Botox Injections

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a Botox injection?

A Botox injection is a minor procedure that treats lines and wrinkles of the face and neck. A Botox injection contains botulinum toxin, a neurotoxin that relaxes muscles to smooth out lines and wrinkles. Botox temporarily creates a more youthful appearance. You must repeat Botox injections every three to four months to maintain results.

A Botox injection is only one method to treat wrinkles and aging skin. Discuss all of your treatment choices with your doctor to understand which option is best for you.  

Why is Botox injection performed? 

Your doctor may recommend Botox injections if you are middle-aged, younger than 65, and want a more youthful look of the face and possibly the neck. You should be physically healthy and have realistic expectations of temporary improvement, not perfection.

A Botox injection can improve the appearance of the following signs of aging for three to four months:

  • Crow’s feet around the eyes
  • Forehead lines

  • Frown lines between the eyebrows (glabellar lines)

  • Neck wrinkles and bands

Who performs a Botox injection?

Many types of doctors and other professionals perform Botox injections. It’s important to find the right professional to give you a Botox injection. Choose a professional who is licensed and specializes in facial aesthetics (cosmetics) and has experience in injecting Botox, such as a dermatologist or plastic surgeon

A dermatologist specializes in the medical and surgical care of the skin, hair, and nails. A plastic surgeon specializes in cosmetic and reconstructive surgery.

How is a Botox injection given?

Your Botox injection will be performed in a clinic setting. The procedure includes the following steps:

  1. Your doctor will determine if you are a candidate for Botox injections. This includes performing an examination, taking a medical history, and asking about your goals and expectations for Botox injections.

  2. Your doctor will develop a personalized treatment plan and discuss it with you.

  3. Your doctor may numb your skin in the injection area with a cold pack or anesthetic cream.

  4. Your doctor will use a tiny needle to inject Botox into the muscles that cause lines and wrinkles. Each injection takes a few seconds.

Will I feel pain with a Botox injection?

Your comfort and relaxation is important to both you and your doctor. You may feel a brief pinch or prick during the needle insertion. Take a few long, deep breaths to help yourself relax. Tell your doctor if any discomfort does not pass quickly.

Types of anesthesia that may be used

A Botox injection causes minimal, brief discomfort and does not generally require anesthesia. Tell your doctor if injections make you nervous or anxious and ask about numbing the area with a cold pack or anesthetic cream before the injection. 

What are the risks and potential complications of a Botox injection?  

Potential complications and side effects of Botox injections include: 

  • Allergic reaction

  • Discomfort or pain at the injection site

  • Dry mouth

  • Eyelid problems including drooping or swelling of the eyelids

  • Facial asymmetry

  • Fatigue

  • Headache

  • Infection

  • Neck pain

  • Pain, redness, swelling, bruising or bleeding at the injection site

  • Vision and eye problems including dry eyes, double vision, blurred vision, and decreased eyesight

The botulinum toxin that makes up Botox can spread to other areas in rare cases. This can cause a serious disease called botulism

Botulism can cause weakness of other muscles, including muscles that control swallowing and breathing. Spread of the botulinum toxin can be fatal in extreme cases. However, it has not occurred in properly selected patients who receive the recommended dose of Botox.  

Reducing your risk of complications

The risk of serious complications with a Botox injection is greater in people with certain conditions. Tell your doctor if you have any of the following: 

  • Breathing problems or diseases including asthma or emphysema

  • Difficulty swallowing

  • History of bleeding problems or are taking blood thinner medications

  • Pregnancy or nursing, or plan to become pregnant or nurse. It is not known if Botox injections are safe for unborn or nursing babies.

  • Recent surgery or plan to have surgery in the near future

  • Side effects from a botulinum toxin product in the past

  • Weakness of facial muscles, such as trouble raising your eyebrows

You can reduce the risk of some complications by: 

  • Consulting with your doctor before taking any prescriptions, over-the-counter medications, supplements, or herbal preparations. Certain medications can interact with Botox injections and cause serious side effects.

  • Notifying your doctor immediately of any concerns, such as pain, eye or vision problems, weakness, bleeding, fever, and difficulty swallowing or breathing

  • Telling all members of your care team if you have any allergies 

  • Telling all your healthcare providers, including your dentist, that you have had Botox injections

How do I prepare for my Botox injection?

You are an important member of your own healthcare team. The steps you take before your Botox injection can improve your comfort and outcome. 

You can prepare for a Botox injection by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Following your doctor’s instructions exactly. This may include not consuming alcohol for two days, aspirin products for two weeks, and certain other medications that can increase bleeding and bruising.

Questions to ask your doctor

It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with any concerns and questions before Botox injections and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Am I a good candidate for Botox injections? Why or why not?

  • What are my other options for treating wrinkles and lines?

  • What cosmetic results can I expect?

  • How often will I need Botox injections?

  • How long will the procedure take?

  • How should I take my medications? What medications should I avoid?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my Botox injection?

Knowing what to expect after a Botox injection can help you get back to your everyday life as soon as possible.

What results can I expect after Botox injection?

Results of a Botox injection will vary from person to person and do not occur immediately. You should begin to see results within one to two days after your treatment. Your results may continue to improve for the next two weeks.

Your results should last three to four months. At that point, your lines and wrinkles will gradually return to their normal state. Talk to your doctor about a regular treatment plan to provide continuous results. Your doctor may change the dose of Botox to achieve the best results for you.   

When can I go home?

Most patients go home and return to everyday activities right after the procedure.

When should I call my doctor?

It is important to keep your follow-up appointments after a Botox injection.  Contact your doctor for questions and concerns between appointments. Call your doctor immediately if you have:

  • Bleeding

  • Difficulty breathing—

    call 911

  • Fatigue, weakness, or loss of strength

  • Fever

  • New or unexplained symptoms

  • Pain including neck pain or headache

  • Pain, redness, swelling, bruising or bleeding at the injection site

  • Rash, hives or itching

  • Vision and eye problems including dry eyes, double vision, blurred vision, drooping eyelids, and decreased eyesight

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 22
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. BOTOX Cosmetic, OnabotulinumtoxinA. Allergan, Inc.
  2. Cosmetic Procedures, Botulinum Rejuvenation. American Academy of Dermatology.