Botox: Uses, Recovery, and Results

Quick Facts

About

• Botox injections are derived from botulinum toxin, a purified neurotoxin that temporarily relaxes muscle movement, smoothing out wrinkles in the process.

Botox Uses

• Aesthetic: crows feet, forehead wrinkling, and fine lip lines are all improved by Botox injections.
• Therapeutic: migraine headaches, temporomandibular joint pain (TMJ), crossed eyes, and muscle spasms. 

Top Brands

• Although Botox is a household name, other brands like Dysport, Xeomin, and Myobloc offer comparable results.

Recovery and Results

• Results of Botox start to become visible one week after injection and are fully visible after one month.
• The results of Botox are temporary and will begin to fade at the four month mark. Further injections are required to maintain results. 

Cost

• Botox injections are typically priced at a flat rate or per unit cost.
• While the exact cost will vary by region, treatment, and provider, flat rates usually range between $300 and $1,000 per treatment.
• Per unit prices typically range from $10 to $15 per unit. Most treatments will require 20-35 units, however this number can vary drastically depending on your exact needs.

Find a Provider

• Botox injection requires extensive training and practice. As a result, using Botox at home is not recommended.
• Working with a certified injector can help provide ideal results and minimize the potential for complications.  

With over 7 million procedures performed every year, Botulinum toxin type A injections are the most common anti-aging treatment in the United States. This guide provides detailed answers to the key questions you may have about Botox or other botulinum toxin based products.

What Is Botox?

Botox, as well as Dysport, Xeomin, and Myobloc are all medical products derived from the botulinum toxin and generally used to reduce the activity of specific muscles.

The botulinum toxin is a purified neurotoxic protein taken from the Clostridium botulinum bacteria. This same C. botulinum bacteria is responsible for foodborne botulism, commonly referred to as food poisoning. In fact, the botulinum toxin is the most potent toxin known to mankind. However, it has effectively been harnessed for medical and cosmetic benefits.

There are seven distinct botulinum toxins produced by different strains of the C. botulinum bacteria, but only types A and B are used medically. When injected into the muscles or glands of your body, botulinum toxin blocks the chemical messages from the nerves that control muscle movement or gland production. This in turn relaxes the muscles or glands, temporarily smoothing out wrinkles, relaxing overactive muscles, or reducing sweating.

What Is Botox Used For?

Most people are only aware of the cosmetic abilities of Botox and other botulinum toxins. However, as the mechanics of Botulinum toxins have become better understood, the FDA has approved them for diverse therapeutic purposes as well.

Cosmetic Uses

• Hyperkinetic facial lines: The primary use for cosmetic BTX-A in facial surgery is to treat frown or “glabellar” lines, crow’s feet, and platysma banding, commonly called “turkey neck.”
• Eyebrow lifting: A small injection of botulinum toxin into the brow muscle can result in improved brow height thanks to the toxin’s paralyzing effect. This is often performed as an alternative to a surgical brow lift.
• Hyperactivity in the frontalis muscles, which control the eyebrows and forehead.
• Dimpling of the chin because of overactive muscles.
• Raising drooping corners of the mouth.
• Fine lines around the lips.
• Fine wrinkles under the eyes.
• Jawline softening by targeting the masseter muscle.

Therapeutic Uses

• Migraine headaches: This use was also discovered by accident when patients being treated for frown lines reported fewer headaches. Though it’s not entirely known how it works, BTX-A has been shown to be a safe and effective way of preventing migraines.
• Dystonia: This describes any abnormal muscle spasms in the eyelids, face, jaw, neck, vocal chords, forearm, hand and arm muscles.
• Hemifacial spasms: These are involuntary, repeating twitches of the eyelids and other facial muscles on only one side of the face.
• Strabismus, or crossed eyes.
• Hyperactivity of the exocrine glands: This includes salivary glands, sweat glands, mammary glands, and some glands in the digestive system, such as the palms, hands, soles of the feet, armpits and face.
• Relative sialorrhoea: BTX-A has been used to control drooling in conditions like Parkinson’s Disease, motor neuron disease, and bulbar/pseudobulbar palsy without causing dry mouth.
• Frey’s syndrome: This rare neurological disorder causes redness and sweating on the cheeks when the afflicted person simply sees, talks about, or even thinks about certain foods that cause a lot of salivation.
• Crocodile tears syndrome: This rare syndrome occurs when salivary glands are damaged and mistakenly regrow into a tear gland. This results in the patient tearing up as their mouth waters to eat.

