BOTOX 101
What is Botox?
Botox, also known as Botulinum toxin, is the brand name of a neurotoxic protein produced by the bacterium Clostridium botulinum. It works by preventing the release of the neurotransmitter, acetylcholine, which is responsible for muscle contraction. This blocked signal causes weakness in the targeted muscle.
Botox is an FDA-approved injectable treatment commonly used in small doses to relax facial muscles, thus, eliminating or diminishing the appearance of wrinkles.
Am I a good candidate for Botox?
Avoid Botox if you have a pre-existing motor neuron disorder, myasthenia gravis, previous reaction to toxin, are pregnant, or are breastfeeding. Inform your provider of any recent injectable treatments. It is important for the injector to know if there might be traces of different neurotoxins, such as Dysport or Xeomin, in the areas being treated.
Where can I get Botox?
Botox can be injected in the face and body to manage a wide variety of medical conditions, not just to decrease facial wrinkles!
Common conditions and areas of treatment:
Wrinkles: forehead, in between eyebrows ("11s"), crow's feet around the eyes, smoker's lines around the lips, chin, neck, and chest
Hyperhidrosis (excessive sweating): underarms, palms, and soles of feet
TMJ or teeth grinding: masseter muscle around the jaw
Chronic migraines: forehead, temples, and back of head and neck
Bladder dysfunction: reduces urinary incontinence caused by an overactive bladder
How soon before I see my results?
Botox generally takes effect in 3-5 days, but does not fully settle for 7-10 days. It is recommended to schedule your treatment a minimum of 2 weeks before an important event. This allows enough time for the Botox to take full effect and for any touch-ups that need to take place for the best results. For the best case scenario, injectors will typically suggest scheduling your first Botox appointment 6 months prior to an important event, such as a wedding. This timeline is ideal.
How long does Botox last?
Botox lasts between 3-4 months, sometimes even up to 6 months. This depends on where your Botox is injected, how many units are injected, and the speed of your metabolism. It is also common for first-time users to notice that their results may not last as long initially, but last longer with recurring treatments. For example, a first-timer with a fast metabolism (a young person who exercises regularly) who has only a small amount injected above the lips for a lip flip could have results that only last two months. On the other hand, a patient in their 40s who has been receiving Botox treatments regularly for a few years and has 40 units injected in her forehead and in between her brows could have results that last 4-5 months. Everyone has a unique situation and results may vary. The lasting effects of Botox can be illustrated by a bell curve, slowly increasing to your max result, then decreasing to the point of your Botox no longer working.
How many units of Botox do I need and how much does it cost?
This is a very common but difficult question to answer.
The number of units you need varies due to many reasons:
The areas of treatment
Your age, metabolism, sex, and lifestyle
Your preference on what kind of "look" you want to achieve
The fact that every person is unique!
You will truly only know how many units of Botox are needed to achieve your goals by scheduling a consultation with an injector.
Cost varies as well based on your city, your injector's credentials, and if there is a membership involved. A plastic surgeon in L.A. could charge $15/unit, whereas an RN not located in a major city who is running a special could charge as low as $8/unit. For example, if you receive 50 units at $12/unit then your total would be $600.
When should I start getting Botox?
There is technically no "right" time to get Botox. This is a personal decision based off of your own wants and concerns. Botox has been approved by the FDA for people over the age of 18, and injectors are seeing these younger patients now more than ever.
Botox is most effective in preventing instead of reversing facial wrinkles, which is why it is common to see people in their 20s lining up for Botox before a wrinkle even touches their face. "Preventative Botox" has become a very popular term for this treatment widely used among young consumers that gives their skin that flawless, smooth canvas trending on social media.
On the reverse side, there is no age limit for receiving Botox. However, more mature skin tends to have deeper and more permanent wrinkles that are more difficult, sometimes impossible, to fully eliminate. There is hope though! With consecutive Botox treatments, the appearance of deeper-set wrinkles can be improved.
What are the side effects of Botox?
When injected correctly, Botox treatments are generally well-tolerated and have very minimal, if any, side effects. This includes mild pain, swelling, and bruising at the injection site. Some patients may also experience headaches.
Avoid managing these side effects with Aspirin or Ibuprofen as they are mild blood thinners, increasing your risk of bruising or bleeding. Instead, Tylenol is recommended for any discomfort. Update your provider on side effects such as eye dryness or excessive tearing.
