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Botox: What You Need to Know


Updated March 10, 2009

What it Is:

Botox injections have in recent years become the undisputedly most popular of all cosmetic procedures, with well over 4 million patients being treated with botox in 2006. BOTOX® is the product name for injections containing a refined form of botulinum toxin (the toxin that causes botulism, a type of food poisoning). When injected into a muscle, the toxin blocks the nerve impulses that would normally cause that muscle to contract. The resulting absence or reduction of muscle contraction leaves the skin smoother and lends a more relaxed appearance to the patient’s facial features.

The Many Uses of Botox:

The signs of aging that respond best to botox injections are those lines and wrinkles caused by the repeated contractions of muscles used during facial expressions, especially those activated when we are frowning or squinting. Therefore, botox is used most commonly for reduction of the appearance of frown lines between the brows, forehead furrows, and lines at the outer edge of the eye, commonly referred to as "crow's feet".

Botox can also be used for lines and wrinkles of the lower face, and even to decrease nostril flaring, although these practices are controversial due to risk of damaging important facial nerves.

Who Is a Good Candidate:

  • patients who are showing early signs of aging
  • patients whose frown lines give them a tired, sad, or angry appearance
  • those who may not be suitable candidates for more invasive facial cosmetic procedures

Who Is Not a Good Candidate (Contraindications):

It is very important to disclose to your surgeon any and all medications or supplements you may be taking, since the use of certain medications (antibiotics, anti-inflammatories, or aspirin) and even some vitamins and herbal supplements may increase increase bleeding and bruising at the injection sites.

Pregnant or nursing women should not get botox injections. Also, any person with an infection present at or near the injection site should postpone treatment until the infection is resolved. Furthermore, there is a greatly increased risk of serious side effects in patients with any pre-existing neuromuscular disorder.

Risks & Complications:

Most complications are temporary and risks can be minimized with proper injection techniques. The most common side effects of botox injections include:

  • temporary drooping of the eyelid
  • nausea
  • headache
  • localized pain, tenderness, or numbness
  • infection
  • inflammation / swelling
  • redness, bleeding, and/or /bruising at the injection sites
  • reduced blinking, which can lead to increased likelihood of corneal abrasion

Rarer complications or adverse reactions have included cardiac complications, anaphylaxis, and other serious (including fatal) reactions. It is very important to inform your surgeon of any pre-existing medical condition.

Recovery & Downtime:

Most patients can immediately resume normal activities, although there may be some unsightly swelling, bleeding, bruising or redness at the injection site, which usually lasts only a few hours, but can persist as long as 24-48 hours in highly sensitive patients.

The Upside / Fringe Benefits:

  • If the patient is dissatisfied, effects reverse themselves within several months.
  • Because of its muscle-relaxing effect, many surgeons claim to have had success using botox in the treatment of migraine headaches, excessive sweating, and muscle spasms.
  • Effects can be cumulative over time with repeated treatments, or even preventative if injections are begun before expression lines begin to appear.

Things to Remember:

  • In most cases, it takes at least 3-7 days to fully realize the effect of botox injections.
  • The effects generally last for 3-6 months. Repeated treatments are required to maintain results.
  • A small percentage of patients are reported to experience no improvement at all, demonstrating a sort of Botox immunity or resistance.


Costs vary widely depending on a variety of factors, including geographical area and the facial areas which are being treated. Costs can also vary depending on the qualifications of the person who is administering the injections---whether it is a surgeon, nurse, medical assistant, or clinical aesthetician. The US average cost for botox injections is between $375-$500 per area treated.

How It's Done:

Botox is usually injected directly into the muscle using a very small needle. Your surgeon will ask you to make certain faces in order to contract the muscles in the treatment area. This enables him or her to determine the precise locations where the injections should be placed. Most treatments require multiple injections.


American Society of Plastic Surgeons

American Society for Aesthetic Plastic Surgery


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