Doctor’s Note: Your Ultimate Guide to Botox and More

As dermatologists, we understand the importance of safe and effective treatments for enhancing your appearance. Botox is one of the most popular options for reducing wrinkles. In this guide, we’ll explore how Botox works, its benefits, potential risks, and what you can expect before, during, and after your treatment.

What is Botox?

Botox is a brand name for botulinum toxin, a substance that blocks certain nerve signals in the body. When injected into muscles, Botox prevents them from contracting, which reduces the appearance of wrinkles and lines on the skin. It can also be used for medical conditions, such as excessive sweating or muscle spasms.

While the treatment is often associated with cosmetic purposes, Botox has been used in medicine for decades to treat various conditions, from eye disorders to chronic migraines.

How Botox Works

Botox works by temporarily blocking the signals between nerves and muscles. Normally, when a nerve sends a signal to a muscle, it contracts. With Botox, this signal is blocked, which means the muscle can’t contract as strongly. When injected into areas of the face or body, Botox helps relax the muscles, which can smooth out wrinkles and lines caused by muscle movement.

In the skin, wrinkles are often caused by repeated muscle movements. For example, frowning or squinting over time can cause lines to form between the eyebrows or around the eyes. Botox can target these muscles, relaxing them and making the skin appear smoother and more youthful.

Common Botox Treatment Areas

Botox is commonly used to treat facial wrinkles and lines caused by repeated muscle movements. Common treatment areas include:

Forehead: Smooths horizontal lines from raising the eyebrows.
Between Brows ("11s"): Reduces vertical lines from frowning.
Crow's Feet: Reduces fine lines radiating from the eye corners.

Botox treatments are priced by either the unit or the treatment area:

By Unit: Price is based on the number of Botox units used (~$10 - $20 per unit in the USA).
By Area: Some providers offer set prices for specific treatment areas, such as the forehead or glabella, simplifying patient pricing.

The cost depends on factors like treatment area size, provider expertise, and location. Botox is typically performed every three months, so keep that in mind!

Other Botox Treatment Areas

Botox isn’t just for smoothing forehead lines or frown lines—it can also enhance other facial features and areas. Below, we’ll show before-and-after images of different Botox treatment areas that can help you achieve your desired look. These include treatments like DAO Botox to soften downward-turned mouth corners, gummy smile Botox for a more balanced smile, Botox for crow’s feet to smooth eye wrinkles, and even Botox for a brow lift to open up the eyes. We’ll also explore treatments for the neck, chin, and jawline, such as masseter Botox for a slimmer jaw and Botox for double chin reduction. Let’s get into each!

Botox Brow Lift

A Botox brow lift generally requires 2–5 units per brow to gently raise the brows. In the before photo, the eyebrows sit lower, which can make the eyes appear smaller. After treatment, the brows are lifted, giving the eyes a more open, refreshed look.

Botox for Crow’s Feet

For crow’s feet, 10–15 units are injected around each eye. In the before photo, fine lines and wrinkles appear at the outer corners of the eyes when smiling. After treatment, the crow’s feet are softened, creating a smoother look.

Gummy Smile Botox

Gummy Smile Botox usually involves 2–4 units to relax the upper lip muscles, reducing gum visibility. In the before photo, more gums show when smiling. After treatment, less gum is visible, resulting in a more balanced smile.

Botox Lip Flip

The Botox lip flip usually requires 4–6 units to gently roll the upper lip outward. In the before photo, the upper lip curls inward when smiling. After treatment, the upper lip flips outward slightly, making it appear fuller.

Masseter Botox Before and After

Masseter Botox, often used for jaw slimming, typically involves 15–50 units per side. In the before photo, the jaw appears wider due to prominent masseter muscles. After treatment, the jawline looks slimmer and more contoured.

Chin Botox

Chin Botox typically uses 2–6 units to smooth out any dimpling or "orange peel" texture. In the before photo, the chin appears bumpy or uneven. After treatment, the chin looks smoother and more even.

Botox for Double Chin

For the area under the chin, usually, 20–30 units are used to tighten and smooth the area. In the before photo, extra fullness is visible under the chin. After treatment, the chin area appears more contoured and refined.

DAO Botox

DAO stands for “Depressor Angularis Oris,” which is the muscle that pulls down on the corners of the mouth) Botox uses around 4-6 units per side to lift the mouth corners. This is the treatment of choice for “Resting Bitch Face” (RBF).

