Dermatologists Answer Your Most Burning Botox Questions

Ever since Botox was FDA-approved over 20 years ago, it has moved through the stages of being a high-end exclusive cosmetic treatment to something that’s as common and accessible as getting a bikini wax. And since it launched in 2002, over 100 million vials of Botox have been sold, making it the leading brand of injectables on the market.

But just because most people have heard of Botox doesn’t mean they truly understand it. There are so many questions surrounding the product, and dermatologists have pretty much heard them all. If you’ve been curious to try it out, want to know how long it lasts, or want to know if you’re already late to the party (seriously, how young is too young for injectables?), Bustle spoke with the experts who assess and treat fine lines, wrinkles, TMJ, and more with Botox injections in their office. Here are the top 10 questions Botox providers get asked the most from patients, and everything you need to know about trying and maintaining the injectable if you decide to get it.

1. How Long Does Botox Last?

Botox isn’t forever (sigh). As for how long it actually lasts, the answer you’re going to hear most often is three to four months, which is the average result seen in patients. It all has to do with the way your body metabolizes Botox once it’s injected.

“I see most of my patients for Botox every four months,” says Dr. Julie E. Russak, M.D., FAAD, a board-certified dermatologist based in New York City. You might find that your Botox wears off sooner than that if, for instance, you run a lot, says Russak, as this affects your metabolic health. “Fast metabolisms cause it to wear off faster,” she explains. “If you’re not stressed [and you’re] eating well and healthy, it will last a little bit longer.”

2. When Will Botox Kick In?

There’s not a one-size-fits-all answer to this one either, but according to Dr. George Bitar, M.D., FACS, a board-certified plastic surgeon, most patients see results three to five days after injections and the maximum effect in about a week. Unlike filler, it’s not instant. “It takes time because the substance has to reach the muscle’s cellular level to block the nerve’s neurotransmitters to cause muscle paralyzation,” Bitar explains. “Timing can also vary among patients due to muscle thickness, the area of treatment, and dosage of Botox.”

As for which areas of the face Botox works fastest in? “A good rule of thumb is usually the finer the lines, the faster the result,” says Dr. Alexis Parcells, M.D., board-certified celebrity plastic surgeon, and founder of SUNNIE Skin Care. “For example, expect to see results faster around the eyes like the crow’s feet, whereas deeper and more noticeable lines — like on the forehead and angry ‘11s’ between the brows — may take longer to kick in.”

3. Do You Have To Keep Getting Botox Once You Start?

You or someone you know may have gotten Botox just once and noticed its effects for much longer than four months, which can make you wonder if you really have to keep getting it. “At the time of injection, Botox binds to nerve endings and turns off their ability to make the chemical acetylcholine (ACH), which creates muscle movement,” Parcells explains. “This binding is immediate and permanent.” Eventually, though, Botox wears off as your nerves begin to grow new fibers, which will then make it ineffective. This typically happens within three to six months, says Parcells.

So, in short: Yes you will have to keep getting Botox if you want the “fix” to continue after Botox has worn off, but it’ll wear off at different times for different people.

4. Does Botox Hurt?

Because Botox providers are able to use super small needles to inject, getting Botox is relatively low on the pain spectrum. Your provider may also ice the injection area prior to administering it, which can lessen the pain. Most doctors describe it as a quick pinch on the skin.

If you’re extra nervous, you can ask your doctor about numbing creams or using a vibrating device to ease injection pain. Dentists utilize this latter practice when injecting novocaine into the gums: It often consists of placing a vibrating tool outside of the skin near the injection site to distract from the pain of the needle. Studies report that this method can help reduce felt pain to an infection site.

5. Do You Need Preventative Botox?

The simple answer is: If you don’t see wrinkles, you don’t need Botox. There’s no need to inject Botox in an area where there’s not even a faint line present, but you might want to consider it if you do see a faint line, as it has the potential to turn into a stronger, more visible wrinkle.

The way Botox has been used since it first got FDA approval has changed over time, and that includes when doctors suggest beginning injections. According to Russak, research has shown that Botox can have a long-term effect if you start early. “If you start it young, it will last you much longer,” she tells Bustle. This doesn’t mean that getting Botox once in your late 20s will last you into your 30s, 40s, and beyond. “If you don’t wait until you have deep lines settled and do it early instead, you don't develop those lines,” she explains.

