Univ.-Prof. Dr. Dr. Ludwig Heindl is a renowned physician with over 20 years of experience in aesthetic medicine. As a specialist, he places great importance on personalized consultations and tailored treatment plans to meet the individual needs of his patients.
At the private practice "New Aesthetic Vision" in Cologne, he offers a wide range of aesthetic treatments that combine top-tier medical expertise with the most advanced techniques. He is one of the leading experts in aesthetic facial surgery in Germany. The esteemed professor merges the latest medical findings with outstanding surgical expertise. His name stands not only for highly specialized eyelid surgery and the treatment of conditions affecting the tear ducts, ocular surface, and eye socket (orbit), but also for innovative, minimally invasive procedures—such as scar-free laser surgeries.
Prof. Dr. Dr. Heindl is nationally and internationally recognized—not only for his scientific publications but also for his pioneering advancements in ophthalmic reconstructive surgery. In addition to his extensive expertise in the field of ophthalmic oncology (eye tumors), he is known for his comprehensive, interdisciplinary therapeutic approach. Every patient benefits from individually coordinated treatment strategies developed in close collaboration with other medical disciplines. With his passion for ophthalmology, scientific dedication, and commitment to holistic patient care, Prof. Dr. Dr. Heindl always puts the individual needs of his patients first. Moreover, he illustrates how modern aesthetic procedures go far beyond purely cosmetic corrections: Under his medical expertise, Botox and fillers are used not only for wrinkle reduction but also to treat migraines, neurological disorders, excessive sweating, and teeth grinding.
The editorial team of Leading Medicine Guide was able to learn more in a conversation with Prof. Dr. Dr. Heindl.
Botox and fillers are often regarded merely as cosmetic procedures for smoothing wrinkles or reshaping facial contours. However, modern applications go far beyond this: Botox is now successfully used to treat migraines, excessive sweating, and teeth grinding. Fillers, too, can provide not only aesthetic enhancements but also relief from functional disorders. The medical benefits of these substances demonstrate just how diverse today’s treatment possibilities are—and how closely connected health and aesthetics often are.
The main component of Botox, botulinum toxin type A, blocks the release of acetylcholine, a neurotransmitter responsible for muscle contractions. This property makes Botox a highly effective tool in treating numerous medical conditions that extend well beyond cosmetic use.
“When people think of Botox, they often picture its aesthetic use—such as smoothing forehead wrinkles. But botulinum toxin type A, as the active ingredient is correctly called, is far more than just an anti-wrinkle agent. It’s one of the most thoroughly researched drugs in neurology and has a long-standing medical history that predates cosmetic medicine. Its first applications were in treating neurological movement disorders. Back in the 1980s, Botox was already being used—for example, to correct strabismus (crossed eyes) or treat eyelid spasms, also known as blepharospasm. Particularly in ophthalmology and neurology, this agent has since become a mainstay. Today, Botox is officially approved for a wide range of medical conditions and is also used successfully in off-label therapies. These include the treatment of chronic migraines, especially in patients who suffer from more than 15 headache days per month. Additional indications include cervical dystonia—marked by involuntary movements of the head and neck—facial spasms such as hemifacial spasm, and again, blepharospasm. A highly relevant field of application is also the treatment of spasticity—for instance, following a stroke or in cases of multiple sclerosis. Botox is also used to combat bruxism, or teeth grinding, when the jaw muscles are overly active. It also helps with hyperhidrosis—excessive sweating—especially under the arms or on the palms. Moreover, Botox can provide pain relief, for instance in cases of muscle tension or chronic pain syndromes. All of these treatment options show one thing very clearly: from a medical standpoint, Botox is a true all-rounder—far more than just a remedy for frown lines,” Prof. Dr. Dr. Heindl explains at the start of our interview.
In medical applications, Botox is increasingly used for neurological conditions such as migraines and bruxism (teeth grinding), as it can regulate communication between nerves and muscles.
In migraines—a neurological disorder characterized by recurring, often severe headaches—Botox can reduce both the frequency and intensity of episodes. Migraines are often associated with overactivity of certain nerves in the brain, leading to increased pain signaling.
“Botulinum toxin specifically blocks the release of the neurotransmitter acetylcholine at the so-called motor endplate. This means the nerve can no longer transmit impulses to the muscle—so the muscle either doesn’t contract at all or only does so weakly. This muscle-relaxing effect is useful in traditional movement disorders. In the case of migraines, the mechanism is a bit more complex. Botox here inhibits not only muscle activity but also the release of specific neurochemical messengers—like CGRP, substance P, and glutamate. These substances play a central role in pain processing and inflammatory activity involving the trigeminal nerve. By injecting into clearly defined areas—such as the forehead, temples, back of the head, and neck—nerve system hypersensitivity can be significantly reduced. Studies have shown that this noticeably lowers the frequency of migraine attacks,” explains Prof. Dr. Dr. Heindl, before elaborating on how it works for teeth grinding: “In this case, treatment targets overactive jaw muscles, especially the masseter muscle. By injecting Botox, we reduce bite force specifically—this relieves jaw joint pain, prevents dental damage, and stops the muscles from becoming excessively developed. However, precise dosing is essential to avoid impairing functions like chewing and speaking.”
