What You Need to Know Before and After Getting Botox Injections

It’s natural for people to yearn for agelessness, as beauty-consciousness is programmed in our social genes. And when we talk about enduring allure, Botox cosmetic treatment is usually the first thing that comes to mind.

Hollywood swears by it. Your friends may have even jumped on the bandwagon, too.

But what can you expect before and after a Botox procedure? If you’re still on the fence about getting one, then this article is for you. Here, we explain what you can do before and after your session to get the best results. We also dispel some false beliefs about the treatment.

But first, a brief background on this ever-popular wrinkle relaxer.

What Is Botox?

Botox is the brand name of a drug derived from a paralyzing bacterial toxin, botulinum toxin type A. Large amounts of this substance cause botulism, a potentially fatal illness presenting as severe head and neck muscle weakness. However, controlled doses allow doctors to turn it into a remedy for various conditions stemming from muscle overuse or spasticity.

In cosmetic dermatology, Botox is indicated for “dynamic wrinkles”—the creases forming from repeated facial muscle contraction. The FDA approved it for injection in three areas: the forehead, glabella and beside the eyes. But a board-certified dermatologist can use it off-label—or without FDA approval—to smoothen movement-borne skin folds in other parts of the face.

You may read our article on Botox recovery and aftercare for more information.

What Can You Expect During Your BHSKin Dermatology Consultation for a Botox Procedure?

Cosmetic Botox patients normally seek a specialist’s help because they want to remove wrinkles and delay facial aging effectively. So your doctor at BHSkin Dermatology will examine the problem thoroughly before formulating a treatment strategy. Botox is just one of many wrinkle remedies, and they will recommend it if it is the most suitable for you.

Your dermatologist will start by asking questions about your skin problem’s history. They may inquire about your lifestyle, e. g. smoking and sun exposure, which can accelerate skin aging. Medications, allergies, family history and occupational stress are relevant, too.

They will then proceed with their physical examination. They may ask you to make facial expressions to better assess the problem’s severity. 

Once they complete their evaluation, they will discuss their findings and propose a treatment plan. They may then schedule you for a Botox appointment. If necessary, they may recommend combining it with a skin-rejuvenating procedure like microneedling, PRP injection, laser therapy, chemical peel, dermabrasion, dermal filler injection, IPL, etc. They may prescribe a regular skin care regimen and advise lifestyle changes to slow down facial aging.

How Do You Prepare for Your Botox Session?

Preparing your skin well for a Botox procedure minimizes complications. We recommend the following:

• Avoid smoking and drinking starting a week before your appointment, as they can delay skin healing.
• Take bruise-preventing supplements like arnica and bromelain 2-4 days before your session if you are bruise-prone.
• Avoid blood thinners like non-steroidal anti-inflammatory drugs and some health supplements starting two days prior.
• Consider an extra workout the day before your procedure.
• Leave your face makeup-free before coming in for your appointment.

You may check out our in-depth Botox injection guide for other pre-treatment preparation tips.

What Can You Expect During Your Botox Procedure?

Your Botox specialist will clean up the treatment areas at the start of your session. They may ask you to make facial expressions so the dynamic facial lines become visible and easier to map out. It also helps them determine the dose. Then, they will inject the drug at different points while applying light pressure on the skin. Pain-sensitive patients may apply an ice pack or a topical painkiller minutes before injection.

The entire procedure should take no more than 15 minutes.

What Are the Dos and Don’ts After Botox Facial Injections?

Taking care of your face after Botox treatment is easy.

The Don’ts

Your doctor may advise you to refrain from the following until four hours have passed after your procedure:

• Lying flat on your back
• Scratching or applying pressure or heat on the treated areas
• Activities that can cause flushing, such as suntanning, sauna-bathing and exercising

Doing so minimizes the risk of spreading the drug to distant muscles. You may resume your normal after this period. 

The Dos

Some people recover quickly from a Botox procedure, while others bruise or feel sore for a few days. If you’re the latter type, we recommend protecting the area from trauma or heavy pressure until the inflammatory symptoms are gone. Use makeup only if your skin has no signs of irritation.

