Procedures Resource Center Plastic Surgeon Info Contact Us Forum Blog Videos Home


Frequent Asked Questions of BOTOX Cosmetic


                                   Woman receiving BOTOX Cosmetic                          

                                                 Licensed image for




  • What is BOTOX Cosmetic?

BOTOX Cosmetic is a therapeutic muscle-relaxing agent derived from the bacterium, Clostridium Botulinum. For over a decade, ophthalmologists have applied BOTOX Cosmetic for its original intention, the treatment of blepharospasm. Physicians have utilized BOTOX Cosmetic for years as a cosmetic treatment to correct visible signs of stress and aging.



  • How does BOTOX Cosmetic work?

The contractions and movements of the facial muscles are controlled by signals from the brain. BOTOX Cosmetic simply prevents the muscle from allowing responses to these messages. As a result, the muscle relaxes and the overlying skin remains unwrinkled and smooth.



  • What do most expect with treatment of BOTOX?

With a very fine needle, BOTOX Cosmetic is injected into the specific muscle that is contracting and causing the lines and wrinkles on the face. Treatment is effective, safe, and takes approximately 10 minutes. The pain is a minimal "pin prick" and no anesthetic is required.  BOTOX will paralyze the muscles and stop the lines created with muscle motion and soften the lines present at rest due to resting tone of the muscles.



  • How long does a BOTOX Cosmetic treatment last?

The effects usually last 3 to 4 months, and fade away gradually. Following several treatments, the results may last 4 to 8 months or longer. BOTOX Cosmetic offers extended relief over the course of long-term treatment.

Read more about the longevity of BOTOX



  • Is the treatment with BOTOX Cosmetic painful?

Any discomfort if at all from BOTOX is minimal and very brief.  Some physicians prefer to numb the area first with a topical anesthetic cream (such as EMLA Cream), which you leave on for at least 10-15 minutes before the injection.  However, many patients require nothing prior to the injections.  After the injections, your physician might give you a cold compress to help at the injection sites to make sure no bruising occurs.



  • What are the side effects of BOTOX?

Side effects of BOTOX Cosmetic, if any, are usually mild and temporary. Botulinum toxins contain proteins, which in some circumstances may be naturally safeguarded against by the body's ability to produce antibodies. If antibodies are formed, the therapy will generate a lesser response. Temporary bruising is sometimes experienced, though this symptom resolves itself within 2 to 3 days. In rare cases, there can be a slight drooping of an eyelid or asymmetry of expression. If this should happen, return to your physician.

The most common side effects from BOTOX include:

  • temporary eyelid droop

  • nausea

  • localized pain from the injection site

  • infection

  • inflammation

  • tenderness

  • swelling

  • redness

  • bleeding/bruising

BOTOX should not be given with patients who have certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome – as they might be at an increased risk of serious side effects.



  • What typically are the results seen with BOTOX?

The effect of BOTOX Cosmetic is visible within 3 days. Maximum benefits are reached between 10 to 14 days; however some patients notice results within 3 to 5 days. Once the muscle becomes dormant and the skin softens, you will have a more relaxed and youthful appearance.



  • How much does BOTOX cost?

The price of BOTOX has significant geographic variability.  Prices per unit vary from about $10 per unit to $25 per unit.  Each area requires around 10-30 units.  Some patients require more BOTOX depending on the severity of the wrinkles they are trying to treat.  The manufacturer however states, that no more than 200 units of BOTOX should ever be used.  In one vial of BOTOX there are 100 units available.

Most physicians charge by area of injection without disclosing to the patient how many units of BOTOX Cosmetic will be injected in each area.   You must be aware that dilution matters, ask the doctor how much saline solution he or she uses to dilute the vial of BOTOX Cosmetic and how many units will be injected in each area.

Each vial contains 100 units and should be diluted with no more than 4 cc of saline.

If the doctor dilutes the BOTOX with more then 4 cc of saline, then you will be getting a smaller dose of BOTOX Cosmetic which will be less effective and shorter lasting.

When comparing BOTOX Cosmetic injection prices among different offices, be sure to ask each office how much they dilute the pure BOTOX.  Be aware of BOTOX injections at very low prices may be suspect for over diluting the BOTOX.  Highly diluted BOTOX will usually give a short and less than optional result - NOT what you want!

You are better off asking the doctor to charge you the BOTOX Cosmetic injections by the unit, rather than by area of injection.

Allergan, Inc. has a discount program you can investigate and is available at offices with experience with the product.



  • Who should administer injections of BOTOX?

State regulatory agencies oversee who can inject BOTOX and this varies state by state.   The cosmetic market is inundated with medical spas performing BOTOX injections at discount prices.  This should never be a factor when deciding who you trust to inject BOTOX; ideally it should be performed by a board certified physician in a medical office.

In the state of California, BOTOX may be administered to a patient by an MD, Physician Assistant (PA), or Registered Nurse (RN).  Both the Physician Assistant and the Registered Nurse should work under the medical direction of the physician in order to inject BOTOX.  RN's may inject BOTOX only after the patient has first been seen by the physician or physician assistant.

This is an answer as to the regulatory qualification. From the perspective of who is most qualified, you should consider the training and experience of the professional that you choose to administer your BOTOX.

Allergan’s website has a list of physicians who are “Platinum Level” practices.  This means that there is a lot of experience with the administrating of BOTOX Cosmetic.

You should always ask questions of your injector in regards to how long they have been administering BOTOX Cosmetic and how many patients do they see each week for BOTOX alone.



  • What is a BOTOX party?

