Botulinum toxin (Botox)

Treatment Overview

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The injection of botulinum toxin, commonly known as Botox, has become very popular for reducing wrinkles and rejuvenating the aging face. The effects are only temporary, but the injections can be done quickly, require no recovery time, and are not as complicated as many other cosmetic procedures for the face.

Botulinum toxin is produced by Clostridium botulinum bacteria. When a small amount of Botox is injected into a muscle, it blocks nerve signals that tell your muscles to contract. The effect is that it temporarily weakens or paralyzes the facial muscles and smoothes or eliminates wrinkles in the skin for a few months.

Getting a Botox injection takes just a few minutes.

What To Expect After Treatment

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For the first 2 to 3 hours after treatment, take it easy and do not rub the treated area. After that, you can return to your regular activities.

It can take 3 to 4 days before you notice an effect from the Botox. The full effect may take up to 1 week. The results may last 90 to 120 days. After that, you will begin to see the wrinkles return.

Why It Is Done

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Botulinum toxin has been approved by the U.S. Food and Drug Administration (FDA) for treating frown lines in adults younger than 65.¹ Botox injections also are frequently used to reduce other wrinkles on the face and neck, such as crow's feet, brow furrow, and forehead lines.²

Botulinum toxin is also approved by the FDA to treat eye muscle disorders, including strabismus (cross-eyes), abnormal neck and shoulder contractions, and vocal cord spasms. Current research also suggests botulinum toxin injections may relieve migraine and tension headache symptoms.³

How Well It Works

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Within 72 hours after treatment, the injection of Botox partly or completely smooths wrinkles for most people. It works in up to 85% of adults younger than 50 and up to 70% of adults between 50 and 65.¹ But the results are temporary, typically lasting only 3 to 4 months. You will have to return for injections every 3 to 4 months to maintain the effects.

The long-term effects of repeated Botox injections are not known.

Risks

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The most common side effects are:

• Headache.
• Bruising.
• Flu-like symptoms.
• Drooping eyelid (ptosis).
• Nausea.

Other side effects include temporary facial pain, redness at the injection site, reduced blinking, and weakness in the muscles of the face. In extreme cases, this muscle weakness can limit your facial expressions. On rare occasions, a sore may develop on the white of the eye (corneal ulceration).

The risks of repeated Botox injections are not known.

What To Think About

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Botox injections are more convenient and less painful than other procedures for reducing wrinkles and making your face look younger (chemical peels, dermabrasion, laser resurfacing, face-lift). Keep in mind that the effects of an injection last only a few months. To maintain the effects, you will have to receive injections several times per year. While a single injection may seem inexpensive, the cost of repeated injections can quickly add up.

There are no known serious side effects from Botox. Be aware, however, that it is too soon to know whether any long-term problems will result from repeatedly injecting a paralyzing agent into the muscles.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

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Citations

1. Botulinum toxin (Botox cosmetic) for frown lines (2002). Medical Letter on Drugs and Therapeutics, 44(W1131A): 47–48.

2. Glogau RG (2003). Botulinum toxin. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., vol. 2, chap. 276, pp. 2565–2567. New York: McGraw-Hill.

3. Rohrich RJ, et al. (2003). The cosmetic use of botulinum toxin. Plastic and Reconstructive Surgery, 112(5, Suppl): 177S–191S.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Patrice Burgess, MD - Family Medicine
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	James D. McMahan, MD, FACS - Plastic and Reconstructive Surgery
Last Updated	August 25, 2006