What Is Botox And How Is It Used?

Ask The Doctor > Plastic Surgery > What Is Botox And How Is It Used?


BOTOX® is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause a form of muscle paralysis known as botulism, which is usually associated with food poisoning. Even though one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted (weakened) amounts can be directly injected into specific muscles, causing controlled relaxation of the muscles.

Click Here to book a consult with Plastic Surgeon Dr. Kunaal Jindal

The FDA approved such usage in the late 1980s when it was discovered that BOTOX® could stop ailments such as blepharospasm (uncontrolled blinking) and strabismus (lazy eye). Cosmetic physicians have been using BOTOX® for years to successfully treat wrinkles and facial creases. BOTOX® is approved for treatment of frown lines on the forehead, crow’s feet (lines around the eye), and axillary hyperhidrosis (increased sweating of the armpits). Within the past few years, new products that have similar preparations have been introduced into the U.S. market and have been well-received by patients.

We will refer to the toxin as BOTOX® from here on out, but please know that this includes all of the formulations:

BOTOX®: OnabotulinumtoxinA
Dysport®: AbobotulinumtoxinA
Xeomin®: IncobotulinumtoxinA

How does BOTOX® work?

BOTOX® blocks the signal from the nerve to the muscles. The injected muscle can no longer contract (tighten) as forcefully, which causes the wrinkles to relax and soften.

BOTOX® can be used on the forehead lines, frown lines, crow’s feet, bunny lines (lines in the nose), chin (for dimpling), skin bands on the neck, and around the mouth (for smoker’s lines and down-turned corners of the mouth). Wrinkles caused by sun damage and gravity often will not respond to BOTOX®. It is important to re-emphasize that BOTOX® is NOT a facial filler (that is, it does not fill existing wrinkles)–it merely relaxes the muscles that are creating those wrinkles.

How is the BOTOX® injection procedure performed?

BOTOX® is injected with a fine needle into specific muscles, with only minor discomfort. The procedure takes only a few minutes and no anesthesia is required. It generally takes three to seven days, but sometimes even as long as two weeks, to take full effect. It is best to avoid alcohol at least one week before treatment. Aspirin and anti-inflammatory medications should be stopped two weeks before treatment (if given permission by a physician) in order to reduce the risk of bruising.

How long does a BOTOX® injection last?

The effects of BOTOX® will last four to six months. As muscle action gradually returns, the lines and wrinkles begin to reappear and will need to be re-treated to maintain the effect. After repeated injections, the lines and wrinkles will often appear less severe because the muscles are being trained to relax.

What are the side effects of BOTOX® injections?

The most common side effects of BOTOX® injections are temporary bruising and slight pain with injection. Headaches, which go away in 24 to 48 hours, can occur, but this is rare.

A very small percentage of patients may develop eyebrow or eyelid drooping, drooping of the corner of the mouth, or inability to use a straw, depending on where the BOTOX® is injected. For this reason, one should not rub the treated area for 12 hours after injection, or lie down for three to four hours after injection. No serious side effects have been noted when using BOTOX® at the dermatologic (prescribed) doses.

Who should NOT receive BOTOX® injections?

Patients who should not use BOTOX® are those who:

are pregnant;
are breastfeeding;
have a neurological disease; or,
are allergic to albumin or a constituent (part) of the preservative.
As BOTOX® does not work for all wrinkles, a consultation with a doctor is recommended.

Will my insurance pay for a BOTOX® injection?

BOTOX® is not generally covered by insurance when used for cosmetic purposes. Check with your insurance carrier for coverage details.

Was this answer helpful?

Dr. Kunaal Jindal

Dr. Kunaal Jindal received his medical degree from the University of Manitoba and completed his residency in Plastic Surgery at the University of Toronto. His education and training has been further enhanced by an Oculoplastic and Aesthetic Surgery fellowship in Atlanta, Georgia and a Hand & Wrist Surgery fellowship at Toronto Western Hospital.

Book Appointment