Let’s be very clear right up front: Fine lines and wrinkles are 100% normal and something that everyone experiences at some point in their life. That said, if you prefer a smoother, line-free complexion, Botox is here to help. And, believe it or not, more people than you might think have undergone the cosmetic treatment. After all, according to plasticsurgery.org, Botox is the #1 most popular minimally-invasive cosmetic procedure in the United States, with over 4 million people partaking in the treatment. While that number is down 13% since 2019, it’s up 459% since 2000. Which is all to say, Botox remains a go-to treatment for those wishing to minimize the appearance of fine lines and wrinkles. But the real question is, what is Botox? Furthermore, does it hurt, and does it come with any adverse effects? We discuss all that and more, below.
Meet the Expert
What Is Botox?
Botox is a drug manufactured by Allergan. As the name insinuates, it’s made from a toxin, which cosmetic dermatologist Michele Green, MD, says is produced by the bacterium Clostridium botulinum. “Botox has been used for cosmetic purposes for years, for treating wrinkles that are a result of muscle movement,” she explains. “The mechanism of action of Botox is to ‘freeze’ the muscle, which causes the wrinkle to form.” In doing so, Botox is able to inhibit movement and lend to a smoother, line-free complexion.
But Botox doesn’t only treat fine lines and wrinkles, it prevents them, too. “Botox Cosmetic is an acetylcholine release inhibitor, and thereby is a neuromuscular blocking agent, and both treats and prevents a dynamic wrinkle from forming,” Green explains. Hence why there’s so much hype about getting Botox earlier and earlier as a preventive measure. Once upon a time, Botox wasn’t sought after until you reached your 40s and 50s. Now dermatologists are recommending it for clients in their early 20s. It all depends on your cosmetic goals.
Of course, nowadays Botox does more than just treat wrinkles. According to facial plastic and reconstructive surgeon Sarmela Sunder, MD, it can be used to treat hyperhidrosis (aka excessive sweating), neck spasms, an overactive bladder, migraines, and lazy eyes. Additionally, she says that it can be used to reduce the side of the masseter muscle, which lends to a more slimmed jawline.
Benefits of Botox
- Temporarily improves the appearance of fine lines and wrinkles
- Temporarily reduces excess sweating
- Temporarily alleviates migraines
- Temporarily reduces the size of muscles
- Temporarily adjusts lazy eyes
Botox has an array of benefits, all of which can be achieved in as little as a single 15- to 30-minute treatment. That’s one of the biggest benefits of Botox—just how quick the treatment time is. Plus, after just one treatment, patients can expect the results—which don’t fully set in for up to two weeks post-injection—to last for months on end, typically in the three to four range.
While Botox for fine lines and wrinkles, migraines, and excess sweating is nothing new, recently dermatologists have been using the injectable to slim facial structures.
“In the case of masseter [aka jaw] muscles, Botox can be used to slim the appearance of the face,” Sunder says. “Used creatively, it can also lift the brows, turn up lip corners, and subtly lift the lips.”
As someone who has gotten Botox in their jaw (at the suggestion of my dermatologist, I might add), I can’t say that I’ve noticed a huge difference. However, some derms say that these very procedures have become among the most popular in their NYC and DC offices because of how they can effectively but almost imperceptibly alter the jawline and lengthen the face. “When Botox is injected into the masseter muscle, it makes the muscle smaller, and gives the face more of a V shape—narrower and more feminine,” Green says.
Baby Botox: Explained
If you’re unsure whether Botox is right for you, it could potentially be due to the fear of injecting too much and freezing too noticeably. If that’s the case, Green makes a case for “pre-juvenation” or Baby Botox. “Not only does Botox treat existing wrinkles, but Baby Botox injections can be used in the face to prevent many dynamic wrinkles from forming,” she says. “Tiny amounts of Botox are injected in various areas of the face, and the result is an inability for forehead, glabella, and crow’s lines (wrinkles around the eyes) from forming.” In other words, no wonder so many folks are using Botox preventively in their 20s.
The Best Candidate for Botox
Considering Botox treats and prevents fine lines and wrinkles, excess sweating, migraines, neck spasms, and lazy eyes, and can effectively reshape the face, anyone with goals to address said symptoms is a good candidate for Botox, so long as they’re healthy.
“The best candidate for Botox is someone in good physical and psychological health,” Green says. “If you are pregnant or breastfeeding, or have certain neurologic diseases, you should not have Botox injections.”
If you have any questions surrounding your eligibility for Botox injections, simply talk with your dermatologist or certified injector prior to getting any injections.
Does Botox Hurt?
One of the most common questions surrounding Botox is whether or not the injections hurt. As someone who has undergone Botox treatment a number of times over the past four years, I can attest to the fact that Botox is relatively painless. Part of this is because the needle used is so tiny, and part of it is because, more often than not, the injector applies a topical numbing agent beforehand. Of course, not all patients require it, and some forgo it to speed up the treatment time, as it takes anywhere from 20 minutes to an hour for the numbing cream to set into effect.
While facial Botox is definitely manageable, Green points out that getting Botox elsewhere in the body can be more painful. “When Botox is used for treating hyperhidrosis, in the axillae for sweating, or the hands, this is significantly more uncomfortable, and I always insist on patients using topical numbing cream before their Botox injections,” she says.
How to Prepare for Botox
Since Botox is a quick and relatively painless procedure, not much prep goes into it. Simply show up to your appointment with a fresh face and make sure to take simple precautions in the days leading up to treatment.
