What Is Botox? (Plus, More Helpful Info)

Botox isn't really the new kid on the injectables block, but what is it, exactly? Find out the answer — plus, how it works, who it's right for, and more, according to experts.

What Is Botox?
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Depending on your experiences, you may consider Botox a must-try and one of the best tools for fighting off the visible signs of aging. Or maybe you have negative associations with the injectable, thinking it leads to an unnatural, "frozen" look.

Truth is, Botox has its pros and cons; it's not perfect, but it also doesn't have to mean sacrificing the ability to make facial expressions. Whether you're considering trying out the treatment or just want to learn more about how it works, here's everything you want to know about Botox.

What Is Botox?

"Botox is a chemical that comes from the botulinum toxin," according to Denise Wong, M.D., F.A.C.S, a double board-certified plastic surgeon at WAVE Plastic Surgery in California. When injected into a muscle, "that toxin prevents the muscle from working," she says.

Botulinum toxin comes from Clostridium botulinum, a type of bacteria that can cause botulism, a rare but serious illness that involves difficulty breathing and paralysis of muscles in the body, according to the Centers for Disease Control and Prevention. "Scientists knew this effect of botulinum toxin to produce this muscle paralysis," says Konstantin Vasyukevich, M.D., a double board-certified plastic surgeon at New York Facial Plastic Surgery. "And, they decided, 'maybe it's a good idea for us to start using it in a situation when muscles are working too hard.'" Initially, ophthalmologists used Botox to treat blepharospasm (uncontrollable eye twitching) and strabismus (a condition that results in becoming cross-eyed) in the '80s, according to Time. But soon practitioners began noticing its wrinkle-reducing effects, as well. (Related: This New "Wrinkle Studio" Is the Future of Anti-Aging Skin Care)

If you want to get technical, Botox prevents nerves from releasing a chemical called acetylcholine. Normally, when you want to initiate a movement, your brain tells your nerves to release acetylcholine. The acetylcholine binds to receptors on your muscles, and the muscles respond by contracting, explains Dr. Wong. Botox prevents the release of acetylcholine in the first place, and as a result, the muscle doesn't contract. "It causes a temporary paralysis of that muscle," shesays. "That allows the overlying skin above that muscle to not contract, which leads to smoothing out of the wrinkles or the creases that you see on the skin."

The reason that Botox doesn't cause completemuscle paralysis is the dosage of the botulinum toxin in the formula,says Dr. Vayukevich. "'Neurotoxin,' sounds very scary, but the reality is that all medications are toxic in high doses," he explains. "Even though Botox is toxic in very high doses, we use a very minuscule amount, and that's what makes it safe." Botox is measured in units, and injectors typically use multiple units in a single treatment. For example, an average dosage of 30 to 40 units might be used for the forehead area, according to the American Society of Plastic Surgeons (ASPS). The botulinum toxin in Botox is extremely diluted. To give you an idea of just how much, "baby-aspirin-size amount of powdered toxin is enough to make the global supply of Botox for a year," according to Bloomberg Businessweek.

Botox is the name of a specific product, and it's one of several neuromodulator injections that contain botulinum toxin currently available. "Botox, Xeomin, Dysport, Jeuveau, all of those fit under the broad term of neuromodulator," says Dr. Wong. "They kind of differ in how they're purified and the preservatives and things that [are] within the formulation. That leads to slightly different effects, but they all kind of do the same thing" (i.e. relax a muscle).

What Is Botox Used For?

As you may have surmised from the aforementioned wrinkle-smoothing effects of Botox, it's commonly used for cosmetic purposes. Botox is approved by Food and Drug Administration for three cosmetic uses: treating the glabellar lines (the "11 lines" that can form between the eyebrows), lateral canthal lines ("crow's feet" that can form outside your eyes), and forehead lines.

The injectable also has multiple FDA-approved medical uses. Botox's muscle-relaxing effects are sometimes used to help prevent migraines (when injected into the forehead area and neck at the base of the skull) or TMJ (when injected into the jaw). It can also treat an overactive bladder, hyperhidrosis (excessive sweating), or the aforementioned eye conditions, among other applications, according to Allergan (the pharmaceutical company that makes Botox).

However, it's extremely common for providers to inject Botox elsewhere on the body, utilizing it in "off-label" ways. "It costs companies a lot of money to get approval [from the FDA], and they cannot just get approval for all the areas at once," says Dr. Vasyukevich. "And the companies just decide, 'Hey, we're not going to do it. We're just going to get it approved for the frown lines and everybody's going to be using it 'off-label' on all those other areas.' That's just how the system works."