“Off-label” therapeutic uses that have not yet been approved by the FDA include:

• Prostate Hyperplasia: BTX-A has been shown to relieve bladder outlet obstructions caused by benign prostatic hyperplasia (BPH). Hyperplasia refers to the enlargement of an organ, in this case the prostate.
• Smooth Muscle Disorders: Direct injection of botulinum toxins has been shown to be a safe, simple, and effective way to treat disorders of the gastrointestinal muscle, and other smooth muscles in the body.
• Overactive Bladder Syndrome, with or without incontinence.
• Spastic disorders that are associated with an injury or disease of the central nervous system, including trauma, stroke, multiple sclerosis, and cerebral palsy.

Ideal Botox Candidates

Botox and other botulinum toxin injectables have been proven safe for a wide variety of candidates. While there are many medical uses for botulinum toxins, the reduction of fine lines on the forehead and around the eyes and mouth are by far the most popular procedures.

Most of these procedures involve several small injections over the course of a 10-minute session. This means an extremely large number of people looking into this treatment will find they are excellent candidates.

Those who may benefit from Botox include those who:

• Are between 18 and 65 years of age.
• Are in good general health.
• Have realistic expectations of what Botox can achieve.
• Would like to smooth out their wrinkles.
• Have not experienced an allergic reaction to another botulinum toxin based injectable.
• Have drooping corners of their mouth that they wish to see corrected.
• Would like to soften their jaw.

Injectables such as Botox, Dysport, Xeomin, and Myobloc have also been used to treat a number of medical conditions as well. These include excessive sweating (hyperhidrosis), migraines, muscles spasms, and chronic pain. Good candidates for these uses of Botox should be evaluated on a case-by-case basis.

10 Tips to Prepare You for Your BOTOX Treatment

1. Ensure you are receiving your treatments from a licensed medical professional. Be careful and do your research; although this is a minor procedure, only an experienced injector can provide the best results.
2. Avoid aspirin, ibuprofen, and vitamin E prior to treatment. Some people have some minor bruising around the injection site after a procedure. Medications and supplements like those listed above thin the blood, and can increase the risk of bruising.
3. Some mild discomfort is very common, so you might wish to take an over-the-counter pain medication before your injections. As Tylenol does not thin the blood, it’s the perfect pain management tool.
4. Tell your injector if you are taking any blood thinning medications. It’s also a good idea to inform your injector of any medications you take.
5. Make sure you’re clear about your goals. It’s essential that you are open and honest with your injector about your goals so they know exactly what you want. A simple conversation can avoid the “frozen face” look.
6. Don’t wear makeup to your appointment. The area where the injection will be made needs to be completely clean to avoid infection.
7. Depending on where your injections are made, there might be some bruising for a few days. A good foundation will help keep it hidden until everything has healed.
8. Skip the gym. A slow, calm heart rate is the best for your injections, so avoiding vigorous exercise for at least a day or two before and after your procedure is highly recommended.
9. Keep your schedule clear. It’s a good idea to keep the time after your injections for yourself; no meetings or important events. Take a relaxing day so you can heal properly.
10. Abstain from alcohol. For at least a few days before your injections avoid drinking any alcohol. Alcohol can lead to extra bruising afterwards.

Botox Recovery Timeline

There is virtually no recovery time associated with Botox treatments. In fact, it’s often referred to as a “lunchtime procedure” because patients are usually able to immediately return to their daily activities, including work. There are no incisions, sutures, or bandages of any kind. Generally, Botox side effects are extremely mild and fade within minutes to days.

Immediately After Treatment

As soon as your treatment is complete, you might notice a small amount of redness and swelling at the injection site. This is normal, and typically resolves itself within a few minutes. Most patients do not feel any pain or side effects during or after their treatment, though a very small group of people have reported a mild headache in the following hours. This is always easily taken care of with over-the-counter pain relief.

Your injector will provide post-treatment information and instructions specifically tailored to your treatment. This will outline all the details and any post-care advice from your injector. Make sure to follow them closely for the best results.

