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Non-SurgicalSkin Care

What Are Botox Injections?

By October 6, 2021No Comments

Definition, Benefits, and Side Effects 

B otox has been used for years as an anti-aging treatment. It is a drug that can paralyze or weaken muscles, but in small doses, it can be used to decrease skin wrinkles and make it younger and smoother.

Botox is made from a toxin called Botulinum toxin produced by a type of bacteria called Clostridium botulinum, which exists in nature such as soil, lakes, some fish, and mammals’ intestines. The bacteria itself and its spores are harmless. However, it can cause problems under certain conditions that make the spores transform, which increases the number of bacteria. At this point, the bacteria can produce Botulinum toxin.

It is the same toxin that causes botulism, which happens when people eat food containing this toxin.

It is also a protein that can have some cosmetic and other medical benefits when used correctly. It is generally safe and does not have any serious side effects. (1)
Furthermore, Botox injections are manufactured carefully and include very small doses of Botulinum toxin. Temporary paralysis of muscles can have many benefits for many muscle and nerve conditions and of course some cosmetic benefits.

Woman with Forehead Rhytids

Figure 1 – Computer generated woman with horizontal forehead rhytids (the most common type).

What Are Cosmetic Botox Injections?

Cosmetic Botox injections use botulinum toxin type A, specifically Onabotulinumtoxin A, to relax the muscles producing wrinkles and fines lines by paralyzing the muscles temporarily, which decreases the appearance of wrinkles, fine lines, and aging signs.

Botox is minimally invasive and approved by the FDA as a safe and effective treatment for facial wrinkles and fine lines. In 1989, the FDA approved Botox as a treatment for eye muscle problems including blepharospasm, then in 2002, it was approved as a cosmetic solution for frown lines, which exist between the eyebrows, and finally, in 2013, it was approved as a treatment for crow’s feet wrinkles, which exit around the eye corners.

A clinical study was done in 2016 confirmed that Botox is one of the simplest, safest, and most effective treatments for forehead wrinkles. Also, in the same year, more than 4.5 million procedures in the United States were performed using Botox injections, according to the American Board of Cosmetic Surgery, which makes it the most popular non-surgical solution for Americans who want to fight wrinkles and aging signs. (2, 3, 4)

How Does Cosmetic Botox Treatment Work?

Botox work by causing temporary muscle paralysis. It is a neurotoxin that targets the nervous system. It blocks the nerve signaling processes that stimulate muscle contractions, which makes them relax temporarily.

Muscles contract when the nerve endings attached to the muscles release a chemical substance called acetylcholine, which attaches to its receptors on the muscles cells and causes contractions. Botox prevents the nerve endings from releasing acetylcholine, which subsequently prevents the muscles’ contractions and makes them less stiff.

When used in small doses, Botox force the muscles that are responsible for wrinkles and fine lines to relax, which reduces their appearance and makes the skin look smoother and younger. It is usually used for forehead wrinkles, crow’s feet wrinkles, and frown lines. However, it is not effective for facial wrinkles caused by gravity or sun damage. (5, 6)

The Types of Botulinum Toxin Injections

Botulinum toxin injections have many brand names. Of course, each product treats a different problem. You should talk with your doctor about all the types of Botulinum toxin injections and discuss the best option for your condition. (7, 8, 9, 10)

Options include:

  • OnabotulinumtoxinA or Botox.
  • AbobotulinumtoxinA or Dysport.
  • IncobotulinumtoxinA or Xeomin.
  • PrabotulinumtoxinA or Jeauveau.

Figure 2 – Ideal candidate for botulinum toxin treatment demonstrating (A) dynamic frown lines with glabellar complex muscle contraction and (B) lack of static lines with glabellar muscles at rest.

The Cosmetic Uses of Botox

The main use of Botox injection is decreasing the appearance of facial wrinkles. The effects last between 3 and 12 months, depending on many factors including the type of the treatment and the condition of the person’s face. (11)

Botox is injected in the following facial areas.

