Your Ultimate Guide to Botox

Botulinum toxin — often referred to as the brand name Botox — wasn't always the Magic Eraser for fine lines and wrinkles like you might know it as today. In fact, ophthalmologist Jean Carruthers, MD, FRCSC, FRC, first stumbled across its smoothing potential while treating a patient for eye spasms in the 1980s. When she noticed fewer frown lines as a happy side effect, Dr. Carruthers relayed the good word to her dermatologist husband.

Fast-forward 30-plus years, and Botox has become so commonplace that injections are served with a side of In-N-Out burgers on the hit Netflix show "Selling Sunset." It's no longer Hollywood's best-kept secret or the making for "have they or haven't they" fodder at cocktail parties. These days, it's the most popular minimally invasive cosmetic procedure in the United States, according to the American Society of Plastic Surgeons, with 4.5 million treatments in 2020 alone.

Still, there's a lot to know about the injectable liquid before going under the needle. If you've ever wondered about the ins and outs of Botox — including injection options, pricing, and potential risks — consider this your guide.

While Botox is the brand name of the first neurotoxin injectable — hence why it's become somewhat synonymous with the treatment, like Q-tips or Kleenex — there is more than one company that manufactures the product, including Dysport, Xeomin, Jeuveau, and Daxxify. Before we get to that, however, let's first answer the common question: what is botulinum toxin type A, exactly?

Scientifically speaking, it's a naturally occurring molecule derived from a culture of bacteria that was purified by a "series of acid precipitations to a crystalline complex containing the toxin and other proteins," says New York City-based plastic surgeon David Shafer, MD, FACS. It was found to temporarily paralyze the facial muscles, or as dermatologist Dhaval G. Bhanusali, MD, FAAD, tells POPSUGAR, "It essentially blocks the nerve signals to the muscles under the skin, preventing contractions and movement at a localized site."

Of course, the claim to fame for any injectable neuromodulator is its ability to soften fine lines and wrinkles — particularly frown lines, crow's feet, and forehead lines. "By reducing the contractions of the muscle, it significantly reduces the overlying wrinkles," says Dr. Shafer. "Therefore, the effect is primarily on the dynamic wrinkles, which occur with movement. However, over time, even the static wrinkles that are apparent at rest will also show significant improvement."

Still, that's not all it can do. "Botox has many functions," says Dr. Bhanusali. "The most popular use is for minimizing muscle contraction, but we also use it for a range of other issues off-label. That includes treating excess sweating, reducing a gummy smile, helping with extending the life of a hair blowout, opening up the lip, softening the jaw, minimizing migraines or headaches, smoker's lines, bunny lines, and sometimes in aiding with scar treatments."

It can also be injected into the jaw to treat TMJ pain from teeth grinding; prevent an overactive bladder, leakage of urine, and eyelid twitching (also known as blepharospasm); and temporarily correct eye-muscle disorders. As always, it's best to talk with your dermatologist about treatment options for you.

While we're referring to botulinum toxin A by the brand name Botox, which is manufactured under the company Allergan, there are other injectable options to consider: Dysport, Xeomin, Jeuveau, and (just FDA-approved as of September 2022) Daxxify. But what's the difference?

"While the active ingredient — botulinum toxin A — is the same, the protein structure of each is slightly different," says Dr. Bhanusali. "Xeomin, for example, is considered to be a purified form with no additive proteins. Per my experience, Dysport and Jeaveau tend to work a bit quicker, and most dermatologists I've spoken with believe that Dysport diffuses a little more — meaning covers more surface area — which can be a good thing when covering a larger area. With Botox, you know exactly what to expect and it's predictable. That's the tried-and-true method."

Because, at least clinically, the general belief is that they are all similar, Dr. Bhanusali adds that which one you choose really boils down to personal (yours and your practitioner's) preference. "I often mix and match based on the patients or have them try various versions," he says. "It's good to try and see what suits you best before deciding which type to commit to long term."

Much like real estate, the price of Botox is all about location, location, location. In general, you are either charged by unit (i.e., how much of the actual Botox fluid you require) or by the specific area being treated, which varies depending on where you live and where you go for treatment.

"Rates for individual units do vary between brands, sometimes greatly, but between $10 to $20 is a common range," says Larisa Fridlyand, board-certified nurse practitioner and area lead nurse practitioner at the Botox studio Peachy. That means nailing down the exact price depends on the area you're treating; typically, crow's feet can require anywhere between 10 to 15 units per side, while frown and forehead lines average between 20 and 30 units.

Some cosmetic and medical aesthetic studios offer a flat rate for full transparency. Peachy, for example, operates on a fixed-rate pricing model across all brands: $375 for the dose you need, including consultation and a touch-up after two weeks. (For what it's worth, this tracks with what the American Society For Aesthetic Plastic Surgery reports, which is around $376 per session.)

While pain is relative and wildly dependent on each individual person, the broad answer is no. "On the scale of painless to flu shot, Botox is a nip to the skin," says Fridlyand. "Momentary discomfort is common for some, but the reality is Botox should never be painful when it's done correctly."

That said, if you're especially sensitive to pain, ask your dermatologist or practitioner to apply a topical anesthetic cream 10 minutes beforehand to numb the area. Otherwise, it's called a "lunchtime treatment" for a reason — the entire procedure takes 10 to 15 minutes, tops. Even with the minimal redness at the injection sight, nobody will suspect a thing.

You wouldn't be a modern human living in the 21st century if you didn't want instant gratification when getting Botox injections. Unfortunately, though, you typically have to wait anywhere from four to seven days to see results.

Once it kicks in, though, "it has a wear time of three to four months, meaning a few treatments is all you'd need to keep lines fewer and finer year-round," says Fridlyand.

How long you can expect the smoothing effects to last also depends on the area injected and your specific dosage. "There are some studies showing that using more units increases the longevity of Botox results," says Dr. Shafer. In some cases, it can even depend on the brand. "[Daxxify] is the new kid on the block. It has an additional protein that's said to help extend the length of efficacy to between six to eight months," says Dr. Bhanusali. (He notes that he can not verify this claim, as he has not yet injected any patients with Daxi.)

Either way: "It's important to have your next treatment before the previous treatment has worn off or you will lose the preventive effects of the Botox, especially on the improvement of the static wrinkles," says Dr. Shafer.

There are risks associated with any beauty procedure, medical treatment, or "tweakment." With Botox specifically, a number of factors can contribute to adverse side effects, from the person holding the needle to where it's being injected. The most common side effects include swelling and bruising, which typically subside after 24 hours.

Less common? Ptosis, which can lead to the dreaded "eyelid droop", or a heavy feeling around the eye or brow area. This tends to happen when the injection is administered incorrectly. "When the injections are placed too close to the eye, the medication can temporarily weaken the lifting muscles of the eyelid, leading to eyelid ptosis, or the muscles of the forehead leading to brow ptosis," says Dr. Shafer.

The best way to lower your chances of experiencing any complications is to visit a licensed, experienced medical professional (and avoid those $50 Groupon deals . . . trust).