Once you return home, it’s best if you try not to lie down for a minimum of four hours, and avoid rubbing the treated area for at least 12 hours. Either of these actions may cause the injected solution to move outside the targeted area.

1 Day After Treatment

The majority of people who undergo an injection treatment will not have any outward signs of the procedure at all. That said, mild bruising is always a possibility, and can usually be easily covered with a concealer. Some individuals experience a mild headache, which can be easily treated with mild pain medication.

It takes some time (3-7 days) for the Botox to take effect, so do not be concerned if you don’t see an improvement one day after treatment.

1 Week After Treatment

At the seven day mark you should be able to see the results of your treatment. The area will look smoother, and appear more refreshed. After your first treatment it’s not uncommon to feel a mildly tight sensation in the skin and muscles, or even a feeling of heaviness. These fade over the course of a week or two. If it’s your first treatment, your clinic may follow-up with a call to check in on you, see how you’re feeling, and answer any recovery questions you might have.

If you don’t see anything at this point, you may need to wait one more week. Some patients find that their results appear more slowly, taking up to 2 weeks to appear. If you don’t see anything by the second week, make sure to return to your injector to discuss your results. You may need a touch-up.

1 Month After Treatment

After a month your results should be clearly visible, and still very noticeable. Some people may start to see a small amount of movement return to the treated area, but it varies for everyone.

4 Months After Treatment

After four months you will slowly start to see movement return to the treated area. Many injectors will recommend you book another assessment, and possible follow up treatments at this time.

Botox Risks, Side Effects, and Complications

When performed by an experienced and knowledgeable injector, Botox has been proven to be extremely safe with a low risk of complications and side effects, most of which are mild and temporary.

Of course, no procedure is completely without risk, and the possible side effects of Botox include:

• Pain, swelling and/or bruising at the injection site.
• Headache or flu-like symptoms
• Drooping or cockeyed eyebrows.
• Crooked smile or drooling.
• Dry mouth.
• Eye dryness or excessive tearing.
• Neck pain.

Botox and other injectables are derived from the same substance that causes botulism, and although it’s extremely rare and unlikely, the effects of botulinum toxin can spread to other parts of your body and cause botulism-like symptoms.

Contact your injector immediately if you notice any of the following symptoms in the hours and weeks after your treatment:

• Muscle weakness all over your body.
• Vision problems.
• Trouble speaking or swallowing.
• Difficulty breathing.
• Loss of bladder control.

How Long Do Results Last?

Botox is not permanent! The single most important factor to understand regarding your treatment is that results are temporary.

Generally speaking, if performed by a skilled and experienced injector, your results should last three to six months. However, results may vary. For example, first time patients might see their treatment wearing off before the three month mark. This may be because the body has metabolized the Botox faster, or because the amount administered was too conservative.

Injections around the eyes also tend to have shorter results, often wearing off before three months. However, the muscles become conditioned to the Botox with repeated use, and results should last longer.

The longevity of your results depends on three factors: dosage, application and how fast your body metabolizes the product.

If the solution is too diluted, or if you don’t get the necessary units injected, the results probably will not last very long. Similarly, if Botox is used to treat the wrong kind of wrinkles, such as static wrinkles which are not caused by muscle movements, it will not work as effectively.

If you find that your results aren’t lasting as long as they should, speak to your injector to find out why. There are a number of causes for this, including:

• The solution was too diluted.
• Not enough was injected.
• The solution was old, and therefore less effective.
• Your particular anatomy requires a different technique.
• You may be resistant to Botox.

A good injector will work with you to ensure your treatments are worth your time and money.

Frequently Asked Questions

Do botox injections hurt?

Most patients would say no. The needle used is very small, and most patients say the injections feel like a little pinch, but everyone is different. In most cases, patients are surprised at how easy it is, often remarking, “Was that it?”

How long does the treatment take?

The exact length of your treatment will depend on your specific goals, and the areas of your body being treated. Your injector will discuss your goals ahead of time, and carry out an assessment to determine what treatment will be best for you. The actual injection process, however, generally takes between 10 and 25 minutes.

Is Botox safe?

Yes, it is. Botox, and other similar injectables, have been used safely for years. There might be some mild bruising, tenderness, or swelling, but even these are somewhat rare.