"I think generally it's safe [to try an off-label use], as long as you go to someone who obviously knows the anatomy and has a background in terms of experience injecting Botox," says Dr. Wong. (Your best bet is to visit a board-certified dermatologist or plastic surgeon, although other medical professionals can legally administer Botox. In some states, registered nurses and physician's assistants trained in Botox can administer the injection in the presence of a physician, according to the International Association for Physicians in Aesthetic Medicine.) Common off-label uses include injecting Botox to slim out the jaw, smooth out "bunny lines" that form when creasing the nose, smooth creases above the upper lip, add lift to the upper lip with a "lip flip," smooth out neck lines, or lift the brows, adds Dr. Wong. (Related: How to Decide Exactly Where to Get Fillers and Botox)

When Is the Best Time to Start Botox?

If you're considering Botox for cosmetic purposes, you might be wondering, "when should I start?" and there's no universal answer. For one, experts are divided as to whether or not "preventative Botox," administered before wrinkles have formed to limit your ability to form wrinkles-causing facial expressions, is helpful. Those in favor of preventative Botox, which include Dr. Wong and Dr.Vayukevich for the record, say that starting sooner can help prevent minor lines from becoming deep wrinkles. On the other hand, those who don't think it's worthwhile argue that starting Botox too early for a prolonged period might cause a muscle to atrophy and overlying skin to appear thin or that there's not enough evidence proving Botox is helpful as a preventative step, according to reporting from InStyle.

"The more you make a movement, the deeper the crease is going to be," explains Dr. Wong. "Eventually that crease will just get etched into your skin. So if you inject Botox to prevent you from doing that motion, it can help prevent the deepening of that crease." The sooner you start treating a wrinkle, the easier it is to smooth out, she says.

"Not everybody needs Botox in their 20s, but there are some people who have very strong muscles," says Dr. Vasyukevich. "You can tell when you look at them, the muscles of their forehead are constantly moving, and when they're frowning, they have this deep, very strong frown. Even though they are in their 20s and they don't have wrinkles, with all that strong muscle activity it's only a matter of time before the wrinkles start developing. So, in those particular circumstances, it makes sense to inject Botox, to relax the muscles."

What to Expect from Botox

Botox is a relatively quick and easy "lunch break" procedure in which your injector uses a thin needle to inject the medicine into specific areas, says Dr. Vasyukevich. The results (cosmetic or otherwise) typically take four days to one week to show their full effects and can last anywhere from three to six months depending on the person, adds Dr. Wong. Data from 2019 shows that the average (out-of-pocket) cost of a botulinum toxin injection treatment in the U.S. was $379, according to data from The Aesthetic Society, but providers typically charge patients on a "pet unit" basis rather than a flat fee. Getting Botox for cosmetic reasons isn't covered by insurance, but it's sometimes covered when used for medical reasons (i.e. migraines, TMJ). (Related: A TikToker Says Her Smile Was "Botched" After Getting Botox for TMJ)

Common side effects of Botox include minor bruising or swelling in the injection site (as is the case with any injection), and some people experience a headache following the procedure though that's uncommon, says Dr. Wong. There's also the potential for eyelid dropping, a rare complication with Botox that can occur when the medication is injected near the brow and migrates to the muscle that lifts the eyelid, explains Dr. Vasyukevich. Unfortinatelty, as well documented by this influencer whose Botox left her with a misshapen eye, the complication can last for about two months.

While it's not a side effect, there's always the chance that you just won't like your results — another factor to take into account before giving Botox a go. Unlike filler injections, which can be dissolved if you're having seconds thoughts, Botox isn't reversible, albeit temporary, so you'd just have to wait it out.

With all that said, Botox is generally "pretty well-tolerated," says Dr. Wong. And FWIW, it doesn't necessarily have to give you a "frozen" look. "In the fairly recent past, a successful Botox injection would mean that the person wouldn't be able to move a single muscle around their forehead, for example, if that area was injected," says Dr. Vasyukevich. "But, all the time, the aesthetics of Botox change. Now, most people want to be able to express surprise by lifting their eyebrows, [disappointment by being able to] frown slightly, or when they smile, they want their smile to appear natural, not just smiling with their lips." So how do docs make these requests a reality? Simply by "injecting less Botox and injecting it more precisely, specifically into certain areas that cause wrinkles, but not the other areas to completely inhibit the movement," he explains.

That means you've probably encountered at least one person who's had Botox, even if it was unnoticeable to you. Botulinum toxin injections were the most commonly administered cosmetic treatment of 2019 and 2020, according to statistics from the ASPS. If you're thinking of getting in on the action, your doctor can help you suss out whether Botox is right for you.

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