Botox Treatment 101: How It Works, Benefits vs Risks, Costs and What to Expect from the Process

Old or filtered profile pics are social media’s magic solutions for facial aging. But they won’t help you impress people at your class reunion or that first date you keep putting off.

Neither creams nor surgery can make wrinkles vanish overnight. So how can you make yourself look younger just in time for that make-or-break encounter?

Botox treatment is a procedure your BHSkin Dermatology specialist can perform to take years off your face pronto. Everyone talks about it, but you may have lingering questions before booking an appointment.

If this is your first time getting a Botox injection, then this article is for you. Here, we explain how the drug works, its upsides and downsides, costs and what you can expect from the entire experience.

What Is Botox?   

“Botox” is short for “botulinum toxin,” a substance produced by the canned food microbial contaminant Clostridium botulinum.

In large amounts, it causes botulism, a potentially fatal condition that starts as profound head and neck muscle weakness. But in small quantities, doctors can use it to treat a wide variety of medical conditions arising from muscle spasticity or overuse. “Botox” is also the brand name of a drug with botulinum toxin type A as the active ingredient. 

Botox prevents the release of acetylcholine in the nerves. Acetylcholine is an important chemical regulating various functions in the body, such as voluntary muscle contraction, sweating, oil gland secretion and many others.

In dermatology, Botox injections are used to smoothen “dynamic wrinkles,” the skin folds created by repeated facial muscle movement. These blemishes can form in many areas, but the FDA approved the treatment specifically for the following:

• Glabellar lines, aka the “elevens,” which are vertical furrows between the eyebrows
• Wrinkles beside the eyes, known as “crow’s feet”
• Severe frown lines on the forehead

Botox is also FDA-approved for alleviating excessive sweating in the armpits.

Meanwhile, the toxin’s muscle-relaxing ability makes it useful for the following non-dermatological applications:

• Upper limb spasticity, e. g. in an adult patient with cerebral palsy
• Overactive bladder resulting in urinary incontinence
• Chronic migraine
• Severe neck muscle spasm
• Involuntary eyelid movements 
• Some cases of crossed eyes  

Additionally, since the drug has multiple effects, Botox injection specialists can use it to treat dermatologic conditions not included in the FDA’s list of indications. Some examples are acne, certain types of eczema, treatment-resistant rosacea and smokers’ lines.

Botox is not the only formulation of botulinum toxin type A currently marketed in the United States. Dysport is another, though the two have slight differences in chemical composition and clinical use. You may read our article comparing Botox to Dysport to find out more.

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

After a Botox injection, most patients observe weakening of the facial muscles by the third day. It may take shorter or longer by a couple of days in others.

Muscle relaxation typically peaks in the second week and gradually wears off in the third or fourth month. Some patients may see Botox’s effects lasting for five months. Regardless, when you see those facial wrinkles starting to return, we recommend scheduling another session to keep them from deepening again.

Three sessions yearly are enough for most patients. Repeat Botox injections have a cumulative effect, prolonging the drug’s wrinkle-smoothening action with each treatment. So it is common for patients to reduce their maintenance sessions over time.

What Are the Benefits of Botulinum Toxin Injection?

Compared to other wrinkle treatments, Botox has the following advantages:

Quicker Onset of Action

It takes several weeks to months before topical medications start to work. And you won’t see significant improvement from lasers or facial plastic surgery until at least a few weeks after recovery. Botox cuts the waiting period short to about two weeks after your session.

Faster Recovery

Botox injections create only a few pinpoint skin cuts that close up quickly. Your doctor may advise you to limit strenuous activities for a few days, but you can go back to doing light work right away. By comparison, the downtime from plastic surgery and ablative laser skin resurfacing takes at least two weeks to give time for the surgical wounds to heal properly.

Easy Aftercare

Facelifts and ablative lasers create wounds that need weeks-long care regimens. The same is not true for Botox, though some activity restriction is required in the first few days to prevent complications, speed up its onset and prolong its effects.