The following measures can help prevent or quickly clear up bruises:

• Icing the area repeatedly during the first 24 hours after injection
• Avoidance of vigorous activities for a few days
• Continuing arnica or bromelain intake for a few more days
• Sleeping upright in the first few nights after your treatment

Follow your dermatologist’s prescribed post-treatment skin care regimen religiously.

You may read our article on Botox recovery and aftercare for more information.

What Is the Timeline of the Effects of a Botox Cosmetic Treatment?

The timeline of the changes after Botox treatment varies for every patient. But most start experiencing muscle weakness in the treated areas within the first three days after the procedure. The maximal effects usually appear in the second week.

Muscle strength recovery is gradual, beginning from the third or fourth month. The wrinkles return completely by the fifth month unless you avert it with a repeat Botox treatment.

What Can You Do to Make the Effects of Your Botox Injection Last Longer?

Again, doctors approach this question by considering why you’re getting Botox in the first place—facial aging. To ensure that you stay wrinkle-free for a long time, we recommend the following:

• Stick to the recommended pre-treatment and aftercare regimens. Doing so helps avoid complications that can keep you from achieving your cosmetic goals.
• Limit UV damage to the skin, as it can destroy collagen, elastin and DNA. Avoid excessive sun or UV exposure. Use sun protection when going outdoors.
• Make healthy lifestyle choices. Blemish-free skin can only come from good overall health. Stick to a balanced diet and hydrate well. Exercise regularly. Maintain good hygiene. Avoid drinking and smoking. Sleep adequately. Manage your stress. Stay away from polluted areas.
• Follow the anti-aging skin care regimen that your dermatologist recommends. Gentle cleansing and moisturizing twice daily are the mainstays of proper skin care. But your doctor may also advise using topical vitamin A or glycolic acid on fine lines that do not respond to Botox.
• Stay on top of your maintenance Botox treatment schedule. Don’t wait too long to book an appointment.

Most importantly, get a widely trusted board-certified dermatologist to perform your Botox procedure. Only a skin care expert can guarantee the effectiveness and safety of the treatment.

What Are the Common Misconceptions About Botox Cosmetic Injections?

Since it was first used cosmetically in 2002, misinformation has confounded many people about various aspects of Botox treatment. Unfortunately, this keeps patients from taking full advantage of its unique wrinkle-busting effect and other medical applications.

Let’s clear the air on the most common Botox myths.

1. Botulinum Toxin Injection Causes Muscle Damage

The drug does not work on the muscles directly. Rather, it prevents the release of the muscle-stimulating nerve chemical acetylcholine in the nerve-muscle junction, which causes the paralysis we observe. Furthermore, the Botox provider can avoid muscle and nerve tears with the right injection technique.

2. The Effects of the Drug Are Permanent

Botox’s effects wear off gradually, starting from the third or fourth month after injection. The treated muscles fully recover by the fifth month, and rarely, the sixth month. This is because the body metabolizes and clears the toxin.

The duration of Botox’s cosmetic effects varies from patient to patient because everyone clears it at different rates. Factors influencing drug metabolism include interaction with food and other drugs, a person’s medical status, genetics, etc.

3. Botox Is Addicting

Each Botox vial contains botulinum toxin A, human albumin and sodium chloride. None of these substances are addictive. However, patients who want to maintain the drug’s cosmetic effects must have about three sessions a year, owing again to metabolism.

4. Only Women Can Get Botox

Botox treatment is not contraindicated or less effective in men, so it’s not true that only women can have it. However, anatomic differences, e. g. skull size, facial muscle thickness, etc., may slightly increase male patients’ dose requirements.

5. Botox Is Only for Older Patients

Botulinum toxin injection is indicated for moderate to severe forehead wrinkles, glabellar lines and crow’s feet. These blemishes can form at any time during adulthood, though they are more common in more mature individuals.

Age is just one of many considerations when giving this treatment, but the most important is the severity of the dynamic wrinkles. If your dermatologist thinks Botox is the right wrinkle remedy for you, they will recommend it even if you’re still in your 20s.

