Bodywise private practice in Heidelberg-Neuenheim
Dr Michael Pees examines facial movement, skin and tissue and discusses your concerns, previous treatments and realistic expectations. Whether treatment is medically appropriate is decided only after examination and an informed discussion.
Personal advice at Bodywise
The consultation starts with the changes you have noticed and the questions you have about them. Dr Michael Pees examines how muscle activity, skin and tissue contribute to the findings. The assessment may also show that treatment is not appropriate.
Together, you discuss the options, limitations and a realistic treatment goal. Treatment is planned only after an examination and informed consent; treatment at the first visit is not guaranteed.
UNDERSTANDING FACIAL EXPRESSION
Expression lines develop where muscles repeatedly move an area of skin. Initially, these lines mainly appear during active facial movements. Over time, they may remain more visible at rest. Common areas of concern include the forehead, the area between the eyebrows and the outer eye area.
It is important to distinguish lines caused by facial movement from changes that mainly have other causes. If skin quality, tissue laxity or volume loss is the main concern, reducing muscle activity alone is often not enough. A medical assessment beforehand is therefore more important than choosing a procedure based on terms found online.
Understanding the treatment
At Bodywise, expression lines are treated with botulinum toxin. Botulinum toxin, often referred to as “Botox”, can temporarily reduce signal transmission between a nerve and a selected muscle. This allows the activity of specific muscles to be reduced in a targeted way. The aim is not to eliminate all facial expression, but to achieve a controlled reduction in overactive muscle movements so that expression lines can soften.
The extent to which a muscle is treated does not follow a standard formula. Relevant factors include the treatment area, muscle activity, initial findings, the desired change and individual facial anatomy. The same dose is therefore not automatically suitable for everyone.
YOUR INDIVIDUAL FINDINGS
Treatment may be appropriate when visible lines are mainly caused by muscle activity and the findings support temporarily reducing that activity. Common concerns include expression lines on the forehead, between the eyebrows and around the outer eye area.
Whether treatment should actually be performed depends on more than the location of a visible wrinkle. The starting position of the eyebrows and upper eyelids, facial movement, existing asymmetries, skin quality and whether the patient's wishes can realistically be achieved with the procedure are equally important.
Botulinum toxin and hyaluronic acid serve different purposes. Botulinum toxin temporarily reduces the activity of selected muscles and is therefore mainly used for lines caused by facial movement. Hyaluronic acid fillers, by contrast, address volume changes or support contours. The two procedures are not interchangeable.
If a visible wrinkle is mainly caused by volume loss, tissue changes or skin texture, botulinum toxin alone may be unsuitable or offer only limited benefit. Depending on the findings, another treatment may be more appropriate, or the medically appropriate recommendation may be not to have treatment.
Before treatment, Dr Michael Pees looks beyond the visible lines to consider the interaction of facial anatomy, proportions, muscle activity, skin and tissue. Previous treatments also matter. Earlier injections can influence the current appearance and must be taken into account when planning treatment.
Particularly in the upper third of the face, imprecise planning can lead to an outcome that does not suit the individual findings. A structured examination, realistic goals and thorough information are therefore more important than making a quick decision about treatment.
STEP BY STEP
You begin by describing your concerns. The discussion includes how they have developed, previous treatments, existing medical conditions, relevant medication and the change you would like to achieve.
Dr Pees then examines the affected areas at rest and in motion. He assesses facial expression, muscle activity, proportions, any asymmetries, skin and tissue. This determines whether botulinum toxin treatment is appropriate, whether another approach would be more suitable or whether treatment should be advised against.
Before a decision is made, you discuss how the treatment works, realistic benefits, limitations, possible side effects, less common risks and aftercare. A consultation-only appointment and a treatment appointment serve different purposes.
If treatment appears medically and aesthetically appropriate and you choose to proceed, injections are given in the areas agreed beforehand. The specific dose depends on the treatment area, anatomy and treatment goal.
The effect is not immediate. It develops over time. Dr Pees explains when a review is appropriate and which changes fall within the expected course of treatment.
Results and progress
Botulinum toxin does not take effect immediately after injection. Initial changes typically become apparent only after a few days. Assessing the result on the same day is therefore not meaningful.
How long the effect lasts varies from person to person. It often lasts several months. Muscle activity, the treatment area, dose, individual metabolism and previous treatments can influence its duration. A fixed duration cannot therefore be guaranteed.
Softening expression lines is a realistic aim when they are mainly caused by the activity of specific muscles. The goal is an improvement, not the technical perfection of a motionless face.
Limitations are particularly relevant when lines are already deeply established, changes in skin or tissue are the main issue, or the desired change cannot reasonably be achieved given the anatomy. Existing asymmetries cannot always be fully corrected either. A factual discussion of what can and cannot be achieved is therefore part of the treatment decision.
