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Botox Talk with Dr. Cara Duminy

I’ve been getting Botox for the past 18 months and I’ve never once been shy to admit it. If you want to get botox for aesthetic enhancement reasons, that’s completely your own choice. Don’t let anyone make you think that your decision is wrong some people find that they want help with their jawline and botox might be helpful with jawline slimming as well as other nonsurgical procedures. There’s nothing to be ashamed of. Why should I be? It’s a part of my beauty routine and I’ve only ever felt true, deep gratitude at the results. I inherited a deep frown line between my eyes from my mom and just after I turned 25, I noticed it getting ever-deeper. It often made me look tired and angry, so why not get rid of it?

I’ve only ever been to one doctor for my Botox, Dr. Cara Duminy, who I would go so far as to call a Botox Artiste. Cara is a qualified GP with a particular interest in Aesthetics. The first time I visited her practise, I was really nervous. I didn’t know much about Botox and its side-effects, and I was scared that I’d walk out looking surprised or with paralysed eyebrows. But Cara was very straight with me about every single aspect of the product and the treatment, and I felt super comfortable with her.

The results made me so happy I couldn’t stop staring at myself for the first few days. I didn’t look shocked or swollen. I just had a really smooth forehead and dramatically reduced frown lines. I felt and looked great. Since then I’ve been back twice and I’ve always been so pleased with the results, which for me, last about 4-5 months.

Would I recommend getting Botox from anyone other than a medical doctor? No. In the same way that I wouldn’t recommend getting your eyebrows tattooed by a hairdresser. I’ve heard people tell me that they get their dentist to do it or that the lady who does their wax is offering it, but I would not allow that to happen to my face, especially when there are places out there like Xlash who can help you with your eyebrows. In the same way that I want an eyebrow expert and fanatic to work on my brows, I only want to Botox expert and fanatic to work on my face.

I asked Dr Duminy to fill us all in on some burning questions I get asked about Botox all the time. These are the most common questions I hear – especially the confusion around Botox and fillers, which I hear all the time. If you have any other questions on your mind, leave them in the comments section and I’ll ask Cara to answer them.

What exactly is Botox?

“Firstly, Botox is a trade name, like Hoover or Black Cat. There are other brands that produce similar products, but since Botox was first on the scene people tend to refer to all of these products as Botox. Other brands out there are Dysport, Xeomin and Azzalure to name a few. For simplicity’s sake in this article I will refer to all of these products as BTX since we aren’t only talking about the one product but rather all botulinum toxin, or more specifically onabotulinum toxin type A! In my practice I do only currently use Botox though.

BTX is the neurotoxin “onabotulinum toxin Type A”, a strain of botulinum toxin. It was discovered in the 1800s when a batch of contaminated sausages caused a food poisoning epidemic that left devastation in its wake, which is how it got its name meaning “sausage toxin”!

It is extremely effective in tiny doses and it works by blocking the signals from nerves to muscles – if your nerve can’t tell your muscle to contract your muscle stays relaxed, and in areas where wrinkles are caused by movement no movement means no wrinkles!”

Why was it invented in the first place?

“Botox wasn’t invented so much as discovered. When the contaminated sausage problem happened one doctor in particular became very interested in what was happening to the victims because they were becoming “floppy”. In medicine there are a large number of conditions that are due to overactive muscles and so the seed was planted that perhaps this toxin could become useful to relax overactive muscles.

The first time BTX as we know it today was used for medical purposes was in 1977 when an ophthalmologist used it to inject muscles in the eye to temporarily cure squinting. From there doctors began experimenting with the toxin for a host of other conditions starting with other eye problems but soon moving into treating muscle contractures in all parts of the body.

Ophthalmologists soon had patients returning to them for subsequent doses of BTX, telling them that their frown had returned so they knew it was time for a top up. Being the economically savvy bunch that ophthalmologists are it didn’t take long for them to start experimenting with BTX as a wrinkle treatment, and here we are today with a whole new field of medicine called Aesthetics!

Today BTX for medical purposes is used in a long list of conditions including cerebral palsy, stroke, dystonias, various gastroenteric and urinary sphincter problems, torticollis, blepharospasm, hyperhidrosis and achalasia to name but a few. BTX is often used in paediatric conditions and can be life-saving in certain cases. Cosmetic BTX is actually only a part of what BTX does, but it’s obviously it’s most widely publicised and discussed use…even if you disagree with using BTX for cosmetic purposes it remains a very useful drug for those who really need it.”

Is it really poison?

Yes, BTX is a poison. As is paracetamol and aspirin and alcohol and a lot of things we put into our bodies on a daily basis. BTX can be dangerous in the wrong hands and in excessive doses and no one would ever recommend ingesting it, but in a trained doctor’s hands it’s an incredibly safe drug.

At what age should I start using it for my lines?

“That’s a really tough question. No one needs cosmetic BTX. It’s a very personal choice and prescribing an age is wrong because we all have different risk factors for wrinkling and we all have different ideas about what ageing and ageing gracefully means. Having said that, if wrinkling is something that concerns you BTX offers something that no lotion or potion that I’ve ever come across can and as with many things in life, prevention is better than cure.

If you have lines that stay there even when your face is relaxed that concern you then you might consider getting them treated!”

What’s the difference between Botox and fillers?

“BTX paralyses muscles so it deals with lines that are caused by expressions, while fillers…fill! Fillers are gels that we inject to create the illusion of volume where it has been lost or where you never had any to start with. As we age we lose volume in the fat pads of our faces, making us look deflated. Fillers can “reverse” that process by re-inflating those areas. Kylie Jenner’s lips would be a good example of fillers being used to create the illusion of volume where there was none to begin with.

