While fine lines and wrinkles are a completely normal side effect of aging and something everyone will experience, if you prefer a line-free, smoother complexion, instead, a neurotoxin like Botox is here to help. “Aging is not a disease,” says Dr. Michelle Henry, MD board-certified dermatologist and Harvard-trained Mohs surgeon. “It’s absolutely normal to have fine lines and wrinkles and you can keep them if you’re happy with them.” But it’s understandable to have a lot of questions about the treatment before you book an appointment, such as: how much does Botox cost? Does it hurt? How long does it last? Should I see a dermatologist for Botox, or a plastic surgeon? All are fair and valid questions when trying to suss out the Botox pros and cons. But first, the basics.
Not to be confused with another popular injectable, dermal fillers (which restore volume to create a more youthful-looking appearance), Botox, “is a neurotoxin which works by blocking the signal between a nerve and muscle so that the muscle cannot contract,” says Dr. Melissa Doft, double-board certified plastic surgeon. In other words, whenever it is injected, Botox will cause the underlying muscles to temporarily stop moving. This will prevent the fine lines and wrinkles that form from repeated movement in your forehead, the “11’s” between your brows, and around your eyes (or your “crow’s feet”), as well as soften existing wrinkles (more on that later).
But is it really that simple? And furthermore, is it even safe? Because it’s easy to get confused in the world of injectables, below, discover the top things you should know before scheduling your next, or first (hi, Zoom face) Botox appointment.
1. Botox Is A Neurotoxin
On a chemical level, “Botox is a neuromodulator derived from bacteria called clostridium botulinum, called botulinum toxin,” says Dr. Catherine Chang, plastic surgeon at Cassileth Plastic Surgery.
“Botox is a brand name, and although there are other brands, such as Dysport and Xeomin, Botox is the most well-recognized name because it was the first injectable botulinum toxin,” Dr. Kevin Tehrani of Aristocrat Plastic Surgery in NYC tells TZR.
As for the actual procedure, “Botox is delivered in many tiny microdroplet injections evenly, using a fine needle dispersed in the affected areas,” says Dr. Lara Devgan, MD, MPH, FACS, board-certified plastic surgeon.
All in all, when Botox is introduced into the body, there is less action or pull on the skin when muscles are contracted, which ultimately decreases the formation of wrinkles.
2. Botox Reduces Fine Lines and Wrinkles
Whenever muscles contract and release acetylcholine — a chemical message released by nerve cells, to send signals to other cells — wrinkles will appear on the face. When a patient receives Botox, the release of acetylcholine is stopped and the muscles become relaxed, which helps to smooth fine lines and wrinkles.
With that being said, it doesn't remove fine lines and wrinkles entirely. The 15 to 20 minute procedure treats two types of wrinkles: static (wrinkles that permanently form as we lose collagen and elastin over time) and dynamic (wrinkles that occur from repetitive movements). You’ll see static wrinkles primarily on your arms, neck, cheeks, and mouth. Whereas, dynamic wrinkles will be the crow’s feet from squinting, smile lines from smiling or laughing, and forehead lines from expressive eyebrows.
“Dynamic wrinkles are caused by muscle movement, such as those when you smile, laugh, or squint,” Dr. Tehrani tells TZR. “Botox uses various forms of botulinum toxin to temporarily paralyze or relax muscle activity and is a good option for dynamic wrinkles.”
Static wrinkles on the other hand, are caused by sun damage, smoking, or loss of elasticity and collagen in the skin. “Your skin becomes thinner and drier and the silhouette of your face changes with age due to volume loss. Although some may recommend Botox for static wrinkles, often a combination of Botox and fillers will produce the best results,” Dr. Tehrani continues.
But that’s not all the injectable is able to achieve. Botox can help with excessive sweating, lazy eye, chronic migraines, and bladder dysfunction. But the biggest benefit next to addressing fine lines and wrinkles is its ability to decrease the bulky appearance of certain muscles. “Botox is used to slim down the masseter muscles, which are located at the back of the jawline,” says Dr. Chaneve Jeanniton, oculofacial plastic surgeon, founder of epi.logic skincare, and Brooklyn Face & Eye practice. “When these muscles enlarge, it can give the face a square shape. By slimming the masseter muscles, people can achieve a slimmer jawline or a more heart-shaped face.”
3. Vet Out Your Injector
Alarmingly, there is a huge lack of regulation in the Botox space (despite it being FDA approved), making it extremely important to research your doctor as it could make or break your experience. “Dermatologists are experts at skin and understanding how to inject into the skin,” Dr. Henry tells TZR. “It seems really easy when you see it on Instagram but there are really fine muscles in the face so you want someone who understands the skin and who understands the anatomy of the face.”
When selecting an injector, make sure you look at their training. When in doubt, opt for a board-certified dermatologist, surgeon, or facial plastic surgeon. “Of course some things you can get for cheap,” Dr. Henry continues, “but I always say cheap is expensive. I see a lot of people coming in to fix issues done by an untrained hand. Eye drop, a big one, is a function of not completely understanding the anatomy, so you want to make sure you are with someone that understands the anatomy.”