Make an informed decision
What you should know before and after treatment. Dr Pees will discuss your personal questions during the medical consultation.
More common temporary reactions include redness, minor swelling, tenderness, small pinpoint bruises or a short-lived feeling of tightness in the treated area. Temporary headaches may also occur. These reactions often settle on their own, but must be assessed in the context of the overall findings.
Like any injectable treatment, expression line treatment is not without risk. Possible effects include an insufficient or excessive response, temporary asymmetries or unintended effects on neighbouring muscles. In the upper third of the face, for example, this may cause temporary drooping of an eyebrow or upper eyelid.
Treatment may be postponed or declined if there are acute infections or inflammatory skin changes in the treatment area, during pregnancy or breastfeeding, if certain neurological or muscle conditions are relevant, or if medical information first needs further clarification.
Dr Pees may also advise against treatment if botulinum toxin is unlikely to address the concern appropriately, if another treatment better suits the findings or if expectations do not match what can realistically be achieved.
After treatment, you receive guidance for the following hours and days. It is particularly important to have realistic expectations about progress and not to dismiss unusual symptoms. Aftercare is intended both to review the result and to assess the course of treatment medically.
Costs and appointments
The listed amount relates to the treatment described here. Please ask the practice separately about the fee for a consultation without treatment.
Bodywise lists botulinum toxin treatment from €250. The actual scope is agreed in advance. The dose required depends on the treatment area, anatomy and treatment goal. Following examination and treatment planning, Dr Pees explains the exact cost before you decide whether to proceed. Medical services are billed in accordance with the German medical fee schedule (GOÄ).
Personal care for you
Dr Michael Pees is a specialist in surgery. Surgery forms the foundation of his professional background. He spent many years in senior medical roles in aesthetic surgery in Heidelberg and the surrounding region. At Bodywise, he applies this experience to preventive medicine, weight management and aesthetic medicine.
This experience is relevant to expression line treatment because planning involves more than an injection: the findings need to be assessed precisely from a medical and anatomical perspective. This attention to the starting situation, proportions, risks and appropriate limits shapes Dr Pees's work.
Dr Michael Pees's qualifications and professional background
Frequently asked questions
It is particularly suitable for lines mainly caused by muscle activity. Whether this is actually the case can only be assessed reliably after an examination.
Botulinum toxin temporarily reduces the activity of selected muscles. Hyaluronic acid fillers are used to address volume changes or support contours. The two procedures serve different purposes.
The effect is not immediate. Initial changes typically become apparent only after a few days. Dr Pees will discuss when it is appropriate to assess your individual result.
Duration varies from person to person. The effect often lasts several months. The treatment area, dose, muscle activity and individual factors influence the course.
The aim of appropriately planned treatment is not a completely rigid expression, but a controlled reduction in overactive muscle movements. The appropriate degree of reduction is determined individually.
More common effects are temporary local reactions such as redness, minor swelling, bruising, tenderness or headaches. There are also less common but relevant risks, which will be discussed beforehand.
Noticeable eyelid drooping, significant visual disturbances, unusually increasing weakness, difficulty speaking or swallowing, breathing problems or signs of an allergic reaction should be assessed medically without delay.
Bodywise lists botulinum toxin treatment from €250. The specific dose and actual total cost are determined after a medical examination and treatment planning.
At a glance
Explore medical services, personal consultations and individual treatment planning at Bodywise.
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Jaw muscles
Medical assessment and treatment planning for overactive jaw muscles and bruxism.
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Volume & contours
Learn about hyaluronic acid fillers for volume changes and support of facial contours.
Learn morePatient reviews
Selected Google reviews about consultations and treatment at Bodywise – Dr. Michael Pees. Translated from German.
Google reviews
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A very pleasant atmosphere in pleasant surroundings. Dr. Pees gave me knowledgeable advice that was easy to understand.
I am very satisfied with the result of my treatment. I would be very happy to recommend the practice.
Dr. Pees is a knowledgeable and empathetic doctor with more than 30 years of professional experience. This is also reflected positively in his thorough, open and individual advice and care. I felt very well looked after by Dr. Pees and can recommend him without reservation.
I visited Dr. Pees again today for injectable treatments. Such a wonderful doctor; I would not go to anyone else. He deserves more than just 5 points.
I can really only recommend him.
Dr. Michael Pees gave me excellent advice, and solutions to my problem were found quickly.
Thank you ❤️
Private practice in Heidelberg-Neuenheim
You can contact the practice to request an examination and consultation. The discussion covers your findings, medical history, previous treatments, limitations and risks. An enquiry does not commit you to treatment.