“The best way to prepare for a Botox treatment, as with any cosmetic injectable treatment, is to avoid blood thinners or medications, which can cause bruising, such as Aspirin, Aleve, Motrin, Coumadin, multivitamins, fish oil, etc., for 10 days before your procedure,” Green says, noting that this, and avoiding alcohol for a week prior to injection, will minimize the risk of bruising.
FWIW: In all my years of Botox injections (I’ve probably gotten them done eight or so times), I’ve only ever experienced bruising once, and it was a single pin-prick toward the far outer edge of my eye, moreso located on my cheekbone. The point being: Bruising may happen, but it’s not so severe that you should avoid the treatment altogether if you’ve been hoping to get it.
What to Expect During Botox
When you walk into your Botox appointment, your dermatologist or injector will assess your face and recommend dosage while asking you what your facial goals are. (Some will go so far as to take before-and-after photos from a variety of angles.) From there, they’ll apply a topical numbing cream and let it go into effect for 20 minutes to an hour. Once numbed, your dermatologist will return with a small gauge needle to perform the treatment, which takes mere minutes.
What’s most important to remember is that, unlike filler, Botox isn’t immediately noticeable. According to Green, the full effect of Botox takes up to 14 days to present itself. What you may notice immediately, however, are little bug-bite-looking spots where the injections occurred. Under no circumstances whatsoever should you touch, itch, or massage them—they will go away on their own within the hour.
Botox vs. Filler
Botox and filler are often confused, given both cosmetic treatments are injectables. The biggest difference is that Botox freezes muscles and prevents line formation, whereas filler fills lines and restores volume to lend to plumper, more youthful-looking appearance. “Botox cannot be used to restore lost volume, or fill in deep lines or wrinkles,” Green says. “Since Botox is mainly used for the upper half of the face, dermal fillers [which are often used in the lips and cheeks] are the best complement to Botox.”
Potential Side Effects
As mentioned above, Botox can lead to bruising and temporary swelling of the injection site. Additionally, Sunder says that Botox injections can lead to headache and flu-like symptoms and, in more severe and less common cases, temporary eyelid drooping. The best way to avoid these potential side effects is to book your Botox injections with a dermatologist or skilled esthetician.
The cost of Botox depends on the experience of the injector, as well as the location of the practice in which you book the appointment. As a general rule of thumb, Botox costs more in larger cities and less in the suburbs. That said, Sunder says that a single unit of Botox can cost between $10 and $20. Depending on whether you’re getting Baby Botox or regular Botox, a typical treatment consists of between 10 and 30 units in the forehead and around the eyes, which rings up to between $100 and $200 on the low end, and $300 and $600 on the high end. While that may not seem horrible, remember that Botox results last for only three to four months, so it can quickly add up.
Botox aftercare is simple. Don’t massage your face for 24 hours post-injection, and don’t lay down for at least four hours post-treatment—this will help to avoid diffusion of the product. Additionally, Green says not to exercise or expose yourself to high heat for 24 hours following treatment. What’s more, Sunder says to avoid any headbands or hats for the remainder of the day, again to avoid diffusion. Lastly, some derms (a few of mine have, at least) say to avoid alcohol for 24 hours post-treatment to avoid exacerbating bruising.
The Final Takeaway
Botox is a popular and minimally invasive cosmetic treatment—and for good reason! It’s safe, effective, and quick as can be. When booking an appointment, just make sure to do so with a certified dermatologist or a well-reviewed esthetician. Doing so will help to avoid any adverse effects.
Plastic surgery statistics. American Society of Plastic Surgeons.
Small R. Botulinum toxin injection for facial wrinkles. Am Fam Physician. 2014;90(3):168-175.
Klein AW. Treatment of wrinkles with Botox. Curr Probl Dermatol. 2002;30:188-217.
Sundaram H, Signorini M, Liew S, et al. Global aesthetics consensus: botulinum toxin type a--evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg. 2016;137(3):518e-529e.
Schlessinger J, Gilbert E, Cohen JL, Kaufman J. New uses of abobotulinumtoxina in aesthetics. Aesthet Surg J. 2017;37(suppl_1):S45-S58.
Gart MS, Gutowski KA. Overview of botulinum toxins for aesthetic uses. Clin Plast Surg. 2016;43(3):459-471.
McConaghy JR, Fosselman D. Hyperhidrosis: management options. Am Fam Physician. 2018;97(11):729-734.
Olla D, Sawyer J, Sommer N, Moore JB. Migraine treatment. Clin Plast Surg. 2020;47(2):295-303.
Kim N-H, Park R-H, Park J-B. Botulinum toxin type A for the treatment of hypertrophy of the masseter muscle. Plast Reconstr Surg. 2010;125(6):1693-1705.
Flores-Reyes EM, Castillo-López MG, Toledo-Silva R, Vargas-Ortega J, Murillo-Correa CE, Aguilar-Ruiz A. Botulinum toxin type A as treatment of partially accommodative esotropia. Arch Soc Esp Oftalmol. 2016;91(3):120-124.
Lowe NJ, Halliday D. Vein imaging laser reduces bruising in bruise-prone botulinum toxin injected patients. J Cosmet Laser Ther. 2016;18(3):162-164.
de Maio M, DeBoulle K, Braz A, Rohrich RJ, Alliance for the Future of Aesthetics Consensus Committee. Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the midface. Plast Reconstr Surg. 2017;140(4):540e-550e.
Kassir M, Gupta M, Galadari H, et al. Complications of botulinum toxin and fillers: A narrative review. J Cosmet Dermatol. 2020;19(3):570-573.