An added benefit that many patients welcome: when the forehead is treated as part of migraine therapy, it may also smooth out expression lines in that area. In such cases, medical benefit and aesthetic enhancement can go hand in hand—although the cosmetic effect is not the primary goal. For those who want to preserve their natural expressions, precise placement and dosage can ensure this.
There are clear differences in dosage and technique when Botox is used for medical versus aesthetic purposes. While both applications involve the same substance, different considerations apply in medical treatment.
In aesthetic procedures such as wrinkle reduction or treating frown lines, Botox is typically administered in smaller doses into superficial muscles to achieve the desired cosmetic result. Dosages are usually lower, and the goal is selective muscle relaxation without significantly impacting natural facial expressions. In contrast, for medical conditions like migraines, teeth grinding, or excessive sweating, larger doses are needed, and injections are often made in broader or deeper regions, depending on the condition.
“In medical settings, significantly higher doses are generally required. We follow standardized treatment protocols. For instance, in chronic migraines, approximately 155 units of botulinum toxin are injected into 31 specifically defined points—a well-established method. For neurological conditions like spasticity or dystonia, the required dose may even be several hundred units. The exact amount depends on the size of the affected muscles and the individual diagnosis. Injection techniques also differ. Whereas aesthetic medicine involves more superficial injections—either intradermally or just beneath the muscle—medical treatments often require deep intramuscular injections. This necessitates solid knowledge of neuromuscular anatomy—and sometimes imaging techniques like ultrasound or electromyography are used to target the region precisely. The primary goal in medical treatment isn’t cosmetic smoothing or symmetry, but functional improvement—specifically reducing abnormal muscle activity without significant side effects. A common misconception: the 30 to 33 injection points used in migraine treatment don’t mean 30 separate sessions—it’s all done in one appointment. Even though that means many injections, the procedure is usually well tolerated. Patients typically feel only a slight pinprick. In deeper muscle layers, the injection may be felt a bit more—but for migraine patients, this is minimal compared to their usual pain. The effect doesn’t set in immediately—it usually takes about two to four weeks to reach its peak. After that, the effect gradually wears off. That’s why it’s important for patients not to wait until their symptoms return entirely, but to schedule follow-ups in good time. Treatment intervals are typically between three and six months, depending on individual response,” explains Prof. Dr. Dr. Heindl.
Coverage by health insurance providers is a complex issue. For certain conditions like chronic migraines, reimbursement may be possible if specific criteria are met—such as prior documentation showing the ineffectiveness of other treatment options. If reimbursement is not granted, patients can expect to pay approximately 200 to 300 euros per session, depending on the required dose. Since migraines are a chronic condition, botulinum toxin often becomes a long-term therapy. For many, however, this means a significant improvement in quality of life.
Botox can be an extremely effective treatment option for excessive sweating, also known as hyperhidrosis. This condition involves overactivity of the sweat glands, which occurs independently of external temperatures or physical activity.
Botox works by creating a nerve blockade that interrupts the process responsible for excessive sweat production. It inhibits the release of acetylcholine, a neurotransmitter that stimulates the sweat glands. When injected into the affected areas—typically underarms, palms, or soles—Botox blocks this nerve communication and significantly reduces perspiration.
“The injections are placed directly into the affected areas, and the dosage is carefully adjusted. So, if someone suffers from excessive sweating in the feet, those specific areas can be treated with Botox to block the overactivity of the sweat glands. The effect sets in within a few days and can last up to six to nine months. Many patients report a significant reduction in sweating—often more than 80%. Repeat treatments are possible and can prolong the effect, and in some cases, even lead to long-term desensitization of the sweat glands. For many, Botox is a valuable treatment option—especially when other conservative measures, such as antiperspirants or iontophoresis, haven’t provided satisfactory results. Particularly in professional settings where excessive sweating can be very uncomfortable, Botox offers many affected individuals a reliable solution to feel more secure and at ease again,” Prof. Dr. Dr. Heindl emphasizes.
The sustainability of the effect depends on various factors, such as the individual’s response to Botox and the frequency of treatments. Some patients experience long-term improvement and may require less frequent follow-ups after several sessions. In some cases, the effect becomes more persistent over time as the sweat glands are gradually “retrained” to produce less sweat.
While fillers were originally used primarily to smooth wrinkles and enhance facial volume, today they also play an important role in reconstruction and the treatment of various medical conditions.
Commenting on this, Prof. Dr. Dr. Heindl states: “Fillers, particularly those based on hyaluronic acid, are now an integral part not only of aesthetic medicine but also of medical practice. They’re used to restore lost volume, define contours, and fill in wrinkles. In medicine, fillers are applied in several areas. One example is post-traumatic or post-surgical reconstruction—for instance, in the treatment of scars or tissue loss. Hyaluronic acid is also used for lip or palate augmentation, particularly in cases of speech or swallowing disorders. Furthermore, fillers help treat HIV-associated lipoatrophy, in which subcutaneous tissue breaks down. They can also be used to correct asymmetries caused by conditions like spasticity. Another interesting field is ophthalmology—especially following the loss of an eye. In such cases, filler is injected into the orbital socket to create a foundation for a prosthetic eye, since the tissue tends to shrink over time,” and he adds:
“The choice of filler depends on various factors, particularly the molecule size, cross-linking, and viscosity of the material. Very fine fillers are used for superficial lines, while more heavily cross-linked volumizing fillers are used for larger areas like the cheeks or chin, or for scar correction. So, there isn’t just one filler—there’s a wide range of options tailored to different needs.”
