The formal name is onabotulinumtoxinA. Since that’s a big, complicated word, we’ll use the brand name BOTOX® Cosmetic, usually shortened to the generic term Botox. As anyone seeking youthful, rejuvenated-looking skin knows, Botox is the injectable drug used by doctors to treat wrinkles and facial creases, yielding improvements to appearance that seem to overcome the aging process, at least for a time.
That’s a big promise, and for many of us, an appealing one. Still, the decision to seek Botox treatment is an option that ideally is informed by careful consideration and thoughtful choice.
Why Botox Is a Very Personal Decision
Botox is all about appearance, specifically, how you appear to yourself and your perception of how you look to the world. Having an unblemished, unwrinkled face helps you appear vibrant and healthy. It’s the reason we spend a lot of time, effort, and money on daily skincare routines that keep folds, lines, and wrinkles away. But eventually, wrinkles catch up with all of us. That’s when we start thinking about Botox and wondering whether injections of the drug can bring back the fresh face of youth.
The answer is yes, but only when you’re ready. That includes defining your facial appearance goals and understanding the pluses and minuses of your decision to proceed. Among the considerations:
Botox is a prescription medication. The drug is only available through a board-certified dermatologist or plastic surgeon and should be administered only in a clean, sanitary medical or medical spa facility by highly trained, experienced personnel with in-depth knowledge of facial nerves and muscles, working under the supervision of a physician.
It’s an injectable, which means a needle is required to administer the substance. While the needles are very tiny, you need to understand that if you have an aversion to needles, that’s the only way this drug can be dispensed.
Injections are non-surgical; no incisions or anesthesia are required, so there’s no visible scarring or extended recovery time. Treatments are quick and convenient, which is why Botox is the number one product of its kind on the market. More than 4 million Americans receive injections every year.
Results take 7 to 14 days to fully appear and are temporary, lasting 3 to 6 months. That’s both an advantage and a disadvantage. It’s advantageous in letting you try out treatment without committing to permanent change. If you don’t like outcomes, just wait a few months and they’ll fade away. The disadvantage comes when Botox produces results that make you look good and feel positive about yourself—additional treatments are required to maintain what you’ve achieved.
Good overall physical and psychological health is recommended for treatment, and women who are pregnant or breastfeeding should hold off. Those with neuromuscular or bleeding disorders, extremely sensitive skin, or other conditions should consult their doctors before going ahead.
What You Need to Know About How Botox Works
Botox is actually a toxin produced by the bacterium Clostridium botulinum. First isolated by a Belgian microbiologist in 1895, in its natural form this potent substance can, among other things, invade a wound, trigger intestinal infection, or cause botulism, a potentially deadly form of food poisoning. Over decades of research, the mechanism of botulinum toxin action was identified as blocking the release of the neurotransmitter acetylcholine from nerve endings. Acetylcholine plays a role in brain functions, including controlling contractions that move and relax the muscles, which is key to how Botox works as a cosmetic enhancement. The first injectable botulinum toxin was licensed and trademarked as Botox by the drug company Allergen in 1983 and used for therapeutic medical purposes to treat crossed eyes. Application as a treatment for facial wrinkles was first documented in the journal Plastic and Reconstructive Surgery in 1989. Following clinical trials, in 2002 the FDA approved BOTOX® Cosmetic as a temporary treatment for moderate to severe frown lines in adults. Crow’s feet and forehead lines were subsequently added to FDA-approved treatment areas, although current practice extends to other areas of the face as well.
As a neurotransmitter, Botox works by blocking signals from nerves to muscles, preventing muscle movement. When injected, the drug inhibits or freezes the muscles causing wrinkles to form; those muscles can’t contract. This limiting of muscle movement makes wrinkles and fine lines relax and soften, diminishing their appearance and leading to a smoother, more youthful-looking complexion. The drug targets specific muscles and is most effective in treating the dynamic wrinkles caused by ongoing muscle contractions controlling frown and forehead lines and crow’s feet around the eyes. Static wrinkles, which are caused by factors like sun or smoking damage or loss of collagen due to aging, are deeper, long-standing, and largely unresponsive to Botox; a different treatment approach is required.
In addition to its cosmetic uses, Botox is an effective treatment for health conditions such as uncontrolled neck and other muscle spasms, lazy eyes, excess sweating, migraines, and overactive bladder. And the drug is definitely big business. The global botulinum toxin market in 2022 totaled $6.4 billion; that’s anticipated to grow to $15.2 billion by the end of the decade.
When to Start Botox & What to Expect
At what age to start Botox is a big question with no one-size-fits-all answer. Traditionally, people turned to the drug in their mid-30s to mid-40s when signs of aging became hard to ignore. Nowadays, usage as young as mid-to late-20s is increasingly common as a preventive treatment before wrinkles even appear. As we age, there’s no upper limit on treatment, with patients in their 70s and beyond reporting pleasing results.
Checking your budget is important. Insurance does not cover Botox used for cosmetic purposes, and ongoing treatment gets expensive. Medication is dispensed by unit; the cost per unit is typically $10 to $30, with 10 to 30 units required depending on the facial area injected. Since you can elect to do more than one area at a time, the per-appointment tab can quickly top $1,000, which you’ll be repeating three to four times annually—so be sure to do the math.
To prepare for treatment, stop using blood thinners, multivitamins, and NSAIDs for 10 days prior to the procedure and avoid alcohol for a week. This minimizes bruising or bleeding. Once you’re at the treatment site, your dermatologist may take before-and-after photos to document injection areas and track outcomes, then apply a topical numbing cream before administering the drug. Actual injections are usually painless or nearly so, with the entire appointment process taking an hour or less. Afterwards, you can return to normal activity but don’t lie down for at least 4 hours or massage your face for 24. Don’t exercise, expose yourself to high heat, or drink alcohol. This helps avoid diffusion of the product beyond where you want it to go. Then, be patient, since it takes as long as 2 weeks for lines and wrinkles to fully smooth away.
Possible side effects, such as headache, bruising, muscle weakness, upset stomach, neck pain, nausea, or drooping eyelid or brow, are usually temporary and resolved on their own. Should symptoms linger, see your doctor right away. Overuse or improper injection can cause a permanently frowned or surprised look, squinting, crooked smile, or loss of expression, which is why you want to trust your face only to knowledgeable, licensed professionals who know how to produce positive results.
Which is the whole point of BOTOX® Cosmetic. This popular, minimally invasive cosmetic treatment is safe, quick, and effective at making you appear and feel younger by minimizing and smoothing the lines and wrinkles in your face.
