diluted toxin in fine amounts into the superficial layer of the skin to shift the pulling balance upward.

Q2. When does the effect of London Botox appear and how long does it last?

Usually, changes begin after 3~7 days, peak around 2 weeks, and last about 3~4 months. There are individual differences depending on muscle-use habits and metabolic speed, and repeat treatment every 3~4 months tends to maintain a stable sense of effect.

Q3. If sagging is quite advanced, can London Botox alone provide lifting?

To be honest, it may not be enough on its own. This is because toxin only readjusts muscle pull and cannot restore stretched skin or fat. At Dioré Clinic, in such cases, we first consider a combined plan using HIFU and radiofrequency lifting to create tissue contraction and collagen regeneration, along with toxin to refine the direction of pull.

Q4. I’m worried my expressions will look awkward or my smile will become unnatural after the treatment.

Injection depth and dose design are the key factors. The Microbotox method is designed to partially relax only the superficial muscle fibers attached to the dermis while preserving deep muscle function, so preserving facial expression is itself the goal of the technique. However, excessive dosing or injection into the wrong layer can cause unnatural expressions or asymmetry, so it is important to receive treatment from medical staff who design the plan based on anatomical evaluation.

Q5. If I want to get London Botox in Korea, what criteria should I use to choose a clinic?

We recommend checking four things: ① whether they truly evaluate expression patterns and depressor muscles before treatment, ② whether they use authentic toxin in measured amounts, ③ whether they have standards for managing side effects such as low-dose principles for the neck area, and ④ whether they design combined treatment with device-based lifting depending on the sagging stage. Seoul Dioré Clinic operates these four points as standard protocol, and the chief doctor personally handles everything from consultation to treatment.

Closing

Even if the name London Botox comes and goes like a trend, the principles behind it — depressor rebalancing and superficial microinjection — are validated approaches accumulated through research papers. What matters is not the name, but getting an accurate diagnosis of whether the cause of sagging in your face is muscle pull or skin and fat laxity. If you are considering treatment in Korea, Seoul Dioré Clinic can analyze the pulling structure of your individual face and propose either toxin alone or a combined treatment plan.

ℹ️ This content is intended to provide general medical information and does not replace individual medical care. Treatment results may vary depending on each person’s skin condition, and accurate diagnosis and consultation should be conducted with a dermatology/aesthetic medicine specialist.

References

• Levy PM. The 'Nefertiti lift': a new technique for specific re-contouring of the jawline. J Cosmet Laser Ther. 2007;9(4):249-252.
• Wu WTL. Microbotox of the Lower Face and Neck: Evolution of a Personal Technique and Its Clinical Effects. Plast Reconstr Surg. 2015;136(5S):92S-100S.
• Fabi SG, et al. Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars. Aesthet Surg J. 2023;43(9):1015-1024.