6. Treatment at a Young Age Prevents Wrinkle Formation 

Facial wrinkles form in different ways. Dynamic wrinkles, as mentioned previously, arise from years of repeated facial muscle contraction. “Static wrinkles,” on the other hand, are due to collagen loss and other aging-induced skin changes. No treatment is 100% effective in preventing skin aging, but healthy lifestyle habits and good skin care help delay wrinkle formation.

7. Botox Is Just Like a Dermal Filler

Dermal fillers and Botox work differently. Dermal fillers are substances inserted in the deeper skin layers. They smoothen creases by adding volume to thinned-out areas and do nothing to facial muscles. Dermatologists may use them to improve static wrinkles and plump up the face when it has lost its youthful volume.

Examples of dermal fillers are hyaluronic acid, collagen and the patient’s own body fat (autologous fat transfer).

8. Some Topical Treatments Work Like Botox

To date, no FDA-approved topical medications can effectively stun the facial muscles and get rid of dynamic wrinkles. The actions of topical anti-wrinkle treatments are only skin-deep. Without a skin-rejuvenating cosmetic procedure like laser skin resurfacing, topicals cannot induce changes as dramatically as botulinum toxin injection.

9. The Neurotoxin Gets Rid of All Wrinkle Types

Botox is best used against dynamic wrinkles. It may modify the static wrinkles nearby, but this effect is limited. Your dermatologist may combine Botox injections with other treatments so you can get the optimum anti-wrinkle regimen.

10. Botox Treatment Freezes Your Face

A frozen facial expression may result from using the wrong Botox dose or poor injection technique. But you can easily avoid such complications when you entrust the procedure to a highly experienced, board-certified dermatologist.

11. Injection with Botox Results in Great Pain

The sensation of pain differs for every Botox patient. Doctors use fine needles to inject the drug. The mild sting they cause is tolerable for most people, especially in the hands of a highly-skilled provider. But if you have low pain tolerance, applying an ice pack or a topical numbing medication to the treatment area before injection can minimize the discomfort.

12. You Can Get Botox from Any Provider

Botox treatment is generally safe, but it is not entirely risk-free. One big reason for injuries arising from botched cosmetic procedures is when unlicensed individuals perform them. 

The most common side effects of Botox cosmetic procedures are redness, discomfort, swelling and bruising on the injection site. These are normal body reactions after any injectable treatment. Rest assured that all these symptoms are transient and will go away on their own.

However, unqualified providers won’t know how to prevent the following rare, potential complications of the procedure:

• Severe headache
• Injection site infection
• Stroke-like facial paralysis
• Fainting
• Life-threatening allergic reaction
• Altered sensation or numbness on the injection site
• Cringey cosmetic result
• Botulinum toxicity in extreme cases

Unfortunately, inexperienced providers may lure patients with dirt-cheap cosmetic services. Don’t fall for that trap. If you want to get the most qualified facial Botox provider, you may read our article on finding the right cosmetic dermatologist.

13. Botox Cosmetic Treatment Is Deadly

Any substance taken in excess is poisonous, even food. For instance, type 2 diabetes mellitus is a disease resulting from chronic caloric overindulgence.

In the case of botulinum toxin A, the safety margin is wide—the doses doctors use for cosmetic treatment are typically less than a tenth of its estimated human lethal dose. Metabolism prevents its accumulation in the body.

Additionally, the actions of this drug are limited to the muscles where it is injected. The proper technique keeps it from seeping into the bloodstream and reaching vital organs.

Rare reports of fatalities apparently related to Botox use yield the following information:

• Most are not related to cosmetic treatment.
• In cases where Botox was used cosmetically, the providers were unqualified to give the drug. Some failed to detect a contraindication (see below) before injecting the neurotoxin.

All this highlights the importance of getting only a highly trained professional to perform your Botox procedure.

14. Botox Is for Everybody

Botox is indicated for moderate to severe dynamic wrinkles. But it is safe only for people without the following contraindications:

• History of botulinum toxin allergy
• Pregnancy
• Breastfeeding
• Active infection or inflammation in the treatment area
• Systemic infection
• Paralyzing nerve or muscle diseases
• Intake of medications that interfere with muscle contraction or acetylcholine action
• Blood clotting disorders or the intake of blood thinners
• Connective tissue disorders
• History of keloid scarring

Tell your dermatologist if you have a medical condition. This helps them assess your fitness for a Botox cosmetic procedure.