A BOTOX party is a social gathering at which a doctor injects the participants with BOTOX (botulinum toxin) to reduce or remove facial wrinkles.

The straightforwardness of the procedure has led to the wonder of the BOTOX party; which has been modeled after other type parties where it gets a bunch of people together to buy something.  Some patients prefer going to BOTOX parties, because they have the support of their friends with them while getting the injection and most patients receiving the BOTOX can get a better deal on the cost.

This topic is a controversial discussion for most physicians.  All in all most physicians look down on any procedure that is not being performed in a completely controlled environment, such as a medical office.  However, if a board certified physician is the one giving the injections at the BOTOX party, then most patients have no problem with this type of atmosphere.

The most important factor with deciding if BOTOX is for you is to make an informed decision about the pros and cons of treatment with a qualified doctor.



  • What areas are normally injected?

Three areas are commonly injected:

A talented injector can perform a BOTOX eyebrow lift to elevate your corner of your eyebrow 1 - 2 mm to give your eyebrow a classic arch and to frame your eye.



  • What is a BOTOX Brow Lift?

BOTOX can be used to achieve a 'chemical brow lift'. BOTOX when injected in the wrong area can make a brow droop; however, when injected correctly it can actually cause an elevation of the brow.  There are many muscle groups that work to move the brow. The frontalis and obicularis oculi muscles are "antagonistic muscle pairs" for eyebrow position - when one contracts the other relaxes - changing the eyebrow position. BOTOX Cosmetic works by paralyzing the targeted muscles.



  • How many units of BOTOX can be injected into the crow’s feet?

Typically there is a range of answers, as no two patients are alike with their needs and of course age is a factor.  Patients who are in their thirties normally get a lesser amount as their crow’s feet might not be as severe as a fifty year old.  The range is 10-16 units per crow's feet are injected however; there definitely is some variability from individual to individual.

Another factor to consider is the “freshness” of the BOTOX.  If the BOTOX has been opened for awhile, the injector might use more units than a fresh box.



  • How many units of BOTOX can be injected into the forehead/glabella area?

The average amount of BOTOX used for the “11” lines or Glabellar (which is between the eyebrows) is around 20-30 units for a female.  Males will usually require more units as their facial muscles are often thicker and stronger.  The number of units used for injection depends on the size and strength of your corrugator muscles.

To do the upper forehead area the units range from 15-25; however this changes depending on the severity of the wrinkles.



  • Can I use BOTOX on other wrinkles?

BOTOX is only approved to treat wrinkles between the eyebrows, the forehead wrinkles and crows-feet by the eyes.  Any other application is considered “off label”.

BOTOX is being used by some physicians in these following areas:


  • Frown lines

  • Crow’s feet

  • Forehead creases

  • Brow shaping

  • Brow elevation (lift)

  • Correction of eyebrow asymmetry

  • Elevation of the corners of the mouth

  • Upper/lower lip creases

  • Marionette lines

  • Lip lengthening to correct gummy smile

  • Chin softening (excessive cleft)

  • To improve the appearance of new and old facial scars

Neck Rejuvenation:

  • Horizontal “necklace” creases

  • Vertical neckbands (turkey neck)

Chest Rejuvenation:

  • Women may exhibit wrinkling of the central mid chest (décolleté) BOTOX injections can successfully reduce those wrinkles.



  • Should there be wrinkles after the injection of BOTOX?

You may be noticing previous lower lid wrinkles now that your Crow's feet are improved.  Sometimes the injection is being administered too deep in the muscle around the eye, causing the fatty tissue to also drop creating bags which bunch up when you smile.  The BOTOX will wear off, so this is not a permanent situation.

Sometimes this area looks worse in contrast to the smoother lateral eye area.

If the possible swelling does not improve, 1 to 2 units of BOTOX placed just below the eyelashes works to reduce this creepiness.  Be sure your Cosmetic Surgeon is very experienced to treat this area.



  • Can a person become immune to BOTOX?

There is a rare instance of people becoming immune to BOTOX. This happens in less than 1 out of 10,000 people. These people form an antibody to the BOTOX molecule so a different variant of Botulinum toxin must then be used to achieve the same effect.



  • Will my lines look worse if I choose not to continue treatments?

No. Your lines gradually revert to their pre-treatment appearance.



  • What if a droopy eye results from BOTOX – is there anything to help this?

If you do get a droopy eye from BOTOX, some physicians are using Alphagan and Iopidine to correct the situation.  It is actually quite safe and the only contraindication is use of a (MAO) monoamine oxidase inhibitor.  Alphagan works by stimulating a second set of muscles called Muller's muscle which causes lifting of the eyelid muscle.

Lopidine (Apraclonidine) Eye Drops mode of action is that it goes to work on a tiny muscle in your eyelid and help pull it up 1 to 3 mm. The drops must be repeated a few times a day for a continued effect. If you have drooping eyebrows leading to full eyelids, these eye drops will have no effect.



  • How often can I receive a treatment of BOTOX?

The manufacturer of BOTOX – Allergan, Inc. - suggests injections every 4 months as the most effective suggestion in the average patient.



  • Are Face Creams that use the marketing that they help wrinkles better than BOTOX reliable?

No, most of these are false claims, simply put there are no creams that work like BOTOX does.

BOTOX is a protein that relaxes the muscle that causes wrinkling by blocking the communication between the nerve and the muscle. The result is the nerve temporarily can not tell the muscle to contract.

There is no substitute for BOTOX injections. Creams cannot get into the muscle, which is where the product needs to be in order to have any effect.



BOTOX Competitors:


More BOTOX Cosmetic Links:


Copyright - - A Cosmetic Surgery Support Network