Dermatologists Answer All Your Botox Questions

If you clicked on this story, chances are you’re considering Botox and you have some questions: Is Botox safe? What are the benefits of Botox? How much does Botox cost? Is Botox right for you?

You’re not the only one interested in the injectable: Australians now spend more on cosmetic surgery than Americans. That's $350million a year spent on Botox procedures, according to the Australasian College of Cosmetic Surgery. And even though highly Botoxed celebs like the Kardashians have brought the treatment more attention than ever (for better or worse), the truth is, the effects of Botox can be super subtle.

“My patients know they’re going to leave with a natural look,” says dermatologist Dr Dendy Engelman. That’s because a good derm takes the time to see how your face moves - and injects accordingly: “I’m observing the way you speak, laugh, frown - we go through all your emotions, so I know which muscles to inject and how much,” Dr Engelman says. “And you should never feel pressured to get more than you’re comfortable with.”

Dermatologist Dr Jerome Potozkin confirms: “Over treatment and improper placement are the two biggest causes of ‘bad Botox.’”

So, start slow and see an experienced dermatologist - got it. But you probably still have some questions if you’re considering Botox for the first time. Read on for everything you should know before your first appointment.

What is Botox and how does it work?

Botox is made from a protein (botulinum toxin) that freezes your muscles. “In simple terms, Botox binds to the receptors on the muscles, so that they don’t receive the signal to contract,” Dr Engelman says. And as Dr Potozkin puts it, “Botox essentially acts as a mute button between the nerve and muscle.”

That “mute button” means you won’t be able to make the movements associated with wrinkles between your eyebrows, crow’s feet, and forehead lines. “Botox won’t help with static wrinkles, the wrinkles that are there when you aren’t making an expression,” Dr Engelman says. “The goal is to prevent dynamic wrinkles from becoming permanent static wrinkles.”

Are there any benefits of Botox beyond reducing wrinkles?

You’ve also probably heard of Botox being used to treat non-cosmetic issues, like excessive sweating or eyelid twitching. “Botox blocks the signal of the nerve telling the sweat gland to secrete sweat and relaxes the muscles around the eyes to help with twitching eyelids,” Dr Potozkin says. (Dr Engelman notes that doctors originally learned about the cosmetic benefits through therapeutic observations.)

The muscle-relaxing effects are also helpful when treating chronic migraines, overactive bladder, strabismus (crossed eyes), and maybe even depression. In fact, a Journal of Cosmetic Dermatology study found that “treatments that prevent frowning correlate with reduced negative mood.”

How much does Botox cost and how long does it last?

Prices vary based on your provider, but can cost around $10-$18 per unit (the number of units used will vary on the size of the area). Botox is typically not covered by insurance for purely cosmetic procedures.

It takes five to 14 days to activate fully (“some people go home thinking it’s not working, but it takes a few days to kick in,” Dr Engelman says), and results last three to four months.

Does Botox hurt?

Expect to feel a few quick pricks (it is an injection after all), but you can ask your dermatologist to use numbing cream if you really, really hate needles. Otherwise, the process is short and sweet, and you’ll be able to move on with your day with a little mild redness.

Is Botox safe? What are the side effects?

There is a chance that the toxin can move beyond the site of injection, causing muscle weakness, double vision, urinary incontinence; or difficulty breathing, swallowing, or speaking - any of which require medical attention ASAP. 

However, severe side effects have never been definitively linked to dermatologic use, where the doses are low. Research shows adverse effects are more likely in therapeutic cases, where the doses are much higher and other diseases are at play.

“Botox is safe and efficacious as long as you’re in the hands of someone who’s licensed and trained,” Dr Engelman says. (Note: Pregnant and breastfeeding women should steer clear.)

That said, as with any drug, there are possible side effects, albeit minor ones. “Side effects are uncommon but include a headache, bruising, and a drooping brow or eyelid,” Dr Potozkin says. If you’re one of the few people stuck with one of the latter, Dr Potozkin says your doc can prescribe eye drops to stimulate the eyelid muscle and raise the lid. “Or, if the brow is drooped, you can inject Botox into the muscles that pull the brow down to get some brow elevation.” Again, this is rare, but you can reduce your risk by seeing an experienced provider.

The bottom line: Botox is a popular treatment that comes with limited side effects when performed by an experienced dermatologist. The treatment is not super painful and lasts up to four months, but is pricey when used for cosmetic purposes.