15. This Neurotoxin Works Instantaneously

Complete transformation will not happen overnight after a Botox session. It takes a few days before you start experiencing facial muscle weakness, and the effects will peak in the second week. However, it is a quick alternative to topical treatments and cosmetic surgery.

16. Botox Enhances Your Complexion

The drug’s wrinkle-smoothing action is due to its ability to block the nerve impulses controlling muscle movement. Unlike cosmetic treatments that induce skin cell renewal and collagen production, Botox does not rejuvenate your complexion.

17. The Recovery Period After an Injection Is Long

The downtime after a Botox cosmetic procedure is minimal to none. Your dermatologist may advise you to restrict some activities at first to minimize the risk of complications and speed up the onset of the drug’s effects. But you can do some light work after your session. Bruising and soreness make some patients want to stay home or avoid vigorous activities until these side effects resolve.

18. Botox Is Used Only Cosmetically

Before the FDA approved cosmetic Botox in 2002, doctors had already been using it for crossed eyes, involuntary eyelid twitching and severe neck muscle spasm. After that, the following muscle dysfunction-related indications were added to the list:

• Upper limb spasticity
• Overactive bladder
• Chronic migraine

Acetylcholine has other effects in the body, e. g. perspiration, which Botox can also suppress. That is why the drug is also FDA-approved for treating excessive sweating of the armpits. Specialists may likewise use it off-label to remedy acne, rosacea, and some cases of chronic eczema, all of which are aggravated by acetylcholine.

19. You Can Use Botox Treatment to Boost Self-Esteem and Mood and Eliminate Anxiety

Botox works on the muscles and various other structures, but it is not medically used to treat body image issues, mood disorders or anxiety. 

The apparent psychological improvement after Botox injection is suggested by associational studies—the kind of research that detects an association, and not causation, between different variables. Further, these studies were done on patients with Botox-treatable conditions. So it is unclear whether the psychological enhancement came from Botox directly or from experiencing symptom relief.

Currently, no interventional study supports the use of Botox to treat mental health problems. Interventional research assesses the effects of an intervention, e. g. an experimental drug, on a condition. COVID-19 vaccine clinical trials are examples.

It is important to correct these misconceptions so more people can have Botox when needed and to ensure the treatment’s safety and effectiveness.

Why Must You Have Your Botox Procedure Done by a Board-Certified Dermatologist?

As you can probably guess, the success of your Botox treatment greatly depends on the provider you choose. The drug can be catastrophic in the wrong hands but works wonders if given by a skilled specialist.

Only board-certified dermatologists can guarantee superior aesthetic outcomes and an uncomplicated recovery process after a cosmetic procedure. They are also the best to consult about effective skin rejuvenation and delaying facial aging. Only a bona fide skin care expert, such as our award-winning doctors at BHSkin Dermatology, can give you every penny’s worth of your Botox cosmetic injection.

Things to Remember Before and After Botox Treatment

Botox is a drug derived from a paralyzing microbial toxin. It is a safe and effective wrinkle remedy when given in the FDA-recommended doses and injected by a board-certified dermatologist. Good pre-treatment preparation and aftercare help ensure a hitch-free recovery. Healthy lifestyle habits, a good skin care routine and religious maintenance treatments help prolong the drug’s cosmetic effects.

The misconceptions about Botox procedures arise from non-medical people’s unfamiliarity with how the drug works. Sensationalized media coverage of unlicensed providers’ bungled injections contributes to the confusion. Dispelling the wrong notions about the treatment may encourage more people to seek it when they need it and ensure that it stays safe and effective.

The Most Trusted Botox Specialists in LA

Nobody can stop facial aging, but you can certainly slow it down. To attain ageless, effortless beauty, picky LA counts on no one else but the best skin care professionals.

At BHSkin Dermatology, our award-winning Botox specialists have helped countless patients restore their youthful radiance and keep it for many years. Visit us at our Glendale or Encino clinic or use our telederm portal for a consultation.

Book your appointment today!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online