  • Frown lines or the wrinkles between the eyebrows by relaxing glabellar complex muscles.
  • Crow’s feet wrinkles by relaxing lateral orbicularis oculi muscles.
  • Forehead creases, the horizontal creases in the forehead, by relaxing the frontalis muscle.
  • Lines at mouth corners by relaxing Depressor Anguli Oris muscles.
  • Cobblestone chin by relaxing overactive mentalis muscles.

The treatment of choice for wrinkles in the upper one-third of the face such as crow’s feet, horizontal creases in the forehead, and frown lines is Botox. However, the lower two-thirds of the dace are more challenging and need a highly experienced doctor to perform the procedure. Furthermore, the FDA only approved the use of Botox injections for the upper one-third of the face.

It is worth mentioning that studies do not confirm whether Botox can be used for under-eye dark circles or not. Also, there is little evidence that Botox works for improving hair appearance.

Figure 3 – Representative photographs of Subject 1 and Subject 2 taken at baseline (A, C) and at the end of treatment period 1 on day 30 (B, D). Subject 1, a 53-year-old Japanese female, received onabotulinumtoxinA 12 U, while Subject 2, a 55-year-old Japanese female, received onabotulinumtoxinA 24 U

How Is a Botox Procedure Done?

Botox injections take only a few minutes, do not require anesthesia, and only cause minor discomfort. A small needle is used to inject Botox into the target muscles after diluting the toxin powder in saline.

You will start noticing the effects after 24 to 72 hours. In some rare cases, the effects may take up to 5 days to appear. (12)

Pregnant and breastfeeding women should avoid Botox injections. Also, people who suffer from allergic reactions to the toxin or one of the drug’s ingredients should not try it again and look for safer alternatives.

The Risks and Side Effects of Botox Injections

Generally, most people tolerate Botox, and the risks and side effects are minimal when it is done right by a highly qualified healthcare provider.

The side effects might still occur depending on why the person uses Botox. You should talk with your doctor about the risks and side effects before the procedure. (13, 14, 15)

The following side effects might occur due to how the body responds to the botulinum toxin.

  • Dry eyes, temporary eyelid drooping or blurred or double vision. This happens when Botox is injected around the eyes.
  • Stomach pain and discomfort.
  • Numbness, mild to moderate pain, swelling, and/or bruising at and around the site of injection.
  • Headache, tiredness, and flu-like symptoms for the first 24 to 48 hours.
  • Temporary weakness or paralysis of the muscles surrounding the site of injection.
  • Neck pain and breathing difficulties if the Botox is injected into the neck area.
  • Cardiovascular problems such as MI and arrhythmia, which are extremely rare.
  • a frozen look. This happens when too much Botox is used, which makes you unable to move the rest of your facial muscles.
  • Developing antibodies against the Botulinum toxin, which makes the next injections less effective. (16)
  • Allergic reactions such as asthma symptoms, itching, and/ or rash.

People who are sensitive or allergic to Botulinum toxin should not get this treatment along with people who have an infection at or around the site of injection.

The side effects of Botox can go beyond the site of injection depending on the treatment type. If you are not satisfied with the results, talk to your doctor.

Besides, if you experienced any symptoms or have a serious problem such as an allergic reaction or breathing difficulty, you must go to the nearest hospital immediately.

How to Get Prepared for Botox Treatment?

Botox is a non-surgical, in-office treatment, which means that it requires minimal preparation. Your healthcare providers will ask you about your medical history, medications, allergies, medical conditions, any procedures you have done in the past, and other aspects. Of course, the healthcare providers must be licensed and have enough experience and knowledge to perform the procedure correctly.

Before the Botox Injection, you will be asked to remove your makeup completely and cleanse the target area. Furthermore, you may need to stop taking blood-thinning medications such as aspirin to minimize the risk of bruising.

Botox Aftercare Instructions

Following Botox aftercare instructions will increase the chances of reaching the optimal results and minimize the risk of side effects such as bruising and spreading to unwanted areas. (17)

  • On the Day of the Procedure

On the day you get your Botox injection, follow these tips.

