You’ve been thinking about Botox. You’re noticing fine lines, wrinkles, and crow’s feet staring back at you from the mirror. You’re seeing signs of aging that are starting to concern you. You’re upset about looking tired or stressed when you aren’t. As you’re wondering if it’s time to do something about your appearance, Botox is top of mind. That’s hardly surprising, given that talk about Botox is everywhere. And maybe the product is right for you as a non-surgical way of achieving a more youthful appearance by softening and smoothing out facial creases and wrinkles.
This discussion of the facts and realities of Botox tells you what you need to know before you proceed. Our focus here is actually on Botox® Cosmetic, which is the official name of a botulinum toxin produced by the bacterium Clostridium botulinum; only strain A of the neurotoxin (there are eight in all) has been approved and marketed for cosmetic purposes. Botox strain B has a number of clinical applications as a therapeutic treatment for crossed eyes, facial muscle spasms, foot pain, chronic migraines, overactive bladder, stomach issues, and more. Look for that information in another article available soon in this space.
What to Know
While thinking through whether Botox treatments are right for you, make sure you’re keeping these basics in mind.
- Results are subtle. If you’re looking for dramatic changes to your appearance, you’ll want to pursue other approaches. Botox does improve how you look, but in ways that are soft and nuanced. Outcomes are natural, and you still look like you, just better.
- Solutions are temporary. The improvements produced by Botox injections (that’s how the substance is introduced into the body) wear off. That’s due to how they work. Changes produced by treatments take from two days to two weeks to become evident, with maximum improvement achieved after about a month. The changes then wane gradually, returning your skin to its original condition in 16 to 20 weeks. To maintain your appearance, you’ll have to repeat treatment periodically.
- Treatments are a medical procedure. Botox Cosmetic is available only as a prescription drug from a licensed medical professional. You cannot buy it over-the-counter or online. Although regulations vary somewhat by country, state or province, and regional statute, Botox must be administered by a qualified medical practitioner, such as an MD, DO, physician assistant, or nurse practitioner, who has completed specialized training in the use of cosmetic injectables. These experts have a deep understanding of facial anatomy—the face has 43 muscles, many of which are not Botox-suitable—and are skilled at delivering the precise dosages in exact locations that are specific to your needs and goals. Treatments are administered in a clinic or medical office that is clean and outfitted for this purpose.
- Botox is costly. Since Botox is a cosmetic procedure, and cosmetic procedures are rarely covered by insurance, you’ll be paying for injections on your own. Given that results are temporary, you’ll be repeating this several times a year. Actual treatment cost depends on how many units of Botox are used, how many areas are treated, where you live, professional and facility charges, and other factors. In late 2023, the average price range in most U.S. states was $300 to $900 per treatment, although costs can go much higher. Make sure your budget can cover the expense.
What to Consider
Pursuing Botox should be a thoughtful decision that starts with understanding what it is and how the substance works in your body to produce cosmetic change.
Botox is a neurotoxin derived from the same Clostridium botulinum bacterium that causes a life-threatening type of food poisoning called botulism. Although first discovered by a Belgian scientist in the early 1800s following a botulism outbreak, the toxin was finally isolated in crystalline form in the 1940s. By the 1970s, scientists were using botulinum to treat eye disorders and migraine headaches and noticed that it also reduced wrinkles in the skin between the eyebrows. The pharmaceutical company Allergan, now part of AbbVie, then licensed Botox as a brand. The first FDA approval came in 1989 as a treatment for crossed eyes; in 2002, it was approved for cosmetic treatment of the glabellar lines between the eyebrows. Although a brand name, Botox became a generic term for this entire category of treatment even though competitive drugs manufactured by other companies are available. All of today’s purified forms of the bacterium are highly regulated and safe.
For cosmetic purposes, Botox is injected into specific facial muscles, triggering temporary paralysis by blocking nerve signals. This relaxes the muscles responsible for facial contractions, which, in turn, reduces the appearance of wrinkles and fine lines. Most commonly targeted are forehead creases, crow’s feet around the eyes, and those glabellar frown marks between the eyebrows. Relaxing these muscles can lead to a rejuvenated, more relaxed appearance in those areas.
Verifying the credentials of providers and facilities is an important part of the research you’ll want to do before deciding where to pursue treatment. Check out the experience of medical professionals and ask about quality to make sure only FDA-approved drugs from well-established manufacturers are in use.
Thinking through what you want to accomplish with the procedure and why you’re considering it is important to long-term satisfaction. Be clear about what Botox can and cannot do for you. Certainly, you can improve your appearance (for a period of time), but treatment is likely not a means of changing everything about your life. Defining your objectives also influences the extent of your treatment and how often you’ll want and can afford to return.
What to Expect
Your Botox experience starts with a consultation. Prior to actual treatment, you’ll want to meet with your chosen provider to discuss your goals, health status, medical conditions, current medications, outcomes, risks, and potential complications. Ask lots of questions so you know what you’re doing, starting with determining your eligibility for Botox. Those who are pregnant or breastfeeding, suffer a neurological disorder such as ALS or MS, or have very thick, sensitive, or infected skin should not be treated. Most providers advise avoiding alcohol for 24 hours before and after treatment because it dilates blood vessels and may lead to excessive bruising.
Actual treatment involves the medical provider using ultra-fine needles to inject Botox solution into targeted areas of the face. The amount of Botox and number of injections are determined by the provider in accordance with your appearance goals. No anesthesia is needed; pain is usually limited to a very brief prick which can be counteracted by application of a topical anesthetic prior to injection or other distraction methods. You’ll likely be sitting up or reclining during injection to minimize the risk of diffusion. The entire procedure takes about 15 minutes, and you can resume work or most other activities with no downtime.
Side effects are minimal but can include bruising or pain at the injection site, flu-like symptoms, headache, nausea, redness, and temporary facial weakness. After treatment, avoid rubbing the injected area and remain upright for at least four hours; for 24 hours, stay away from strenuous exercise, don’t sit in the sun or enter a sauna, cover your face in extreme cold, and hold off on washing or touching your face. Don’t have facials or massages for two weeks. This keeps Botox from spreading into unwanted areas or diluting because of increased blood flow.
What To Remember
The fact that there were four million Botox injections in the U.S. in 2023 confirms effectiveness and appeal. But be careful—fake Botox is plentiful, readily available, and potentially dangerous, as are untrained, unqualified people offering injections in unsafe settings at reduced cost. Group treatments are another bad idea, as are limited-time offers demanding immediate commitment and money up front. Practitioners who advertise only online or on social media are suspicious as well.
When done properly, Botox injections are a safe, verified strategy for rejuvenating your appearance by removing wrinkles and fine lines. Know what you’re doing and the providers you’re doing it with, and you’ll enjoy pleasing, appearance-enhancing results.
