A Complete Guide to Botox: Everything You Need to Know

We’re answering all the questions you were afraid to ask.

You've probably heard of people using Botox in many ways, either as a wrinkle remover or preventative measure to prevent wrinkles from forming in the first place. You may have also seen images of unnaturally frozen-looking faces that make you think all Botox is bad Botox (FYI, you won’t be able to recognize good Botox when you see it). For being one of the most popular cosmetic procedures in the United States, there’s still a lot of stigma, confusion, and misinformation about the needle.

Let’s be very clear from the get-go: Fine lines and wrinkles are 100% normal and nothing to be ashamed of. But for people who want to turn back the clock a little, cosmetic injectables are a great way of doing so.

Before you jump into the world of neurotoxins, it’s best to know exactly what your muscles are getting themselves into. Is it safe? Does it hurt? We discuss everything you need to know below.

What is Botox?

Botox, or botulinum toxin as it’s technically called, is a neuromuscular paralytic that works by temporarily preventing the underlying muscle from contracting, explains Barry Weintraub, MD, FAC, plastic surgeon in New York City. When the muscles stop moving, the wrinkles stop forming. In other words, it’s anti-aging below the surface.

“Some of the most common areas treated include glabellar frown lines (or 11’s), crow’s feet, bunny lines (the lines that form on either sides of the nose), and forehead lines,” notes Caroline Robinson, MD, FAAD, dermatologist and founder of Tone Dermatology. “Most people see results from Botox in as little as 72 hours and those results can last for several months.”

The liquified protein also helps to atrophy muscles and paralyze sweat glands, which is why they’re sometimes put into the masseter muscles to reduce a bulky jawline or injected into the underarms to reduce excessive sweating. It’s sometimes used to help with medical conditions including neck spasms and an overactive bladder.

Although the FDA-approved treatment is designed to paralyze your muscles, it will not affect the nerves that cause sensation or make you feel numb.

Are there side effects to Botox?

“The most common adverse effects of Botox are related to the injection, rather than to the botulinum toxin itself,” says Dr. Robinson. “These adverse effects can potentially include pain, bruising, swelling, and redness at the injection site.” Your doctor will pre-screen you to see if you’re a candidate for Botox, and some patients with conditions that already weaken their muscles (such as certain neurological conditions) may not be candidates.

How long does Botox last?

According to Dr. Weintraub, it depends on the patient. “Certain people metabolize Botox more quickly than others, and where the Botox is injected also influences how long it lasts,” he says. “It’s also important to not dilute it too much, which unfortunately some offices do in order to offer a discounted rate. But in general, most people experience the effects of Botox for approximately 3 to 4 months. It is worth noting that with repeated use, Botox helps the muscles to atrophy (grow weaker), so that over time, wrinkles don’t manifest as deeply.” He notes that if you budget for treatment three times a year, your needs should be covered.

How much does Botox cost?

Botox and other neurotoxins are typically priced by the unit (meaning the quantity used) or the area (meaning the areas of the face that are treated). This cost is determined by the person injecting the product, but usually ranges between $300 and $600 per area.

This wide variance is all the more reason why a quality consultation should always be conducted prior to treatment. While there are often cheap deals on online platforms, the price should be predicated on the experience of the person holding the needle, with plastic surgeons and dermatologists charging the most due to their extensive training, expertise, and knowledge of the underlying anatomy. “The more experienced the injector, likely the more expensive, as that person is bringing to you not only the price of the product, but the consistency, experience, and knowledge of how to administer it safely, effectively, and consistently,” says Dr. Weintraub. He also stresses that if Botox is being offered at a low price, there is a reason that might involve over-dilution, bootleg product, or an inexperienced injector.

Does Botox hurt?

At its core, Botox is an injection, so you will feel a pinching needle sensation when it’s being administered. Some areas can be more painful than others (such as between the eyebrows), but some doctors offer topical anesthesia to apply before the procedure or ice the area to numb it and lessen any sensation there.

How long does Botox take to show up?

Unlike filler, Botox isn’t immediately noticeable. The full effect can take one to two weeks to present itself. Relaxing of lines takes time—the longer the muscle isn't contracting, the more the lines relax over time. You may notice bug bite-like bumps on the injection sites immediately after treatment, but these should go away within a couple hours.

How do you prepare for Botox?

Botox prep and aftercare are simple. It’s recommended to avoid blood thinners like alcohol or medications such as Advil which can increase the risk of bruising for a week before your procedure. Post-Botox, don’t massage your face for 24 hours or go into a sauna for at least a few hours to avoid diffusion of the product.

Are there alternatives to Botox?

Botox is a drug manufactured by Allergan, but there are other injectable neurotoxins like Jeuveau, Daxxify, Xeomin, and Dysport that work in a similar way. You should always consult with your dermatologist before choosing a brand-name neurotoxin in order to determine which option is best for you.

When should you start Botox?

This is totally up to you—there is no right or wrong age to begin. Anyone can start Botox whenever they’re bothered by their wrinkles or simply want to prevent them from forming in the first place. “It is extremely helpful to incorporate Botox into a prevention program,” says Dr. Weintraub. “By using Botox regularly, damage and what can be termed ‘deferred maintenance’ are avoided, allowing one to physically stave off the obvious signs of aging.”

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