Neck Botox

For smoothing neck bands, 25–50 units are commonly used. In the before photo, vertical bands are visible along the neck. After treatment, these bands are softened, resulting in a smoother neck appearance.

Trap Botox

Trap Botox refers to the trapezius, the muscle in the back of the neck. This area typically requires 25–50 units to reduce visible muscle. In the before photo, the neck appears thicker. After treatment, the neck appears more elongated and “swan-like.”

Botox Procedures Basics

Here's a simple overview of the Botox procedure:

Consult: You'll meet with a healthcare provider to discuss your goals and areas of concern.
Preparation: The provider cleans and marks the treatment area.
Injection: The provider injects small amounts of Botox into specific facial muscles. This feels like a pinch - not too bad!
Aftercare: You can resume normal activities but avoid rubbing the treated area or lying down for a few hours.
Results: Results appear in 7 - 10 days. Effects last around 3-4 months for most areas.

We’ve made it easy! This FREE handout covers everything you need to know, from benefits and risks to precautions and aftercare tips, ensuring you’re fully prepared for your treatment.

Download FREE Botox Handout

Results of Botox

The effects of Botox typically become noticeable within 3 to 7 days after treatment. You may start to notice smoother skin and a reduction in wrinkles and fine lines. The full effects can last anywhere from 3 to 6 months, depending on the area treated and your body’s response to the toxin. Over time, the effects will wear off, and the muscles will begin to return to normal, causing wrinkles to reappear.

Many people choose to schedule follow-up appointments to maintain their results. Regular treatments can help prevent new wrinkles from forming, as Botox can also relax muscles that might otherwise cause further skin aging.

Safety and Side Effects

Botox is generally considered safe when administered by a trained professional. However, as with any treatment, there can be side effects. The most common side effects are mild and include:

Redness or Swelling: Some patients experience slight redness or swelling at the injection sites. This typically resolves within a few hours.
Bruising: Since Botox is injected with a needle, there is a small chance of bruising.
Headache: Some people report mild headaches after Botox treatment, but these are usually temporary.
Drooping Eyelids: In rare cases, Botox can cause temporary drooping of the eyelids. This is typically a result of the injection being too close to the eyelid muscles and can be avoided with proper technique.

Serious side effects are rare but can include difficulty swallowing or breathing. If you experience any unusual symptoms after Botox treatment, it’s important to contact your doctor right away.

How Long Does Botox Last?

Botox results typically last 3 to 6 months, but this can vary depending on the individual and the area treated. Some people may find that the effects last longer with repeated treatments, while others may need touch-ups more often. Your dermatologist can help you determine a treatment schedule that works best for you.

Dysport vs Botox

We’ve been talking a lot about Botox — Botox this and Botox that — but are there other options besides Botox? Yes, there are! Botox isn’t the only neuromodulator available for reducing wrinkles and fine lines. Other popular alternatives include Dysport, Jeuveau, Xeomin, and Daxxify. While they all work similarly by relaxing the muscles that cause wrinkles, each has unique characteristics that might make one better suited for certain people or areas. Here is a summary of the differences between these brands:

Feature	Botox	Dysport	Xeomin	Jeuveau	Daxxify
Structure of Molecule
Weight	900 KDa	500–900 KDa	150 KDa	900 KDa	150 KDa
FDA Approval	2002	2009	2011	2019	2022 (NEWEST)
Time to See Results	7 Days	3 Days	7 Days	3 Days	2 Days (FASTEST)
Duration of Results	3 Months	3 Months	3 Months	3 Months	6 Months (LONGEST)
Noted Facts	- Original and most well-known	- Spreads more due to smaller proteins - Great for diffuse wrinkles	- No proteins - Better for sensitive skin	- Marketed as cheaper Botox	- Fastest and longest-lasting - Try if Botox no longer works

Dysport vs. Botox: Dysport is known for spreading more easily, which can be helpful for treating larger areas like the forehead. It may also show results a bit faster than Botox, typically within 2–3 days. However, Botox might be a better option for smaller areas where more precision is needed, as it doesn’t spread as much as Dysport.