6. Is It Possible To Start Getting Botox Too Early?

The FDA approves Botox in patients of 18 and older, so of course if you’re under 18, you won’t be able to get the treatment. “The idea behind preventive or baby Botox is to prevent dynamic wrinkles from starting to form,” says Parcells. “For this reason, many people start getting baby Botox in their late 20s or early 30s.”

Of course, you should always do what feels right for you when considering Botox. If your doctor or injector is suggesting it in places where you don’t see lines, Bitar says to speak up. “An excellent plastic surgeon listens to why a patient came in for Botox and addresses those concerns. He or she does not ‘invent’ invisible lines or wrinkles and trick a vulnerable patient into thinking they need more Botox,” he says.

7. How Do You Choose Between Dysport Vs. Botox?

Although Botox is perhaps the most well-known brand, there are multiple brands of botulinum toxin injectables. Another popular one is Dysport, which was approved by the FDA in 2009 to treat glabellar lines and crows feet.

“Dysport and Botox work in the same way,” explains Parcells. “They feature the same primary ingredient, botulinum toxin type A, which weakens the muscle strength to reduce the depth of facial lines. Pre and post-care is the same for both, and results routinely last the same amount of time. Because they are made by different companies, they are formulated slightly differently and their dosages vary,” she says.

The only difference? According to Parcells, Dysport effects will often be seen sooner than Botox — usually between one to two days. When deciding between Botox or Dysport, you should speak with your doctor about your main concerns so they can help come up with the best plan for you.

8. Should You Get Botox Or Filler?

Parcells says this question comes up a lot with her patients, and it’s important to know the difference between the two aesthetic treatments. “Botox works to selectively freeze muscles and prevent movement and lines, while filler — which usually consists of hyaluronic acid — restores volume and leads to plumper, more youthful looking skin,” she says. “Botox is usually used on the upper third of the face, and filler is commonly placed in the mid and lower face to complement a youthful glow.” Filler lasts longer, too; results can be noticeable for anywhere from six to 12 months after injections. Your doctor can help you decide which treatment will be best for you.

9. What Are The Side Effects Of Botox?

As long as you’re not allergic to Botox, Russak says the biggest side effect is bruising, which is typically mild due to the small size of needles used for injecting. Since alcohol can make the risk of bruising even higher (it increases clotting time), it’s recommended to avoid drinking alcohol for at least 24 hours prior to treatment. Otherwise, there’s not much else to worry about. “Other than patients who could potentially be allergic, there’s really no side effect,” she says.

Though it’s technically a toxin, Bitar notes that, when used properly, Botox is very safe. Rare complications may include double vision, headaches, and blurry vision, which Bitar says “typically fade within the first month to two months.”

10. What’s Botox Aftercare Like?

There are a few easy ways to take care of yourself after getting Botox injections. “After having Botox injections, do not lie down for at least three hours,” says Bitar. “Bending or reclining could spread the toxin and increase bruising.” This is why doctors will also recommend not to do yoga or any inversions, although there haven’t been studies proving that this affects the outcome of Botox.

Additionally, Bitar and Parcells recommend avoiding hot tubs, saunas, and blood thinning medications, as these might help you avoid bruising to the area (there are limited studies on this, though).

Studies referenced:

King, M. (2017). The Management of Bruising following Nonsurgical Cosmetic Treatment. The Journal of Clinical and Aesthetic Dermatology, 10(2), E1. https://doi.org/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367875/

Kuwahara, H. (2016). Using a Vibration Device to Ease Pain During Facial Needling and Injection. Eplasty. 2016 Feb 4;16:e9. PMID: 26933468; PMCID: PMC4750366.

Satriyasa, B. (2019). Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect. Clin Cosmet Investig Dermatol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489637/

Experts:

Dr. Julie E. Russak, M.D., FAAD, New York-based board-certified dermatologist.

Dr. Alexis Parcells, M.D., New Jersey-based board-certified celebrity plastic surgeon, and founder of SUNNIE Skincare

Dr. George Bitar, M.D., FACS, Fairfax, Virginia-based board-certified plastic surgeon.