Everything You’ve Always Wanted to Know About Botox (But Were Afraid to Ask)
Cosmetic botulinum toxin therapy, aka neurotoxin injectables, work to help diminish the appearance of fine lines and wrinkles by paralyzing the muscles underneath. Typically used to help treat frown lines, crow's feet, and hyperhidrosis (excessive sweating), neurotoxin brand names include Dysport, Xeomin, newly FDA-approved Jeuveau, and perhaps the most well known of all, Botox.
Botox is an injectable neuromodulator that works to relax nerve-muscle imbalance, explains Los Angeles–based dermatologist Harold Lancer. In other words: Wherever its injected, Botox causes the underlying muscles to temporarily stop moving. When the muscles stop moving, the wrinkles stop forming. But is it really that simple? Not to mention, safe?
You've probably heard of people using it before they even have any fine lines, in order to prevent their development in the first place. Or, maybe you've seen images of unnaturally frozen-looking faces that have turned you off to Botox altogether. Perhaps you've even been invited to a Botox party (which, for the record, we'd recommend you skip). Despite the immense and continually growing popularity of Botox and other brand names, the cosmetic injectables industry still presents many unknowns and inconsistencies.
As such, it's always wise to do your research before going under the needle. To answer all of our collective questions, we consulted a slew of experts to break down all things Botox.
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Does Botox Prevent Wrinkles?
Absolutely. Botox (and competitors like Dysport, Xeomin and Jeuveau) are highly purified toxins that can temporarily erase or reduce horizontal forehead lines, vertical frown lines, and crow's-feet. "The injections slow muscles that contract hundreds of times a day, eventually etching lines in the skin," says New York City board-certified plastic surgeon Michael Kane, author of The Botox Book.
Basically, wherever Botox is injected in the body, it paralyzes the muscles underneath the skin. "Botox interferes with the nerve stimulation of the muscle causing excess facial expressions," Lancer explains. "When the muscle relaxes, the line diminishes."
In addition to relaxing frown lines in between the eyebrows, Botox can also lift the corners of the mouth that sag with age, smooth out the "pincushion" look in some chins, soften smoker's lines around the mouth, and soften vertical neck cords.
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Will Botox Make Me Feel Numb and Look Frozen?
"Botox is not designed to remove facial expressions,” Lancer says. "It's designed to soften lines of excessive facial expression from squinting, frowning, and smiling." It does paralyze your muscles, but it will not affect the nerves that cause sensation, or make you feel numb. When it is used correctly, it can lift the brow to give an appealing and sincere look.
"But if too much is injected in the danger zone — the horizontal lines in the forehead — you can look Spocked, as in Spock from Star Trek," says Jean Carruthers, a Vancouver eye surgeon who, with her husband, Alastair, coauthored the first paper on the cosmetic benefits of Botox in 1989. That's why it's important to be treated by an experienced doctor who can judge the size of your muscles and how much Botox you will need.
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Does Botox Hurt?
Like most injections, Botox can be slightly painful, especially between the eyebrows. Some doctors offer topical anesthesia (aka numbing cream) 10 minutes before the procedure or ice the area to numb it.
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Does Botox Have Side Effects?
Every drug has side effects, and Botox is no exception. Luckily, “Botox side effects are rare and temporary,” says Adam Kolker, a board-certified plastic surgeon based in New York City. Potential side effects (in just 1 to 5% of cases) include mild droopiness of the eyelid or eyebrow, which usually goes away within two weeks, slight bruising at the injection area, and headaches.
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How Much Does Botox Cost?
As with most cosmetic treatments, the prices for Botox vary widely, depending on what region you go to for treatment. Some doctors will charge per unit of Botox used (which can range between $15 to $25 per unit, approximately), which others will charge per total area. For reference, “a vial of Botox contains 50 or 100 units, and it [typically] takes about 40 to 60 units to smooth a 30-something’s forehead,” says Howard Sobel, a board-certified dermatologist in New York City and founder of Sobel Skin. For those looking to stave off fine lines and wrinkles, in general, "you can expect to spend about $400 to 500 per area."
The cost of Botox treatment for hyperhidrosis (excessive sweating) and migraines is a different story. The former usually only requires about 200 units, Sobel says, while the latter is often covered, at least partially, by insurance. This wide variance is all the more reason why a quality consultation, including an estimate, is key to a positive overall experience, Sobel says. Besides the price, "the quality of the result always depends on who is on the other end of the needle," says Kane.
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What's the Ideal Age to Start Using Botox?
This also varies — and it's mostly up to you! You don't need it before you have wrinkles to hide, or you can use it preventatively. “To be clear, it is much more about anatomy (as a result of genetic and environmental factors) than it is about a stereotypical age at which to begin,” Kolker says. “Prevention is the new mantra, [but] I have seen women in [their] 40s with few or no wrinkles who require very little [Botox], and women in their 20s who require more.”
Basically, a patient can have Botox safely whenever they are bothered by their wrinkles or simply want to prevent them from forming in the first place. There is no issue with long term use, either: "I've had patients who have used it repeatedly for over 20 years without bad effects," says Kane.
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How Long Does Botox Last?
Everyone is different, so the answer varies from patient to patient. In general, "the results can be seen within four to five days, and [they] last for three to six months with no downtime or surgery, and little to no discomfort," Sobel says. As such, "some patients enjoy treatments every three months, [and] many will treat every 4 to 6 months," Kolker shares.
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Where Do I Find a Reputable Provider?
Chances are your dermatologist offers it in their practice, or can recommend someone who does. If not, you can visit manufacturers' websites —botoxcosmetic.com, dysportusa.com, and xeomin.com — to find board-certified providers in your area. A new injectable neurotoxin called Jeuveau was also approved by the FDA earlier this year and is rolling out in doctors offices nationwide now.
Jeuveau is actually the first new brand of neurotoxin to come to the U.S. market in almost 10 years, actually, and according to the brand's clinical trials, it promises results similar to competitor Botox. Of course, you should always consult with your dermatologist before blindly choosing a brand-name neurotoxin in order to determine which option is best for you. Also, ask your friends — the ones who admit to using it, that is. For the best treatment, seek out doctors in academic settings or those who have written about it. "This is where you have to use all your antennae," says Carruthers.
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Will My Friends Know I Got Botox?
Yes and no. A good result will leave you looking fresher, more cheerful, and perhaps younger. Telltale signs of Botox that has been badly done are a smooth and shiny forehead, or crow's-feet that don't move when you laugh or cry.
However, whether or not you've got the telltale signs of a recent neurotoxin appointment, as long as you're happy with the results, it shouldn't matter if your friends, family, or complete strangers on the street can tell the difference.
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What Can I Expect the Day After My Botox Appointment?
Everyone is different, but generally, not too much. Results will usually begin to show within four to five days after the treatment, and there is no downtime, as well as little or no discomfort. After those first few days, results will continue to develop gradually over the course of two weeks. "I tell anyone preparing for a big event to have shots two weeks ahead of time," says Kane.
Patients taking medications that contain aspirin or NSAIDs can develop pinpoint blue bruising. Patients can wear makeup immediately but should avoid heavy workouts for 24 hours, says Carruthers.