Xeomin vs. Botox: Xeomin is unique because it doesn’t contain any additives—just pure botulinum toxin. This can be beneficial for people who may have built up a resistance to Botox or those who prefer a "cleaner" formulation. Xeomin and Botox have similar effects and durations, usually lasting 3–4 months.

Jeuveau vs. Botox: Jeuveau is sometimes called “Newtox” because it’s newer to the market. It’s very similar to Botox in its formulation and effect, though it’s marketed mainly toward cosmetic use rather than medical applications. People who try Jeuveau often notice results comparable to Botox, but some report it may be slightly more affordable.

Daxxify vs. Botox: Daxxify is the latest neuromodulator to hit the market, and it boasts a longer-lasting effect. While Botox generally lasts 3–4 months, Daxxify claims to last up to 6 months or more. This can be a great option for people looking for fewer treatments over the year, though it may be priced higher due to its extended duration.

Each of these alternatives has its pros and cons, and the choice between them often comes down to personal preference, treatment goals, and how each product interacts with your unique skin and muscles. Consulting with a professional can help you decide which option best fits your needs.

“My Botox Doesn’t Work Anymore”

Botox resistance is rare, affecting about 1.5% of people. It happens when the body makes antibodies against Botox, making it less effective over time. This is more likely if someone gets high doses or frequent treatments. People with resistance may notice that Botox doesn’t last as long or doesn’t work at all.

To treat this, doctors may switch to a different treatment called Xeomin. Xeomin is a good choice because it doesn’t have proteins, so it’s less likely to cause the body to build antibodies.

To reduce the risk of resistance, it’s best to use the smallest dose that works and have fewer treatments. Newer treatments like Jeuveau and Daxxify have smaller proteins, which makes them less likely to trigger the immune system.

Botox FAQ

Does Botox hurt?
Botox injections are typically not very painful. You may feel a small pinch or slight discomfort during the injection, but the procedure is quick and usually well-tolerated.

Can you do Botox microneedling after you get Botox injections?
It is generally recommended to wait at least 7-10 days after Botox injections before undergoing microneedling to ensure the Botox has settled and to avoid potential interference with the results.

Can you use silicone patches after Botox injections?
Yes, silicone patches can be used after Botox injections, but it’s best to wait 24-48 hours to avoid unnecessary pressure or manipulation of the treated areas.

How long after Kybella injections can you use Botox?
You can typically get Botox 2-4 weeks after Kybella injections, but always consult with your provider to determine the best timing based on your individual treatment plan.

What kind of doctor administers Botox?
Botox is often administered by dermatologists, plastic surgeons, or other licensed medical professionals trained in cosmetic procedures.

Can you drink after Botox?
It’s best to avoid alcohol for at least 24 hours after Botox injections, as alcohol can increase the risk of bruising and swelling.

What is a ponytail Botox lift?
A ponytail Botox lift is a cosmetic procedure that uses Botox to lift the eyebrows, smooth forehead lines, and create a more youthful and refreshed appearance, mimicking the effect of a tight ponytail.

Do aestheticians do Botox?
In some regions, licensed medical aestheticians with proper certification may administer Botox under the supervision of a physician, but regulations vary by location.

Can you get Botox while on antibiotics?
Some antibiotics, particularly aminoglycosides, may interact with Botox. It’s important to inform your provider about any medications you’re taking before getting Botox.

Can I tan after Botox?
It’s recommended to avoid tanning, including sun exposure and tanning beds, for at least 24-48 hours after Botox to reduce the risk of swelling or irritation.

Can I take Tylenol before Botox?
Yes, Tylenol is safe to take before Botox injections if needed, as it does not increase the risk of bruising like other pain relievers such as aspirin or ibuprofen.

Can Botox help with a double chin?
Botox is not typically used to treat a double chin. However, other treatments like Kybella or dermal fillers may be better suited for this concern.

Can I get a massage after Botox?
Avoid massages, especially on the face, for at least 24 hours after Botox injections to prevent the product from migrating to unintended areas.

Can you do microneedling after Botox?
It’s best to wait 7-10 days after Botox injections before undergoing microneedling to allow the Botox to settle.

How long after microneedling can I get Botox?
You can typically get Botox 7-10 days after microneedling once the skin has healed.

Why does Botox make your forehead shiny?
Botox can make the forehead appear shiny because it relaxes the muscles, reducing wrinkles and creating a smoother surface that reflects light more evenly.

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