Administered by injection, Botox is commonly used to help diminish fine lines and wrinkles as an out-patient procedure that’s much less invasive than going under the knife.
But with Botox injections costing from $250 to $600 per treatment for most patients, it’s important to educate yourself about what to look out for before spending your hard-earned money.
This article addresses common questions relating to Botox, including how it works, what it’s used for, cost, safety factors, and potential side effects. We also discuss ways to make Botox last as long as possible, so you get the biggest bang for your buck.
We’ve interviewed two medical doctors who have offered their expertise, and combined their findings with other sources, including the U.S. Food & Drug Administration.
We’ve spoken with Marc M. Kerner, Medical Director of Dermatique Medical Center for Advanced Skincare in Southern California. Dr. Kerner is certified by the American Board of Facial and Plastic Reconstructive Surgery and the American Board of Otolaryngology. He is also known as one of the first doctors in the country to use Botox.
Advice has also been provided by Yuly Gorodisky, owner of the West Coast Plastic Surgery Center in Southern California. Dr. Gorodisky is board-certified in plastic surgery by the American Osteopathic Board of Surgery, and he has more than 10 years of experience with providing Botox treatments.
Let’s begin by exploring what Botox is used for and how it works. Later on, we’ll discuss factors to keep in mind before you spend money on a Botox treatment, and how to get your money’s worth from Botox injections.
Common Use of Botox Injections
Botox can be used as a temporary way to smooth facial wrinkles in areas like the forehead, or right above the nose between the eyes. For the most part, people wanting Botox are seeking the aesthetic benefits of diminished fine lines and wrinkles on the face.
The Mayo Clinic noted that the most common use of Botox injections is to temporarily relax the facial muscles that underlie and cause wrinkles, such as:
- Frown lines between the eyebrows
- Crow's feet, a term that refers to the lines fanning out from the corners of the eyes
- Forehead furrows
While some patients in their 20s use a very small amount of Botox to prevent wrinkles, people in their 30s and 40s benefit the most by treating the wrinkles that are just starting to show up, Dr. Gorodisky said.
“Older patients may still benefit, but usually need other treatments in addition to Botox, such as fillers, lasers, or surgery,” he said.
Aside from diminishing facial wrinkles, Botox is also used for the temporary treatment of the following:
- Severe underarm sweating
- Chronic migraines
- Overactive bladder
Ultimately, Botox contains properties that affect the muscles in the area being treated. The next section talks about what Botox is made of and how it works.
How Do Botox Injections Work?
Botox is made from a toxin produced by the bacterium Clostridium botulinum, and Botox works by “weakening or paralyzing” certain muscles by blocking certain nerves, according to Dr. Kerner.
Dr. Gorodisky noted that in its medicinal form, the purified Botox protein acts within the vicinity of the injection site to relax the contraction of muscle fibers. As a result, by injecting Botox into the muscles that are very active, their activity is reduced.
“In certain parts of the face – between the brows, across the forehead, around the eyes, around the mouth – relaxing these muscles has the effect of decreasing the wrinkles that are formed when these muscles contract,” Dr. Gorodisky explained.
Botox can also be used to treat excessive sweating, according to the International Hyperhidrosis Society, a nonprofit that serves those who suffer from uncontrollable, excessive sweating. Botox injections can help decrease sweating in areas such as the armpits, under the breasts, hands, and feet, and can last up to 14 months.
Botox has also been approved by the FDA to help diminish chronic migraines. This works by getting injections around the head and neck, which can dull future headache symptoms.
People suffering from an overactive bladder can also benefit from Botox. According to the FDA, Botox can be injected directly into the bladder muscle to cause the bladder to relax, which can increase its ability to store urine and diminish urinary incontinence. Patients who undergo this procedure – which should be done in a doctor’s office – are typically under local or general anesthesia.
Now that we’ve discussed the uses for Botox and how it works, let’s explore the safety factors.
Botox Safety Factors
Botox is a medication, and like any other medication, it can make a person sick if it is not used properly, Dr. Gorodisky said.
“Botox requires proper administration by an experienced clinician to achieve its desired results,” Dr. Gorodisky noted. “Botox has a tremendous safety record over many years of use. Even if occasional minor side effects occur, Botox is generally very safe and effective.”
Dr. Kerner agrees that Botox is safe – as long as a licensed professional administers Botox injections.
“Botox cannot kill you,” Dr. Kerner said. “The biggest myth about Botox is that many people assume it is permanent. It is not.”
A routine Botox injection involves about 25 to 50 units, and it would take over 100 times that amount to cause problems, Dr. Gorodisky said.
“Thankfully, FDA regulates the quality and production of medications used in the U.S.,” Dr. Gorodisky said. “However, if Botox is obtained from another country that does not have the same regulations, or has not been designated for human use, dangers may arise.”
Now that you’re aware of the safety factors, let’s talk about ways to get the most out of the money you spend on a Botox treatment.