Less Expensive than Cosmetic Surgery

The average cost of a facelift in the US ranges from $8,000 to $12,000. Laser skin resurfacing prices vary from $1500 to $2500 per session, depending on the equipment type used and the treatment area’s extent. These figures vary by geographic location and do not include the providers’ fees and other related expenses.

Meanwhile, Botox injections are cheaper, as we shall see later. When you account for the number of sessions needed yearly, Botox is the most cost-effective among these wrinkle treatments.

According to the American Society of Plastic Surgeons, Botox was the most popular minimally invasive cosmetic procedure in 2020, with 4.4 million sessions done that year. This treatment has become very accessible and convenient for many Americans looking for a quick wrinkle remedy.

What Are the Risks of Botox Treatments?

Botox cosmetic procedures are generally safe, but the tiny skin punctures induce some inflammation. It is normal to observe mild discomfort, redness and swelling right after injection. These symptoms may last for a few days at most, but they usually go away on their own. Vulnerable patients may also see transient bruising. 

If done properly, complications are uncommon after a Botox session. But they include the following:

• Headache
• Injection site infection
• Allergy
• Fainting, particularly if a patient has pain anxiety
• Stroke-like facial muscle paralysis
• Numbness or altered sensation on the injection site
• Antibody reaction, which can shorten the duration of the drug’s effects
• Poor cosmetic result

Even rarer is botulinum toxicity, wherein the drug has spread to distant head and neck muscles. The symptoms include difficulty talking, swallowing and breathing. Botulinum toxicity is a medical emergency.

However, the good news is that the chance of complications becomes insignificant when you entrust your Botox injections to a board-certified dermatologist. Only a highly trained medical expert can guarantee the effectiveness and safety of any cosmetic procedure.

Are Botulinum Toxin Cosmetic Procedures Right for You?

Botox treatment has a broad safety margin. But the following medical conditions can make it unsafe for some people:

• History of botulinum toxin hypersensitivity, e. g. if you have experienced itching or shortness of breath resulting from a prior Botox or Dysport injection
• Pregnancy
• Breastfeeding
• Infection on the treatment area
• Systemic infection
• Paralyzing nerve or muscle disorders, e. g. myasthenia gravis, ALS, multiple sclerosis, etc.
• Intake of drugs that disrupt muscle function or acetylcholine activity. There is a long list, but they include some antibiotics, heart disease medications, treatments for Parkinson’s and Alzheimer’s disease, etc.
• Blood clotting abnormalities or the intake of blood thinners

Additionally, Botox has limited efficacy on “static wrinkles,” the fine lines resulting from collagen loss and not muscle contractions. So your specialist may suggest a more appropriate remedy like dermal filler injection, which also has an immediate impact.

Your dermatologist will evaluate your fitness for Botox treatment during your initial consultation. If you have a chronic health condition, they may ask for medical clearance to make sure that the procedure is safe for you.

How Do You Prepare for Your Botox Appointment?

Pretreatment preparation is crucial in any cosmetic procedure. You can prevent complications and other inconveniences as early as this stage. You may do the following to get ready for your Botox session:

• Schedule your procedure at least two weeks before your important event to give the drug enough time to work.
• If you are bruise-prone, start taking anti-bruising supplements like arnica and bromelain 2-4 days before your appointment.
• Avoid blood thinners at least two days before your session. Examples are non-steroidal anti-inflammatory drugs like aspirin and ibuprofen and supplements like garlic, turmeric, ginkgo biloba and vitamin E. These substances increase your risk of bruising and bleeding after an injection. If you need them for a chronic medical condition, seek clearance from your primary care doctor before you stop intake.
• Consider an extra workout before your appointment.
• Avoid smoking and drinking starting one week before your procedure, as they can delay skin healing.
• If you plan to have another cosmetic procedure, make sure to schedule it weeks before or after your Botox session or as advised by your physician. Your skin will need time to recover after therapy. Spacing your treatments adequately will also let you and your doctor see their full effects and assess the need for another procedure.
• Cleanse your face and leave it makeup-free before coming in for your appointment.