  • Take the day off and relax.
  • Avoid exercising and try to keep your heart rate normal.
  • Do not touch, rub, or apply pressure on the injected area.

Botox is a non-surgical, minimally invasive treatment. Therefore, it does not require any recovery time. You can return to your normal activities immediately after getting the injection.

  • Exercises

If you exercise regularly, your doctor will suggest waiting for 24 hours to several days before returning to your exercise routine.

Exercises increase the heart rate and blood flow, which can spread the Botulinum toxin to other areas causing side effects and decreasing the effectiveness of the treatment at the site of injection. Besides, physical activity increases the risk of bruising and contracts your muscles, which reduces the toxin’s effectiveness.

The only exercises allowed during the first few days are facial exercises such as smiling, frowning, and raising your eyebrows to enhance the effects of Botox to appear.

  • Make-up

After getting your Botox injection, it is recommended to stay make-up-free for the first 24 hours. That is because you will rub your skin while applying makeup, which may spread the toxin to unwanted areas.

  • Sit Up

Try to stay sitting up for the first 4 hours after receiving your Botox injection since lying down or bending may spread the toxin to unwanted areas and enhance bruising.

  • Discuss Your Medications with Your Doctor

Some medications such as blood thinners can increase the risk of bruising. Inform your doctor about your medications and when it is safe to take them again after receiving your Botox injection.

Botox Aftercare Precautions

Aftercare precautions are necessary after Botox injections. On the procedure day, here are some tips that you need to keep in mind.

  • Avoid Drinking Alcohol

Your doctor will ask you to avoid drinking alcohol before the procedure for at least 24 hours. This is also applied after getting your Botox injections. You should wait for at least 24 hours before starting drinking again. Alcohol has blood-thinning properties. Therefore, it increases the risk of bruising

  • Avoid Touching Your Face

You should avoid touching your face for the first 24 hours after the Botox injections to prevent the toxin from spreading to other areas.
Your doctor may increase this no-touching period up to 3 days depending on the condition and type and dosage of the injection. This is also applied to professional massages. Just keep your hands away from your face for several days to get the best out of the Botox injection.

  • Avoid Skin Treatments

Botox takes time to reach the targeted muscle and start working. Therefore, for the first 24 hours to 3 days, avoid other skincare treatments such as facial masks, facial massages, exfoliating scrubs, and dermal fillers because they may reduce the effectiveness of your Botox injection.

  • Avoid Sleeping on the Site of Injection

It can be hard, but you should try to avoid sleeping on the treated area for the first 24 hours to 3 days to decrease the pressure, prevent the spread of Botulinum toxin to unwanted areas, and let it settle into the targeted muscles.

Besides, you should avoid sleeping for the first 4 hours after the procedure.

  • Avoid Sun Exposure

Try to avoid sun exposure for the first 4 hours after your Botox injection since the heat enhances flushing and increases blood pressure, which can increase the risk of bruising. Some doctors suggest staying out of the sun for 24 to 48 hours.

Furthermore, avoid other heat exposure sources such as hot showers, saunas, tanning beds, and hot tubs.

How Much Does Botox Cost?

In 2016, the average cost of a Botox injection was $375. The costs vary widely depending on many factors such as the target area, the number of injections needed, the condition of the target area, and the geographic locations where you will get the Botox injection.

Notice that health insurance does not cover Botox for cosmetic purposes.

FAQ about Botox

  1. What Does Getting a Botox Injection Feel Like?

Botox injections are quick and cause minimal discomfort at the site of injection. They do not even require local anesthesia or any recovery time. You can literally have your Botox injection during your lunch break and return to work immediately after the procedure.

  1. Is the Botox Procedure Painful?

According to most persons, the procedure is not painful. You will experience some discomfort during the injection, which disappears in a while once the procedure is over.

  1. When Will I See Actual Results?

The appearance of the full effects of Botox injections varies from one patient to another. In most cases, it takes 3 to 5 days to see the full effects while in some cases, it may take up to 2 weeks.

