Toxin fear is not uncommon in Germans. This is quite difficult to understand as botulinum toxin is one of the safest drugs available – specifically when used in the indications of aesthetic medicine. Toxin fear is not without risk as it might lead to unnecessary treatments e.g. filler injections which in the case of the glabella might be unsightly at least (the ‘unicorn’) or even a disaster when filler injections are followed by arterial occlusion.

Where does the German ‘Angst’ come from? Well does it come from fairy tales? You might remember Snow White who ate the poisoned apple. However, the British know Snow White too and they are less afraid! (maybe they remember more the prince part at the end) Or is it something else? Does it come from marketing propaganda from non-doctors as the German natural healers (‘Heilpraktiker’) who are not allowed to use botulinum toxin (because they are drugs) but fillers (because they are just medical devices) e.g. is it: if you cannot use it you damn it!? Or is it more the marketing noise from irresponsible medical devices companies that want to market their devices by raising toxin fears - you might remember a device that was supposed to have a similar effect like the botulinum toxins in the glabella area by selectively freezing nerves … the device is long gone – but the fear might have stayed!

So what can we do? Does rewording the toxin make a difference? There are a group of Germans who speak of botulinum instead of botulinum toxin. After several years of playing with the words the effect - at least in my experience – is not measurable, maybe because they still call themselves German Society for Botulinum Toxin. In my opinion we have to try to target irrationalism with rationalism. We need to point out to our patients e.g. that efficacy and safety of the botulinum toxins in the glabella area are much higher compared to filler treatment. Let’s go for it! The unicorns should leave the real world to return to wonderland!