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Botulinum Toxin Injections -- Cosmetic


Botulinum toxin (botox) is made from a type of bacteria. Another name for it is bacterial neurotoxin. An injection of botox blocks the chemical signal from the nerves to the muscles, resulting in temporary paralysis of that muscle. This will decrease muscle contraction and reduce the formation of wrinkles.

There are several types and brands of this toxin. Examples include Botox, Dysport, and Reloxin, which are formulations of botulinum toxin type A. Myobloc is another brand, but it is a formulation of botulinum toxin type B. These products are used for cosmetic and medical reasons.

Botox is a general term. Any brand of the botulinum toxin may be used.

frown line
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Reasons for Procedure

This is most commonly used as a treatment to smooth wrinkles on the face and neck. It is FDA-approved for the treatment of frown lines between the brows (glabella wrinkles) and the treatment of wrinkles at the outer corner of the eyes (crow's feet).

Possible Complications

Complications are rare. When they occur, they are temporary and mild. Side effects are related to the site of injection. For example, if injections take place near the eyes, there may be complications with eyelids or the brow line.

Temporary issues may include:

  • Redness
  • Bruising
  • Stinging around the injection sites

The following are less common reactions. They are generally mild and do not last long.

  • Nausea
  • Fatigue
  • Flu-like symptoms
  • Headache

Other complications that may occur include:

  • Excessive weakness of the muscle around the eyes—can cause drooping of the eyelids or obstruction of vision
  • Difficulty swallowing—can occur in patients receiving injections in their neck

FDA Public Health Advisory for Botulinum Toxin

There is a risk that the botulinum toxin could spread beyond the injection area. This can cause botulism symptoms, including difficulty breathing and death. These symptoms appear to be more common in children with cerebral palsy who receive the injection to treat spasticity. The warning is for Botox , Botox Cosmetic, Myobloc , and Dysport. For more information, please visit: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm .

  • This procedure may worsen nerve or muscle disorders, such as:

The toxin can also interact with medications, such as antibiotics. Tell your doctor about all of the medications that you are taking.

You should not have botox if you:

  • Have an infection or inflammation in the area where botox will be injected
  • Are sensitive to the ingredients in botox
  • Are pregnant or breastfeeding
  • Are taking blood thinners

What to Expect


Most often, none is given. Some patients may prefer to have the area numbed for comfort. In this case, a topical anesthetic may be used.

Description of the Procedure

A thin needle will be used. The toxin will be injected through the skin into the targeted muscle. You will often need several injections in a small area.

After Procedure

There is little recovery needed, but remember to:

  • Remain upright for several hours
  • Avoid alcohol
  • Avoid massaging the area for 24-36 hours

How Long Will It Take?

The length will depend on the number of sites involved. It is often less than 20 minutes.

Will It Hurt?

You may have some minimal discomfort.

Post-procedure Care

Normal activities may be resumed after the procedure.

The toxin temporarily weakens targeted muscles. It can take up to 72 hours before the effects are noticeable. The treatment typically last for 3-4 months. With repeated use, the effects may last longer.

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • Difficulty breathing
  • Difficulty swallowing
  • Difficulty speaking
  • Severe lower eyelid droop or obstructed vision
  • Excessive weakness around the injection site
  • Rash or any other sign of an allergic reaction

If you think you have an emergency, call for emergency medical services right away.

Revision Information

  • Reviewer: Donald Buck, MD
  • Review Date: 09/2015 -
  • Update Date: 09/03/2014 -
  • American Academy of Dermatology


  • American Society of Plastic Surgeons


  • Canadian Dermatology Association


  • Health Canada


  • Ondo WG, Gollomp S, Galvez-Jimenez N. A pilot study of botulinum toxin A for headache in cervical dystonia. Headache. 2005;45(8):1073-1077.

  • Ward A, Roberts G, Warner J, et al. Cost-effectiveness of botulinum toxin type A in the treatment of post-stroke spasticity. J Rehabil Med. 2005;37(4):252-257.

  • 11/4/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: FDA gives update on botulinum toxin safety warnings. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm. Updated April 17, 2013. Accessed September 3, 2014.

  • 10/1/2013 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food & Drug Administration. FDA approves Botox Cosmetic to improve the appearance of crow's feet lines. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm367662.htm. Updated September 11, 2013. Accessed September 3, 2014.