With more than 7.4 million treatments administered in 2018, Botox is the #1 cosmetic nonsurgical treatment in the United States.
Botulinum toxin or Botulinum toxin type A, more commonly known as Botox, is a neurotoxic protein produced by the bacterium Clostridium botulinum.
What is Botox Used to Treat?
In large doses this toxin can cause botulism, a potentially fatal type of food poisoning. In small and regulated doses, however, this toxin has been used for a wide variety of cosmetic and medical treatments since its initial approval by the Food and Drug Administration, or FDA in 1989.
Cosmetically, Botox is used to minimize the appearance of skin damage caused by aging, sun exposure, and smoking.
Cosmetic uses of Botox include, but are not limited to the treatment of:
- glabellar frown lines, or vertical “frown lines” between the eyebrows, also referred to as “the elevens”
- horizontal forehead lines and wrinkles
- periorbital lines, or crow’s feet around the eyes
Medically, Botox is used to treat the symptoms of numerous glandular, ophthalmologic, neurological, neuromuscular, and muscular conditions.
Medical uses of Botox include, but are not limited to the treatment of:
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- chronic migraines
- facial paralysis resulting from Bell’s palsy
- hyperhidrosis, or excessive sweating of the face, head, feet, or armpits
- strabismus, or crossed eyes
- lazy eye
- thyroid eye disease, or bulging eyes resulting from Graves’ disease or hyperthyroidism
- blepharospasm, or uncontrolled blinking or twitching of the eyelid
- hypersalivation, or drooling
- spasmodic dysphonia, a neurological condition which alters the function of the vocal cords
- upper motor neuron syndrome (UNMS)
- cervical dystonia, or neck spasms
- bladder dysfunction
How Does Botox Work?
Botulinum toxin or Botox works by blocking the release of a specific type of neurotransmitter, or chemical messenger in your body. These neurotransmitters carry signals from neurons (nerve cells) to other neurons, gland cells, or muscle cells which tell those muscles to contract.
Because Botox prevents the release of these signals, it stops specific muscle or a group of muscles from moving. In other words, Botox temporarily weakens or reduces movement in targeted muscles, the muscles that form wrinkles.
Once those muscles are weakened, the skin above them appears smoothed or relaxed, thus minimizing the appearance of wrinkles. If administered correctly, Botox will not prevent you from expressing yourself. Rather, it will stop overactivity in a targeted area(s).
Botox is most frequently used to treat dynamic wrinkles, one of the two types of wrinkles. Dynamic wrinkles are lines or folds on your face which come from expressing emotions such as excitement, sadness, surprise, or confusion. Dynamic wrinkles are most visible when you are doing things like smiling, frowning, or squinting. While those lines may disappear after you make an expression, over time the repeated muscle movements will cause dynamic wrinkles to become static wrinkles.
Static wrinkles are finer lines resulting from the loss of skin elasticity. Your skin elasticity diminishes with age and your skin’s collagen begins to break down. Static wrinkles are typically treated with injectable dermal fillers rather than Botox.
How Long Does Botox Last?
The effects of Botox are temporary and reversible. Cosmetic results will vary by individual and are impacted by factors such as:
- how deep your wrinkles are
- your age
- how elastic your skin is
- the location of the wrinkles
On average, the visible effects of Botox generally last up to 4 months. The location of your injection and the dosage you receive, along with the factors listed above will impact how long your results last.
Typically you will begin to see results within a few days of treatment, though it may take one to two weeks for full results to be visible.
If you receive regular Botox injections over extended periods of time, the muscles you have treated will begin to shorten and shrink with lack of use. This often means that the visible effects of your treatments will last longer. As a general rule of thumb, the earlier that you begin to treat a wrinkle, the better your success rate in combating the appearance of what that wrinkle will become.
What Happens During a Botox Treatment?
During your treatment, you will be placed in a chair or on an exam table in an upright position. Your physician will discuss your treatment plan with you and review the areas that will receive an injection. Next, your physician will clean the treatment areas with a non-alcohol cleanser and may opt to apply a topical anesthetic.
Once the injection areas have been prepared, your physician will proceed with the injections. Typically this process takes 10-20 minutes. While most patients receive treatment in two to five areas, your treatment plan may vary depending on your desired results. Once finished with the injections, your physician may apply pressure to specific injection sites to reduce minor bleeding and prevent or minimize bruising.
Avoiding alcohol and medications such as aspirin and ibuprofen for several days before your treatment will help to minimize swelling and bruising.
How Much Does Botox Cost?
While costs will vary depending on who is administering the treatment, on average, an individual unit of Botox costs between $10 and $20.
The FDA has approved the injection of up to 20 units of Botox for horizontal forehead lines and up to 20 units for “frown lines” or “the elevens” between the eyebrows.
Most people receive between 12 and 30 units in their forehead and a much smaller number of units if receiving treatment for crow’s feet (along the outer corners of the eye).
What Are the Risks and Side Effects of Botox?
While the risks associated with Botox injections (when performed by a licensed and experienced physician) are relatively few, the following side effects have been observed:
- temporary swelling or minor bruising at the injection site
- temporary redness at the injection site
- nausea
- headache
- flu-like symptoms
You should avoid Botox if you are pregnant or breastfeeding.
After receiving a Botox injection, you should not rub the treated area for 12 hours. You are advised against lying down for three to four hours following your treatment.
Who Can Give Botox Injections?
Botox must be administered by a licensed and trained physician (medical doctor). In the majority of states this includes physician’s assistants, nurse practitioners, dentists, and registered nurses. Some states, however, may also require these individuals to be under the supervision of a medical doctor.
Botox Before and After Pictures
Crow’s Feet – Before & After
Forehead Wrinkles – Before & After
Sources
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4. Cosmetic use of botulinum toxin type A in the elderly,” US National Library of Medicine, National Institutes of Health, March 2007, accessed July 2019./a>
5. “BOTOX,” American Osteopathic College of Dermatology, accessed July 2019.
6. “Botox injections,” Mayo Clinic, accessed July 2019.