How to Get the Most Out of Your Botox Injections
Botox is injected in measurements of units – and in Dr. Kerner’s office, costs can vary from $12 to $20 per unit.
The cost depends on the amount of Botox needed to treat all the areas that are injected, Dr. Gorodisky said. In his experience, most patients who get Botox injections will pay between $250 and $600 per treatment.
“The cost also varies based on who is injecting,” Dr. Gorodisky said. “Usually physicians charge more than nurse injectors.”
Some patients who have stronger muscles may need more injections than others, Dr. Gorodisky said. Botox starts showing signs of effectiveness after about three days and takes full effect in about seven to ten days.
“The effects last about three to four months in most patients,” Dr. Gorodisky noted. “Receiving Botox is sometimes compared to getting your nails and hair done: in order to maintain the effects, the treatments need to be repeated at regular intervals. If treatments stop, wrinkles will return.”
Botox typically lasts between three and four months but can last up to six months in some patients.
“If they get re-injected before it completely wears off the results will last longer for future,” Dr. Kerner said.
Immediately after getting Botox, it’s important to avoid rubbing or touching the area of injection, Dr. Gorodisky advised. He also said to avoid bending down, getting a massage, or getting a facial treatment after receiving a Botox injection.
Additionally, “avoiding laser treatments or excessive heat in the area of injection, and avoiding strenuous exercise, also helps to get the best effectiveness from the Botox injection,” Dr. Gorodisky said.
It’s also crucial to seek a trained professional to administer Botox, as well as avoid unusual discounts, which we cover in the next section.
Avoid Unusual Botox Discounts and Seek Experienced Professionals
People should be cautious when Botox is highly discounted, and Dr. Kerner recommends avoiding places that offer “unusual discounts or charging by the area.”
Usually, cheap Botox may indicate that the medication is not purchased from a reliable, FDA approved source, Dr. Gorodisky said. Also, facilities that are offering inexpensive Botox may be new to the field, and not have the experience and the quality of a seasoned Botox provider.
“Patients should look for physicians and nurse injectors who are trained in plastic surgery, facial plastic surgery, or dermatology to inject their Botox,” Dr. Gorodisky advised. “Ask how many patients they have treated and how long they have been performing these treatments.”
Dr. Gorodisky further emphasized to avoid getting Botox injections at someone’s house – or at a party after consuming alcohol.
If you’re getting injections in a doctor’s office, “read and understand the consent and the possible side effects and aftercare instructions,” Dr. Gorodisky said.
Additionally, the facility should be clean and the injections should be performed with new syringes and needles.
“The practitioner should be wearing gloves and the skin should be cleaned thoroughly prior to injection,” Dr. Gorodisky said. “Let the injector know if you are taking any blood thinners, have any autoimmune or inflammatory conditions. Also, avoid getting injections if you are pregnant or breastfeeding.”
Knowing what to avoid is important before undergoing a Botox treatment. It’s also important to educate yourself about the possible side effects, which we explore next.
Side Effects of Botox Injections
Injections of Botox are made with super fine needles.
“Most patients do not have a significant amount of pain with injections, but those who are concerned may choose to apply some cold compresses or topical numbing cream to dull the sensation,” Dr. Gorodisky said.
Dr. Kerner agreed that injections are “minimally painful” – but he, too, offers patients numbing cream to ease any pain they might experience.
The most common botox side effects are bruising due to microscopic blood vessels under the skin, or a temporary headache, according to Dr. Gorodisky.
“Other side effects may be due to excessive relaxation of the muscles causing drooping of the brows or asymmetric effects due to the variable thickness and activity of the facial muscles,” Dr. Gorodisky said. “The side effects are temporary and will improve with time. Sometimes a correction is necessary to improve symmetry.”
There are localized side effects that can include temporary paralysis, Dr. Kerner said. Or, if the wrong muscle is injected, the result can cause droopy eyes – which can be immediately corrected.
“Some people will experience swelling and bruising at the injection site,” Dr. Kerner noted. “There have also been reports of difficulty swallowing.”
According to the FDA, side effects of Botox may include:
- Dry mouth
- Discomfort or pain at the injection site
- Neck pain
- Eye problems, such as double or blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids or dry eyes.
- Urinary tract infection in people being treated for urinary incontinence
- Painful urination in people being treated for urinary incontinence
- Inability to empty your bladder on your own and are being treated for urinary incontinence
- Allergic reactions, such as itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint
The Bottom Line
If you want Botox, the best way to find a reputable provider is through a referral, Dr. Gorodisky advised.
“Coupons and Groupon may offer a deal, but may end up costing more in corrective treatments,” he said. “Look for experienced injectors who know how to treat various types of faces and conditions. It is important that the injectors are able to recognize when treatments should not be performed, and when extra care is necessary to avoid and treat problems and complications.”
Dr. Kerner agreed: “Make sure you have a qualified injector with lots of experience.”
If you get Botox injections and subsequently suffer from wheezing or asthma symptoms, or become dizzy or faint, the FDA recommends telling your doctor or getting medical help immediately.