Botulinum toxin therapy

Before treatment: This woman disliked her deep frown lines.

Botulinum toxin therapy: Overview

Also called botulinum rejuvenation

Brand names: Botox® Cosmetic, Dysport®, MYOBLOC®, and XEOMIN®

When you look in the mirror, do you see deep frown lines? These lines bother many people.

To diminish these lines , many choose botulinum toxin therapy. Patients like that they can return to most everyday activities immediately after the procedure. They like that most people see results within 3 to 7 days.

A dermatologist can perform the treatment during a single office visit. The improvements last about 3 to 4 months — and sometimes longer.

After treatment: Relaxing certain facial muscles softened this woman's frown lines.

Uses: Dermatologists use botulinum toxin therapy to diminish signs of aging and to treat a medical condition called hyperhidrosis (excessive sweating). Botulinum toxin therapy is approved by the U.S. Food and Drug Administration (FDA) to treat the following dermatologic conditions:

• Frown lines between the eyebrows.
• Crow's feet.
• Excessive sweating in the underarms when treatment applied to the skin does not work well enough.

Insurance coverage: This varies with insurance plans. In general, you can expect:

• Signs of aging are not covered.
• Excessive sweating may be covered, at least partly. You should contact your insurance company to find out what your policy covers.

Images used with permission of the Journal of the American Academy of Dermatology. Ascher B, Zakine B, et al. “A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A in the treatment of glabellar lines.” J Am Acad Dermatol. 2004;51:223-233.

Botulinum toxin therapy: FAQs

Botulinum toxin therapy is one of the most popular cosmetic treatments available. To help you decide whether this treatment is right for you and to have the treatment performed safely, the AAD provides the following facts.

Warnings

Buying botulinum toxin online jeopardizes your health. This product should require a medical license to purchase. If you do not need to show proof of a medical license, the product differs greatly from what a dermatologist uses.

Injecting a product that you can buy without showing a medical license can cause serious complications. Cases of long-term muscle paralysis, Bell’s palsy, and permanent eye damage have occurred.

Getting botulinum toxin injections in a non-medical setting also can be extremely dangerous. To protect your health, you should never get botulinum toxin injections at a:

• Non-medical spa.
• Party.
• Salon.
• Someone's home.

What happens during this procedure?

A dermatologist injects very small amounts of purified botulinum toxin. 

When treating fine lines and wrinkles, the dermatologist injects botulinum toxin into targeted muscles on the face or neck. This temporarily relaxes the targeted muscles, causing fine lines and wrinkles to diminish. The effect lasts about 3 to 4 months — and sometimes longer.

When treating excessive sweating, a dermatologist injects directly into the skin on the underarm. A single treatment can provide up to 6 months of relief from excessive sweating. 

Will I lack facial expressions after treatment?

Dermatologists want their patients to look natural. To do this, they inject just enough to weaken and relax the targeted muscles without affecting other muscles. This allows patients to maintain their natural facial expressions.

Will I lose my sense of feeling where I have the injections?

No. This treatment does not affect your ability to feel. 

When is it safe to have another treatment?

You can have another treatment when the excessive sweating or lines and wrinkles return. With repeat treatment for lines and wrinkles, the muscle may thin, leading to longer-lasting results.

Is there downtime?

Most people return to the everyday activities immediately. As soon as you leave the treatment room, you can apply makeup.

What must I do after the procedure?

To prevent the injected substance from spreading to areas where you do not want it, you’ll need to take a few precautions:

• Do not rub or massage the areas where you received the injections. 
• If you apply makeup, take care not to press or rub it in.
• Wait two hours before you engage in strenuous physical activity. This includes lifting heavy items, working out, and any other physical activity that raises your heart rate. 

What are the possible side effects?

If a patient develops side effects, these tend to be mild and temporary. The injections, rather than the botulinum toxin itself, cause most mild side effects. For example, a patient may occasionally bruise. If this happens, the bruising lasts about 1 week.

After receiving injections, people have experienced:

• Swelling.
• Redness.
• Soreness.
• Bruising.
• Mild headache (uncommon).
• Weakness in a neighboring muscle, leading to a temporarily droopy brow or eyelid (rare).
• Signs and symptoms of botulism, including problems breathing, swallowing, or speaking (very rare).

What is the safety record for this procedure?

More than 20 years ago, a dermatologist and his wife, an ophthalmologist, began using botulinum toxin therapy to treat signs of aging. Today, medical professionals inject millions of patients each year.

When used by a dermatologist to treat signs of aging or excessive sweating, no serious side effects like problems breathing or swallowing have ever been reported.

Dermatologists continue to make patient safety their No. 1 priority. Each year, the AAD offers continuing medical education sessions that include best practices for treating patients with this treatment. Dermatologists continue to make new research breakthroughs in the use of botulinum toxin therapy.

Dermatologists have millions of satisfied patients. They treat people of all colors and skin types with botulinum toxin therapy.

If you are interested in this treatment, you should consult a dermatologist.

Botulinum toxin therapy: Preparation

To protect your health and get the results you seek, you should see a dermatologist. Injecting botulinum toxin may look easy, but to inject it safely requires in-depth medical knowledge of how the body works.

The AAD recommends the following to everyone interested in botulinum toxin therapy.

Questions to ask before the procedure

Before performing a cosmetic treatment, a dermatologist offers a consultation. During the consultation, you should ask questions. Asking questions will help you know what to expect so that you can make an informed decision.

The AAD recommends asking the following questions before getting this procedure:

• How many of these procedures have you performed? Results depend largely on the expertise of the person performing the procedure.
• Who will give me the injections? You should get all injections from a board-certified dermatologist or a member of that doctor’s medical staff. When a member of the medical staff gives these injections, the dermatologist should be in the office and immediately available. 
• How much will the treatment cost? Most insurance companies do not pay for cosmetic treatments. Some patients need to pay a portion of the cost to treat excessive sweating. Make sure you know your cost before you get the procedure. 
• What results can I expect? A dermatologist can tell you whether the procedure will deliver the results that you seek. A dermatologist can do this by considering the condition of your skin as well as your age and health. 
• Do I have a higher risk for any complications? By reviewing your medical history, a dermatologist can tell you whether you have a higher risk. 

Your dermatologist also can tell you whether another treatment would be a better option for you. You may find that your dermatologist recommends using more than one treatment. Results from many research studies show that combining treatments can lead to better, longer-lasting results.

Vital information to tell your dermatologist

If you decide to have botulinum toxin therapy, be sure to give your dermatologist the following information:

• All medicines you take. Be sure your dermatologist knows about all pain-relievers, blood thinners, and other medicines. Include medicines that you buy without a prescription, such as aspirin. 
• All herbs, vitamins, and minerals you take. Even if you haven’t taken these for a while, be sure to mention them. 
• If you are pregnant or plan to become pregnant. It is not known whether botulinum toxin therapy can harm an unborn child. 
• All surgeries and cosmetic treatments you have had. While some patients feel embarrassed talking about this, the information you share can make a difference in the results you see. Don’t omit anything — even if it seems unimportant.

© 2019 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission. Use of these materials is subject to the legal notice and terms of use located at https://www.aad.org/about/legal