Medical Disclaimer ⓘ
Botox® is the brand name for the industry-leading botulinum toxin A preparation produced by Allergan. (1) This prescription medication has a number of cosmetic and medical uses: (2)
- Botox Cosmetic® is the preparation that is used for cosmetic medicine
- Botox® is used for treating neuromuscular disorders (such as muscle spasticity, tension headaches, or excessive sweating).
In this article we will primarily be discussing Botox Cosmetic®. For convenience, we will refer to it simply as “Botox.”
Botox is an injectable cosmetic product used to reduce the appearance of certain types of facial wrinkles by relaxing the muscles that cause them.
Its safety profile, effectiveness, and ease of use have made Botox injections the most popular cosmetic procedure today.
Botox is approved by the FDA for moderate to severe upper facial rhytides, specifically: (3)
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.
- 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 eyes
- Jawline softening by targeting the masseter muscle.
- 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 exorine glands: This includes salivary glands, sweat glands, mammary glands, and some glands in the digestion 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.
Some “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.
- Anal fissure
- Diabetic neuropathy
- Wound healing
- Excessive salivation
- Parkinson’s Disease
- Depression – in 2014, a study found that people suffering from major depression experienced fewer symptoms 6 weeks after their Botox injection. (4)
Ideal candidates for Botox injections are physically healthy and have no history of neuromuscular diseases such as myasthenia gravis or multiple sclerosis.
Botox may be used in people between the ages of 18 and 65 by trained injection professionals. Anyone who may be pregnant or is breastfeeding should not undergo Botox injections.
Botox is an injectable preparation based on a compound that is naturally made by the bacteria Clostridium botulinum. This compound, known as onabotulinumtoxinA (or simply botulinum toxin A), is a potent neurotoxin that relaxes muscles by blocking the nerves that cause them to tense up (2)
Some types of facial wrinkles are caused by the muscles under the skin. Facial expressions and other movements of the muscles under the skin of the face cause the skin to bend and fold, but the skin’s elasticity allows it to spring back to its proper form once the muscles relax.
However, as we age, our skin becomes thinner and loses its elasticity, and the skin doesn’t spring back to its original supple form when the facial muscles relax. The result is one of the most dreaded consequences of aging – facial lines and wrinkles (known in medical terms as “rhytides”).
Botox works by relaxing the muscles under the skin so that the skin wrinkles caused by muscle tension are reduced and the skin becomes smoother and more youthful-looking.
Botox injection treatments are typically performed in a doctor’s office, although treatments may be offered at spas, salons, and even in-home in the form of “Botox parties.” However, it is strongly recommended that Botox treatment be performed in a doctor’s office by a professional specifically trained in its application.
Botox treatments do not usually require any type of anesthesia, although some doctors may offer topical or local anesthesia upon request. Sometimes your healthcare professional will apply ice prior to the injection to numb the area. A tiny needle is used, so minimal or no discomfort is normally involved.
Once the skin has been cleansed, the doctor will inject each targeted facial muscle with the Botox. One to five injections are usually required per treated area. The entire treatment session usually takes 10-30 minutes.
The Botox procedure is relatively safe if performed by an experienced healthcare professional with a genuine Botox product. However, as with all medical procedures, there are some possible complications associated with Botox injections.
The most common adverse reactions are: (3)
- Drooping eyelids (ptosis) when glabellar lines (between the eyebrows) are injected
- Eyelid swelling after crow’s feet (lateral canthus) injection
- Headache and drooping brow following injections for forehead lines
Other side effects include: (3)
- Facial pain
- Bruising, redness, or swelling at the injection site
- Facial muscle weakness or paralysis, sometimes changing facial expressions
While rare, botulinum toxin products, including Botox, may spread from the site of injection to other parts of the body. This may cause serious and even life threatening side effects, such as: (3)
- Muscle weakness in areas other than the treated skin
- Double vision
- Generalized muscle weakness
- Difficulty swallowing, speaking or breathing
- Urinary incontinence
- Allergic reaction (itching, hives, chest tightness, severe swelling)
Botox treatments are known as a “lunchtime procedure” because people can usually return to their daily activities immediately after a treatment. Ice can be applied to reduce any bruising or swelling.
A few precautions are appropriate for the rest of the day after having a Botox treatment:
- Do not lie down directly on the treatment area for four hours,
- Do not massage or apply heat to the area treated, and
- Avoid activities that cause flushing (such as sitting in a hot tub, exercising, or drinking alcohol).
The results of Botox treatment are not immediate. Results begin to appear 3-5 days after Botox injections, with maximum results becoming apparent after up to two weeks. (2)
During your initial Botox consultation, your doctor will be able to show you before and after photos from past patients to give you a realistic idea of the results you can expect. However it’s important to note that results vary and you may require multiple treatments in order to achieve your desired outcome. It’s a good idea to speak with your doctor during your consultation about your goals to ensure that you set your expectations right.
The youthful effects of Botox treatments are not permanent. It’s a temporary solution to an ongoing problem that will require routine maintenance.
Results vary, but you can generally expect the effects of Botox injections to last roughly 3-6 months, at which time further treatments will be required to maintain results.
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
The overall cost of the procedure will depend on a several factors:
- The amount of Botox used
- The number of areas injected
- Your geographic area
- The skill level and fee schedule of the healthcare professional
On average, each treatment session will cost around $500 – $800. Cosmetic Botox injections are seldom covered by health insurance. However, many doctors offer financing options and flexible payment plans to make this treatment more affordable. Many also offer treatment plans so that follow-up treatments are at a reduced cost.
As the popularity of Botox has soared, so too has the demand for injections among men. Since Botox was first introduced, the number of men seeking Botox treatment has grown by more than 330%.
It’s not surprising that when men see the results of Botox treatments on their partners, many end up seeking Botox treatments for themselves.
- Allergan. Botox Cosmetic [product page]. Retrieved from https://hcp.botoxcosmetic.com/
- Allergan. (2017). Highlights of prescribers information: Botox Cosmetic (onabotulinumtoxinA) for injection Retrieved from https://media.allergan.com/actavis/actavis/media/allergan-pdf-documents/product-prescribing/20190626-BOTOX-Cosmetic-Insert-72715US10-Med-Guide-v2-0MG1145.pdf
- Samizadeh, S., & De Boulle, K. (2017). Botulinum neurotoxin formulations: Overcoming the confusion. Clinical, Cosmetic, and Investigational Dermatology, 11, 273-287. Retrieved from https://www.dovepress.com/botulinum-neurotoxin-formulations-overcoming-the-confusion-peer-reviewed-fulltext-article-CCID
- Eric Finzia, Norman E. Rosenthal. Journal of Psychiatric Research: Treatment of depression with onabotulinumtoxinA: A randomized, double-blind, placebo controlled trial. Retrieved from: http://www.botoxfordepression.com/wp-content/uploads/2014/03/Finzi-Rosenthal-Article-FINAL-copy.pdf