BTX and fillers don’t so much overlap as work together to stop or turn back the clock!”

Will Botox make my lips look like a Hollywood housewife’s?

“No. That’s fillers. And it’s only really if you ask for porn star lips that you should get them. Usually when you see lips like that, or anything that you identify as being due to BTX or fillers it’s really because those injections have been done badly, or that person specifically wanted to look that way. You probably see faces every day that have BTX or fillers on board that you just think were blessed with good genes.”

How much does it normally cost?

“BTX prices vary from doctor to doctor, and you should be more alarmed by suspiciously low prices than by high ones. There are also various ways BTX gets charged for, sometimes by the unit, sometimes by the area and sometimes just a flat fee. Your doctor should tailor your treatment to your face and should be able to explain their pricing structure to you when you call for an appointment.” (For reference, I’ve never paid more than about R1500 for my own treatment – Natalie)

How long does it last?

“BTX treatments last 3 – 4 months. If you maintain your treatments well you should find your treatments last longer and longer until you only need to treat twice a year. Having said that your treatment timeline is your own – many of my patients like to only treat twice a year from the very beginning and that’s totally fine! It’s your face, you get to curate it!”

Is it true that the more I use it, the more I need it?

“No. The converse is actually true. There seems to be some kind of urban myth around that if you stop using BTX your face will become more lined than it was to start with. I can’t wrap my head around how people think this could be the case to be honest. I think maybe if you have a treatment and then you stop you might think your face looks lined because you were used to it being smooth for 3 – 4 months? After a treatment your face will actually still be a little better than it was before because you’ve had a break from making the expressions that cause permanent lines. If you start early and prevent permanent lines from forming you will actually use less BTX over time and will never “need” large doses that render you expressionless.”

I’ve heard it can paralyse your eyebrows?

“Yes it absolutely can, but it doesn’t have to. Since BTX works by paralysing muscles to decrease the wrinkling that repeated movements cause, it will limit the movement of your eyebrows when it is used to treat frown lines or horizontal forehead lines. Limiting movement doesn’t mean complete paralysis though, and in my personal opinion our faces should move. The amount of paralysis produced depends on the dose used. By starting early and with small doses you can actually maintain close to a normal range of movement, just without the formation of wrinkles! If you want your eyebrows paralysed though, that can be arranged!”

Can I just get my beauty therapist to do it?

“No. BTX is a scheduled drug no matter what form it comes in or brand it comes from. What that means is that it can only be injected by a qualified and trained professional. In South Africa doctors and dentists are the only professionals licensed to inject BTX. It is illegal for anyone without a medical degree to inject you with BTX or fillers; not only are they unqualified to do the injections themselves, but they certainly would not be able to deal with any complications that may occur AND are likely using substandard or fraudulent products since reputable brands will only sell to practitioners registered with the Health Professionals Council of South Africa.”

Will I become addicted to it?

“BTX is not addictive in the traditional sense of the word, but the results you get from these injections does keep most patients coming back for more when their treatment has worn off. ”

I don’t want my face to be completely immovable. Should I still get it?

“There is no need for your face to be completely paralysed after a BTX treatment. Your treatment should be tailored to your face and your needs by your doctor, and if you express that you don’t want to be paralysed your doctor should give you a treatment that allows movement!

Your first BTX treatment is really at your doctor’s discretion, and they will treat you according to the movements they see your face making and what you tell them you would like to achieve. After that you will be able to tell your doctor exactly what you liked and didn’t like, and at your next treatment they can slightly change the doses or positions of your injections until you find a formula that is perfect for your face!

If you have lines on your forehead or around your eyes that bother you I would always recommend you give it a try; if it lands up not being for you it will wear off after 3 – 4 months and you can choose not to treat again for a few months or years or ever at all if it really doesn’t suit you.”

Dr Cara Duminy practices at Cape Aesthetics in Cape Town.

Operating Hours:
Monday – Friday: 08:00 am – 5:00 pm


Tel: 021 683 3048
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  1. Hi Natalie

    I have a question: What side effects does BTX have and how long does the side effects last? Can Dr. Cara recommend any specialists on the East Rand?

  2. Hi Natalie
    Since you mentioning it – do you know of a “eyebrow expert” that does microblading in Cape Town? I want to have mine done but want it to look as natural as possible and not overdone.
    Loved you on “Ruil my styl” – hope there will be a new season soon!!

    1. Hi Lolita,

      My friend Misha runs The Browery (www.browery.co.za) and she sometimes comes to Cape Town.

      1. Thanks! I will check the website.

  3. Thanks! I will check the website.

  4. Hi Nats. Please ask Cara if BTX can be used in large muscle, eg: Jonti has very tight muscle in her neck/shoulder causing a lot of pain. She has tried exercise, physio, chirp, massage, stretching, needling.

  5. ….Chiro….obvs.

    Also, please ask if I can have an appointment for Dec 23rd.

  6. Curious to know what the costs are?

    1. You’ll see I mentioned in the post that I’ve never spent more than R1500 on a consultation. But it’s largely based on your needs. Of course there’s always the option to say, “I only have XXX so please don’t go over my budget.”

  7. Hi Natalie!

    Do you have a very good BTX specialist to advice on Joburg?

  8. […] If botox IS for you, then Dr Cara can help! You can read our friend Natalie’s post on Tails of a Mermaid to find out more about the process. You can also follow Cape Aesthetics on Instagram for amazing […]