What is a botox “unit?”

A “unit” of Botox, or any injectable for that matter, is a very small measurement of the drug. The exact number of units you’ll need to reach your goals is something that will be discussed during your consultation.

As an example, treating frown lines between the eyebrows generally requires an average of 25 to 35 units for most women, but can require as much as 50 units for men. Incidentally, frown line reduction is the most common use of Botox by men.

Will it look worse when it wears off?

Absolutely not! Your face will never get worse if you stop using Botox, or if Botox wears off. At worst, your face will simply return to looking as it did when you started your treatments, but there will be no additional “damage” due to using Botox. Some patients remark that they may look worse, but that’s only because they got used to the improvement they got from their treatment!

I don’t want my face to become an emotionless mask. Is there a risk of that?

Not in the hands of an experienced injector. Most people just want to look “natural, relaxed, and refreshed,” without looking like they’ve “had work done.” With the advancements made in both treatment and technique, the “natural” look is easily attainable with virtually no risk of facial paralysis. The key to a natural looking result is to soften wrinkles rather than totally erase them.

Does insurance cover Botox or other injectables?

Generally speaking, cosmetic procedures to address wrinkles and the signs of aging are not covered. However, medical uses for Botox, like excessive sweating or muscle spasms, might be.

Most insurance companies will only approve Botox treatment once all other options have been tried and failed. Even then, it’s important to keep in mind that approval isn’t automatic, and not all plans will cover injectables. However, many people are happy to find that their insurance plan covers all or most of their Botox treatments for therapeutic purposes.

For specific details about your coverage, it’s best to contact both your insurance company, as well as your injector, to consider your options.

If the results are only temporary, is it worth it?

It’s easy to see how someone might believe a temporary solution won’t be worth the cost, but Botox and other injectable treatments have both short- and long-term implications. Short term, these treatments can deal with a variety of issues, like improving the appearance of wrinkles. Long-term, they can prevent those wrinkles from getting worse.

To simplify matters, imagine your Botox treatment costs $300 and lasts for four months. This means, for the best results, you’ll need four injections a year, with a total cost of $1,200. That’s a lot of money, but if you’re able to put aside $75 every month (or even less if you need less frequent injections), you’ll still be able to reap the benefits of Botox. Image, that’s just about $19 a week, or the equivalent of a daily cup of coffee.

If you have the time and money, or are willing to save for the treatment, it is certainly worth it. No cream or moisturizer can do what injectable botulinum toxin can do!

What are the effects of long-term botox use?

Because the results are temporary, many people think medications like Botox are only effective for a “quick fix.” But the truth is you can make your wrinkles look better permanently by preventing them from getting worse over time.

Consider it this way: everyone makes dozens, if not hundreds of facial expressions every day. This causes temporary dynamic lines to appear, which go away when your face returns to its resting position.

As you continue to make these expressions, day after day, year after year, and as your skin ages, these temporary dynamic lines start to etch themselves into your face. That’s how frown lines get deeper and deeper in people who frown all the time. It’s like folding a piece of paper, flattening it out, and folding it again in the same spot – the crease just gets worse and worse. Eventually, those dynamic wrinkles stop being dynamic, and are just there, even when your face is at rest.

This is one of the reasons why Botox has also been touted as a preventative treatment for wrinkles as well, making it suitable for younger patients in their early 20s and 30s.

The Bottom Line

Reducing the visible signs of aging may be Botox’s strongest quality, but it’s also a great tool for lifting eyebrows, reducing cleft chin, and therapeutic uses like treating migraine headaches and muscle spasms. 

While Botox requires reinjection every four months to maintain results, at approximately $300 per treatment it’s among the most affordable cosmetic procedures available.

Botox is the most popular botulinum toxin brand, but alternatives like Dysport, Xeomin, and Myobloc each offer their own set of advantages. Speaking with a qualified injector can help you discover which is best for you. 

Find a Botox Provider

As with all cosmetic injections, your results will heavily depend on the experience level and talent of the person performing the procedure. Be sure that you select a qualified Botox provider in your area for your treatment.

References

Awan K. H. (2016). The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions – An evidence based review. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society, 25(1), 18-24. ncbi.nlm.nih.gov/pmc/articles/PMC5310164