Can Botox be reversed?
The simple answer is no, Botox cannot be reversed. However, there are instances in which something can be done to correct an unwanted outcome. For instance, an uneven result is easily corrected by injecting additional Botox on the side with more movement. This will make the face more symmetrical.
Unfortunately, if too much Botox is injected, there is nothing that can be done to reverse the effects. Then it becomes a waiting game. Over a few months, your body will naturally metabolize the Botox and your face will slowly return to its original state. Your injector should be cautious during your first appointment as there is no guarantee to how your body will respond to the neurotoxin. And after your Botox settles in two weeks, if you would like more, it is very easy for your provider to add additional Botox!
What should I avoid after Botox?
Avoid vigorous rubbing or massaging the area for 2 weeks, this includes while cleansing your face
No facials for at least 1 week
Avoid tight-fitting headwear and strenuous exercise for 24 hours
Stay upright for at least 6 hours; no bending over in exercises such as yoga or a HIIT class; no napping where your face could become buried in your pillow
Avoid blood thinners (Ibuprofen) a few days before and after your treatment to avoid excessive bruising; if mild discomfort occurs, use Tylenol.
Will Botox make me look fake?
As long as you are injected by an experienced and qualified injector who understands your specific goals and concerns, you will love your result. You can look "natural" and still have movement in your face after being injected with Botox, without having that "surprised" look.
However, if you want to be frozen, that's possible, too! It's all about finding an injector who you build a trusting relationship with and who understands your preferences.
Is Botox the same as filler?
Not at all! Botox and filler are made up of different substances, work differently, and target different areas of the body and face.
Botox is Botulinum toxin, and relaxes the muscle. Botox is best used in areas of expression like the forehead and around the eyes to decrease fine lines and wrinkles.
Filler is hyaluronic acid, and fills in lines and plumps or contours areas of the face or body. Fillers are most commonly used to fill in the lips, under eyes, cheeks, jawline, nasolabial folds or smile lines.
PRO-TIP: Finding a Qualified Injector
It is crucial to do your research before choosing your injector. Untrained or unqualified injectors can cause many serious complications such as vascular occlusion, infection, and blindness that can occur. Listed below are a few key factors in finding the right injector for you.
Credentials: your injector should have an active license as an RN, NP, PA, or MD. If a medical assistant or aesthetician is injecting Botox, run the other way!
Consultation: your injector should ask you questions about your skin goals, take their time talking you through the process, and customize a treatment plan for you. A rushed, 5 minute initial appointment including the consult and the treatment is not appropriate.
Knowledge: your injector should be able to describe the effects, benefits, and risks of Botox.
Follow-up: your injector should be available for follow-up questions, concerns, and appointments to ensure you receive your desired results.
When in doubt, ask questions! You must self-advocate for your health. Botox may be an aesthetic procedure, but that doesn't mean this treatment should be taken lightly!
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Approved Uses
IMPORTANT SAFETY INFORMATION
BOTOX® Cosmetic may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® Cosmetic:
Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and
result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing
problems may last for several months.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause
serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.
BOTOX® Cosmetic dosing units are not the same as, or comparable to, any other botulinum toxin product.
There has not been a confirmed serious case of spread of toxin effect when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines, crow’s feet lines, and/or forehead lines.
BOTOX® Cosmetic may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX® Cosmetic. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Serious and/or immediate allergic reactions have been reported. They include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.
Do not receive BOTOX® Cosmetic if you: are allergic to any of the ingredients in BOTOX® Cosmetic (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.
Tell your doctor about all your muscle or nerve conditions, such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX® Cosmetic.
Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; have trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to (it is not known if BOTOX® Cosmetic passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® Cosmetic in the past.
Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.
Other side effects of BOTOX® Cosmetic include: dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids and eyebrows, swelling of your eyelids and dry eyes.
For more information refer to the Medication Guide or talk with your doctor. To report a side effect, please call Allergan at 1-800-678-1605.
BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to temporarily improve the look of moderate to severe forehead lines, crow’s feet lines, and frown lines between the eyebrows in adults.
Please see BOTOX® Cosmetic full Product Information including Boxed Warning and Medication Guide. BCT110378_v4 02/20.
By Lauren Miehl, RN, LE, SLP
ATA Preferred Provider