Cosmetic Botox
Duration
10-15 minutes
Downtime
None
Lasts for
4 months
Cost
300-600$
Setting
Outpatient
Overview
Botox injection is one of the most popular cosmetic procedures worldwide, with 4 million treatments annually. It is FDA-approved for various types of facial wrinkles, including those on the forehead, around the eyes, nose, and smile lines.
How Does Botox Work?
Botox (Botulinum toxin) is a neurotoxin that temporarily paralyzes muscles by blocking nerve signals.
When it paralyzes the muscles of facial expression, it prevents the skin from creasing and softens wrinkles.
When is Botox Most Effective?
Prevention: Relieving muscle contractions before wrinkles appear.
Early treatment: of wrinkles that appear with facial expressions. Carruthers, J., & Carruthers, A. (2001). BOTOX use in the mid and lower face and neck. Seminars in Cutaneous Medicine and Surgery, 20(2), 85–92. https://doi.org/10.1053/sder.2001.25139 Small, R. (2014). Botulinum toxin injection for facial wrinkles. American Family Physician, 90(3), 168–175. Sun, Y., Li, Y., Zhang, Y., Dong, R., Lan, X., Zhang, M., Yu, N., & Long, X. (2023). Unparallel improvement patterns of dynamic wrinkles and skin quality after botulinum toxin type A treatment on the upper face. Skin Research and Technology, 29(3), e13309. https://doi.org/10.1111/srt.13309
Crow’s Feet & Under Eye Wrinkles
Undesired Outcomes
- Lower Eyelid Turning Outwards Di Santis, É. P., Hirata, S. H., Di Santis, G. M., & Yarak, S. (2025). Adverse effects of the aesthetic use of botulinum toxin and dermal fillers on the face: A narrative review. Anais Brasileiros De Dermatologia, 100(1), 87–103. https://doi.org/10.1016/j.abd.2024.04.007
- Asymmetrical Smile (1 in 10 patients) Zargaran, D., Zoller, F. E., Zargaran, A., & Mosahebi, A. (2022). Complications of facial cosmetic botulinum toxin A injection: Analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75(1), 392–401. https://doi.org/10.1016/j.bjps.2021.05.074
- Double Vision (If the toxin diffuses to the muscle that runs across the cheek ) Di Santis, É. P., Hirata, S. H., Di Santis, G. M., & Yarak, S. (2025). Adverse effects of the aesthetic use of botulinum toxin and dermal fillers on the face: A narrative review. Anais Brasileiros De Dermatologia, 100(1), 87–103. https://doi.org/10.1016/j.abd.2024.04.007
Frown Lines & Forehead Wrinkles
Frown Lines
Forehead Wrinkles
Undesired Outcomes
- Drooping of Eyebrows (1-5%): occurs when Botox is injected in higher doses, at the wrong location, or if the toxin spreads to nearby structures. Zargaran, D., Zoller, F. E., Zargaran, A., & Mosahebi, A. (2022). Complications of facial cosmetic botulinum toxin A injection: Analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75(1), 392–401. https://doi.org/10.1016/j.bjps.2021.05.074
- Spock Eyebrows: occurs when Botox is unevenly injected into the muscle that lifts and lowers the eyebrows. This leads to overarching eyebrows. Klein, A. W. (2003). Complications, Adverse Reactions, and Insights With the Use of Botulinum Toxin. Dermatologic Surgery, 29(5), 549–556. https://doi.org/10.1046/j.1524-4725.2003.29129.x
Drooping of Eyebrows
Spock Eyebrows
Neck Lines & Jaw Asymmetry
Neck Lines
Jaw Asymmetry if caused by muscle enlargement at one side
Undesired Outcome
- Asymmetry (2.5%)
- Changes in facial expression: including smile limitation, asymmetric smile, unnatural smile, loss of dimples (0.15%-27.3%) Yeh, Y., Peng, J., & Peng, H. P. (2018). Literature review of the adverse events associated with botulinum toxin injection for the masseter muscle hypertrophy. Journal of Cosmetic Dermatology, 17(5), 675–687. https://doi.org/10.1111/jocd.12721
Off-label Uses of Botox
Botox Types
There are 5 types of Botulinum toxin approved for cosmetic injections: Botox, Dysport, Xeomin, Jeuveau, and Daxxify
Botox is the first option due to its well-established safety profile. You can look for other options if Botox didn’t work.
All types have comparable cost and longevity. However, Daxxify has a relatively longer duration of effect. Daxxify also comes at a higher price, but since it is longer lasting, you will need fewer sessions per year. Carruthers, J. D., Fagien, S., Joseph, J. H., Humphrey, S. D., Biesman, B. S., Gallagher, C. J., Liu, Y., Rubio, R. G., SAKURA 1 and SAKURA 2 Investigator Group, & SAKURA 1 and SAKURA 2 Investigator Group includes the following. (2020). DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Results from Each of Two Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Studies (SAKURA 1 and SAKURA 2). Plastic and Reconstructive Surgery, 145(1), 45–58. https://doi.org/10.1097/PRS.0000000000006327
Botox (Most Common)
Uses: Frown lines, crow’s feet, horizontal forehead lines, vertical neck lines
Dysport
Uses: Frown lines
Xeomin
Uses: Frown lines
Jeuveau
Uses: Frown lines
Daxxify
Uses: Frown lines
Risks
Even though Botox is a toxin produced by a bacteria, it is safe in the doses used for cosmetics. Since its effect is temporary and lasts only for 3-4 months, it doesn’t leave any permanent muscle or nerve damage. Carruthers, A., Carruthers, J., & Said, S. (2006). Dose-Ranging Study of Botulinum Toxin Type A in the Treatment of Glabellar Rhytids in Females. Dermatologic Surgery, 31(4), 414–422. https://doi.org/10.1111/j.1524-4725.2005.31107 Hexsel, C., Hexsel, D., Porto, M. D., Schilling, J., & Siega, C. (2011). Botulinum toxin type A for aging face and aesthetic uses: Botulinum toxin type A. Dermatologic Therapy, 24(1), 54–61. https://doi.org/10.1111/j.1529-8019.2010.01378.x
What could put you at a higher risk?
- Neurological Diseases: If you have multiple sclerosis or myasthenia gravis (a condition that causes easy muscle fatigue), you should avoid Botox.
- Pregnant or Breastfeeding Women
- Botox Allergy
- Infection at the injection site
Results
Timeline of Your Results
Initial results
Changes will begin to appear within 2-4 days after injection.
Full effect
Will become gradually visible over 2 weeks.
Duration of effect: the effect of Botox will gradually fade gradually over 3-4 months, and your wrinkles will return back to how they used to look before the injection.
To maintain the results, you can have a re-injection of Botox. Consider planning ahead for your re-injection session.
What Does a Good Result Look Like?
A successful Botox injection should:
- Make your wrinkles smoother and less visible
- Maintain a natural looking face.
However, it is normal to feel that your facial muscles are more relaxed. Keep photos of you from before the injection to help you assess objectively.
What if Botox wasn’t the Right Fit for Me?
If Botox didn’t provide you with the results you needed, a higher dose might be needed to overcome your wrinkles but at the expense of affecting your facial expressions.
If Botox isn’t the right fit for your goals, you may consider exploring alternative facial aesthetic procedures.
Chapter references
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