Unlike dermal fillers (which can be dissolved if you don’t like the effect), Botox is not reversible, meaning that if you visit an injector and they inadvertently cause your brows to droop (among other possible negative outcomes), you’ll have to wait three to five months on average for the neurotoxin to wear off.
4. Pre-Appointment, Avoid Medication
Similar to most cosmetic injectable treatments, the best way to prepare for a Botox treatment is to avoid blood thinners or medication (Advil, Aspirin, Aleve, and Motrin) for a week or two as it can cause bleeding and increase your likelihood of bruising. While most people will tell you that the injections themselves are not especially painful, you can take acetaminophen after the procedure to minimize any discomfort.
And to err on the side of caution, keep your skin care routine simple in the days leading up to your appointment, meaning no retinol or harsh exfoliating acids. You want minimal irritation so that your skin is not stressed (especially since immediately after your injections, you’ll have slight redness and puffiness, for which your provider will give you an ice pack).
5. There Is No “Right” Time For Botox
Thanks to social media, celebrity endorsements, and an overall desire for transparency, Botox is not as frowned upon as it has been in recent years. In fact, according to the American Society of Plastic Surgeons, Botox injections were the most popular non-invasive cosmetic procedure in 2020, with 4.4 million procedures.
In terms of the age to get it? Dr. Henry believes it is not a safety issue but rather when we see the lines and want to change them. “People start to see lines in their mid to late 20s and early 30s,” she shares. Dr. Devgan agrees. “The best age to start doing Botox is when it first becomes a concern to you,” she says. “If you start Botox when you have the skin quality that you would like to maintain forever, you can truly maintain the turgor and integrity of your skin for several decades.”
6. Botox Can Be Costly
The cost of Botox will vary based on the areas injected and the location where you will receive treatment, meaning in the suburbs or a major city. Typically, Botox costs more in larger cities and less in suburban areas based on demand and the caliber of medical professionals that are available.
Treatment is billed per unit in a range of $10 to $25 per unit. A typical treatment consists of eight to 30 units. For example, “baby Botox”, or preventative Botox, uses 20 to 35 units across the face; the brow area takes 20 to 22 units; and the corners of the eyes, aka crow’s feet, will use three to four units per eye.
This might not sound like a lot, but depending on the amount of units and how many times you go in a year, it can add up. You can expect to drop a few hundred dollars on your Botox treatment, but you can discuss your budget with your provider prior to your appointment. Again, do not skimp on the quality of your injector just to save a couple bucks. It’s all about learning how to budget for your injections.
7. Injections Will Last For 3 to 4 Months
Botox works by temporarily blocking the nerve signals to your facial muscles to prevent them from contracting. But it’s important to note that it is temporary. “The muscles will always form lines when you stop Botox,” says Dr. Henry. Which is why the experts recommended treatment every three to four months.
“As months go by after getting the treatment, patients will start to notice the old facial wrinkles returning,” Dr. Tehrani shares. “With regular treatment (three to four times a year), however, the wrinkles will become less pronounced. Therefore, the recommended treatment is once every three to four months. Nonetheless, if facial muscles begin to train themselves to contract less, the period of time for each treatment may be extended longer than three or four months.” How quickly the injections wear off can depend on your metabolism, among other factors, and is different for everybody, but having a rough estimate is helpful when you’re planning your beauty budget.
8. Post-Treatment Care Is Minimal
Fortunately, Botox aftercare is simple. “[Patients should not] exercise for 24 hours and avoid alcoholic beverages before and after since it can increase the possibility of bruising,” Dr. Parvaneh Rafaeloff, owner and Medical Director of Le Jolie Medi Spa. All experts recommend not laying down four hours after treatment to avoid diffusion of the product, and to avoid high heat (sun, jacuzzi, or sauna).
9. The Risks Are Minimal
Although the movies like to play up the frozen face — or Botox procedures that have removed facial expressions altogether — side effects, although rare, include: slight pain, swelling, and headache. “Bruising is rare but small raised, red areas of swelling can sometimes occur at the injection site,” Dr. Jeanniton states. “These typically resolve within 15 minutes.” The low grade headache is also mild and tends to resolve within a few hours to a few days.
However, if done without a well-vetted, experienced doctor, patients can experience, “droopy eyelids, cockeyed eyebrows, crooked smile, or drooling, and eye dryness or excessive tearing,” says Dr. Tehrani. All the more reason to visit a trusted and well-trained provider.
And, no, you do not have to get so much Botox that your forehead is completely immobile. Talk with your injector and explain just how much or how little you want to be able to move your muscles in your forehead, 11’s, or around your eyes. There is no one-size-fits-all approach when it comes to neurotoxins.
However, if you do partake in this non-invasive treatment, you could reap the anti-aging benefits of smooth wrinkle-free skin and an overall rejuvenated appearance and texture. Luckily, the choice is yours.