  1. How Long Do Botox Effects Last?

The Botox effects last between 3 to 5 months. Over time, the paralyzed muscles start working again leading to the appearance of wrinkles while the body metabolizes the Botulinum toxin.
Periodic Botox maintenance treatments are recommended every 3 to 4 months to maintain the effects for longer periods.

  1. When Should I Start Considering Botox?

Some people think that they are either too young or too old to give Botox treatment a try. When it comes to Botox, there is no perfect timing. Your condition must be evaluated by a professional healthcare provider to decide. Many young people start using Botox in their twenties and thirties as a way to prevent wrinkles from developing in the first place.

  1. Is Botox Safe?

Yes, in general Botox is safe for most people. The risks and side effects are uncommon when the procedure is done correctly by a professional, licensed medical practitioner.
However, pregnant, and breastfeeding women in addition to people who have certain neurological disorders should avoid Botox treatments.

  1. What Is the Difference Between Botox and Dysport?

Botox and Dysport are used for the same cases. However, there are some differences between them.

Botox and Dysport are dosed and diluted differently. One unit of Botox is as efficient in relaxing muscles as 3 units of Dysport. Therefore, if you regularly get a certain dose of Botox, you need to triple it if you decided to switch to Dysport.

This does mean that Dysport will not achieve the same results as Botox. It just means that you will need more units. Besides, the price of Dysport units is much lower than Botox, which means that to achieve the same results with Dysport, you will not pay more money.

Dysport has smaller molecules than Botox, which can be better for some conditions. Smaller molecules work faster and can spread and diffuse better. This is beneficial in treating larger areas since fewer injections will be needed.

On the other hand, the spread and diffusion of Dysport mean that it is less effective in treating smaller where the treatment needs to be focused in the treated area or areas with thicker muscles.

Finally, Dysport is faster than Botox and takes less than 24 hours to see the full effects while Botox can take up to 72 hours to settle in and start working. (18)

  1. Which Is Better, Botox or Dysport?

Botox is recommended for treating smaller areas since it stays put in the injection area. Therefore, it should be used for treating areas around the lips and eyes. On the other hand, Dysport is recommended for larger areas that can benefit from its widespread such as the forehead. Plus, only fewer injections are required to get the same results as Botox.

  • Wrinkles Around the Eyes

Frown lines, the wrinkles between the eyebrows, are better treated with Dysport since they are considered deeper layers while crow’s feet wrinkles are better treated with Botox, to prevent any spread of the Botulinum toxin to the eyes.

  • Forehead Lines

The horizontal lines on the forehead are better treated with Dysport. Dysport is used for larger areas because it can spread beyond the injection site, which means treating more lines using fewer injections.

  • Lip Lines

Lip Lines, also known as smoker’s lines, are the vertical wrinkles above the upper lip, are better treated with Botox since it stays put in such a small area.

  1. What Is the Difference Between Botox and Xeomin?

The main difference between Botox and Xeomin is the formulation. Xeomin is a pure neurotoxin since its only ingredient is Botulinum toxin A. On the other hand, Botox includes Botulinum toxin in addition to protective proteins clustered around it. Xeomin is used for people who have higher chances of developing antibodies against Botulinum toxin. The formation of antibodies can decrease the desired effects significantly.

Another difference between Xeomin and Botox is the period needed to see the full results. Xeomin takes about 4 days until it works while Botox takes 24 hours to 3 days to work. Both Botox and Xeomin effects last for 3 to 6 months. (19)

  1. Which Is Better, Botox or Dermal Fillers?

Dermal fillers are as effective as Botox. Generally, dermal fillers’ effects last longer than Botox. However, the duration still depends on the type of filler. Of course, additional treatments are needed to maintain the results.

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Dr Khaled Mahmoud

Dr Khaled Mahmoud

A medical researcher with more than 5 years of professional academic and medical writing experience. My main goal is to provide readers with evidence-based, data-driven, detail-oriented content to help them make the best choices.

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