Botox treatments do not cause drowsiness or body paralysis, so you can drive home after your session. But you can arrange to have a companion to the clinic if you choose.

What Can You Expect During Your Botox Procedure?

At the start of the session, your dermatologist will clean the treatment areas. They may ask you to smile or frown so they can visualize the target muscles better and determine how much of the drug you will need. They will then inject a few times while applying slight pressure on your skin. The procedure takes only a few minutes.

Many patients can tolerate the discomfort of a Botox procedure. But you may apply an ice pack or ask for some topical numbing medication shortly before injection. 

How Do You Take Care of Your Face After Botox Treatment?

You will not have to care for a surgical wound after a Botox injection. But to avoid spreading it to distant muscles, your dermatologist may ask you to refrain from doing the following until at least 4 hours after your session:

• Lying on your back
• Scratching the injection site
• Applying heat or pressure on the treated area
• Activities that can make you flush like exercise, sauna bathing and suntanning

You may go back to your usual routine after this period, but you must protect the injection site from trauma or heavy pressure for a few days. You may use makeup, but only if your skin does not feel irritated.

If you are prone to bruising, here are some tips to help prevent or quickly get rid of bruises:

• Apply a cold compress on the treated site repeatedly in the first 24 hours after your session.
• Avoid vigorous activities for up to two days.
• Continue taking arnica or bromelain for a few more days.
• Sleep upright in the first few nights after your session.

Additionally, gentle cleansing, moisturizing and sun protection can enhance the effects of your procedure. Use any other prescribed skin treatments as directed.

How Much Do Botox Injections Cost?

The price of Botox procedures varies widely and depends on several factors, the most important of which are the following:

• The number of Botox units required
• The provider’s skill
• Other medical supplies used during the session
• The clinic’s geographic location

Currently, the cost ranges from $300 to $600 per session. Health insurance does not cover botox cosmetic injections, but you may talk to your doctor about payment options.

Why Should You See a BHSkin Dermatology Specialist for Botox Procedures?

The safety and cosmetic outcome of your Botox treatment largely depends on your provider’s skill. As we explained earlier, the procedure is generally safe, but it is not totally risk-free. In the wrong hands, it may cause injury or leave you unsatisfied with your new look. Less qualified providers may charge less for Botox injections, but you might end up spending more on addressing the complications.

On the other hand, our board-certified specialists at BHSkin Dermatology have successfully performed various cosmetic procedures on countless patients. Moreover, with their mastery of skin care, they can help keep you looking stunning at any age. Trust them to give you the best outcomes from your treatment.

Things to Keep in Mind Before Getting a Botox Procedure

In summary, Botox is an injectable wrinkle treatment derived from the nerve blocker botulinum toxin type A. It is a cost-effective and convenient alternative to topical remedies and cosmetic surgery. It gets rid of frown lines and other dynamic facial wrinkles quickly and safely. The downtime is minimal, and most patients need three sessions yearly to maintain its effects.

Good preparation and aftercare are crucial if you want to get the most from your Botox procedure. But most importantly, only by trusting the right provider can you get the long-lasting, head-turning look you want.

BHSkin Dermatology’s board-certified skin care professionals have extensive cosmetic Botox expertise in addition to their advanced knowledge of the skin. You will never go wrong when you turn to these specialists for a beauty boost.

Been Patient Enough with That Wrinkle Cream? It’s Time to See LA’s Best Dermatologists

Topical treatments can be frustrating because they are not always effective on frown lines and crow’s feet. Cosmetic surgery can give fantastic results, but it is pricey, and the aftercare regimen is time-consuming. Botox injection is a good alternative to both—it is not as expensive, though it gets rid of dynamic wrinkles fast.

At BHSkin Dermatology, our award-winning cosmetic Botox specialists are some of the best in California. They can make you look amazing for your age in no time. Visit us at our Glendale or Encino clinic or use our telederm portal for your initial 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