Patients seeking Botox or filler treatments for medical reasons should consider several important factors to ensure the procedure is both safe and effective.
First and foremost, it’s essential to consult with a qualified and experienced physician who has extensive expertise in administering Botox and fillers—particularly for medical indications. This ensures that proper techniques are applied and that the treatment is tailored to the patient’s individual needs.
“Ideally, physicians should come from specialties like ophthalmology, neurology, dermatology, or plastic surgery. A clear medical indication must always be established and documented. Thorough patient education is essential before any treatment: Patients must be informed about potential side effects, alternative therapies, expected duration of effect, and the need for follow-up. Especially with Botox, it’s important to check whether the patient is taking medications that could influence the effect—such as muscle relaxants. With fillers, a detailed medical history concerning autoimmune diseases or allergies is critical. Another crucial point: patients should never undergo treatments performed by non-medical personnel. This also applies to ‘vacation procedures’ sometimes offered at beaches or in hotel rooms—which, in my opinion, is completely irresponsible. Such settings carry a higher risk of complications due to improper technique and lack of sterility. If Botox and fillers are used incorrectly, complications can certainly occur. When administered properly, however, Botox is extremely safe. The most common side effects are usually minor and localized, such as slight injection-site pain, small bruises, mild swelling, or fatigue. Very rarely, systemic symptoms can appear. Specific risks may occur—for example, temporary drooping of the eyelid if forehead muscles are treated, or visual disturbances if Botox is injected too close to the eyes. However, these effects are always reversible and disappear within a few weeks. So, when it comes to Botox and fillers, less is often more. It’s vital to maintain close communication with patients,” says Prof. Dr. Dr. Heindl.
With fillers, the risks are definitely higher—especially if they are accidentally injected into blood vessels. One of the most serious complications is vascular occlusion, which can lead to impaired circulation.
“The first warning signs include pain, paleness, or a cold sensation. Fortunately, such severe complications are very rare and usually only occur when treatments are performed by inexperienced personnel or outside of clinical environments. Training, experience, and proper technique are absolutely essential here,” Prof. Dr. Dr. Heindl emphasizes.
There are even children who suffer from severe migraines for whom Botox may be medically appropriate. However, and this is very important: Botox should only be used in children when there is a clear medical indication and the child is capable of cooperating with the treatment process.
Botox originated in medicine—not in the beauty industry. Its aesthetic use became popular only later.
“In fact, botulinum toxin was already being used in neurology in the 1980s to treat conditions like strabismus (crossed eyes) or eyelid spasms. Botox works by selectively blocking the release of acetylcholine at the motor endplates of muscles. Its earliest medical applications were therefore neurological. Only later was it discovered that Botox could also be used for aesthetic purposes. The term ‘botulinum toxin’ understandably causes concern, since ‘toxin’ literally means poison. But this is a relatively mild substance that is completely broken down by the body after application. So it’s not as dangerous as it’s sometimes portrayed. And clearly, in cases of medical indication—such as patients suffering from severe chronic migraines—it is absolutely justified to inject the toxin to alleviate suffering. Ultimately, however, it’s a personal decision whether or not to pursue aesthetic treatment. Botox and fillers are elective procedures, and everyone must decide for themselves. The key is that patients are well-informed and the treatment is carried out by qualified professionals in a safe environment,” Prof. Dr. Dr. Heindl stresses.
At the private practice “New Aesthetic Vision” in Cologne—one of the leading institutions for aesthetic medicine—only top-quality products from trustworthy sources are used to ensure treatment safety and success. Prof. Dr. Dr. Heindl strongly advises patients to rely only on reputable providers and experienced physicians.
“Competence is critical—and so is product quality. The medication we use must be of the highest standard. We use only premium-grade products from Germany—genuine top-quality materials not available on the open market. These products naturally come at a higher cost. If I were to use a low-quality filler from abroad that costs just one euro, I could perhaps resell it for 50 or 100 euros. But I would never use such a substandard product, which lacks quality controls and regulatory oversight. That would be completely irresponsible. Patients must know what they’re getting into. A 20-year-old girl considering a treatment might not know how to tell the difference between high- and low-quality products. She might just look on Instagram and see someone looking ‘cool’ or ‘pretty’ after a procedure. But a decision like that should never be made lightly. That’s why it’s so important to me that these treatments are performed only by board-certified specialists with the necessary expertise. And of course, the treatment must take place in a medical setting—not in a nightclub or similar environment. It’s about product quality and, above all, patient safety,” Prof. Dr. Dr. Heindl warns with strong conviction.
Thank you, Prof. Dr. Dr. Heindl, for these insightful and informative remarks!
