Botox guide for first time users

botox-factsYou probably won’t be surprised to know that botox injections are the most common anti aging treatment in the western world.

If you are considering a botox injection for the first time – you may think it’s as simple as going to a botox party or booking yourself into a spa.  Botox is everywhere and we tend to treat it as a normal part of life nowadays.

Injecting neurotoxins into your face may be fairly common – but it certainly isn’t normal and it is potentially deadly.  The sensible approach is to tread carefully and put your safety and health first – as you should with any anti aging procedure.

Botox FAQ

With that in mind – this guide is intended to give detailed answers to key questions that a lot of first time users ask about botox.  

I have never had botox nor am I considering it but if I was – these are the things I would want to be clear about:

  • What is botox?
  • How safe is botox?
  • How long does botox take to work?
  • How long does botox last?

I figure these things are the most important questions and only when you are sure about these would you start thinking about finances. Unfortunately – Working out what botox should cost is not as straightforward as it should be but – as this is already a pretty long read – I covered that here in a separate article.

As far as possible the information here is based on research from reputable bodies and informed experts and I’ve linked to sources so you can get more detailed information if you need it.

What is botox?

Botox is a brand name for prescription medicines made by Allergan from two purified substances – Botulinum toxin Type A and Botulinum Type B – both of which are derived from toxic bacteria.

According to information given by the  leading drug information site DrugLib – true botox can only be supplied by Allergan in powdered form to doctors who make up a solution for injections according to recommended dilution rates.

FDA approval is limited

Botox is approved by the FDA for use in certain cosmetic applications (the treatment of frown lines) and to relieve the symptoms of some medical conditions.

Since its approval in 2002 the use of Botox has extended beyond FDA approved guidelines into “off label” areas in both cosmetic and medical uses.

Although FDA approval only covered the treatment of frown lines – plastic surgeons routinely give botox cosmetic (Type A) injections in the forehead, around the eyes and to soften lines around the mouth and nose.

In the medical field Botox has been used to relieve a wide range of conditions which were not covered by the original approval – from excessive sweating to cerebral palsy and Parkinson’s Disease.

How does botox work?

Botox cosmetic injections are commonly used to treat “motion wrinkles” caused by repeated movements of facial muscles.  Botox injections block the uptake of the neurotransmitter acetylcholine by the face muscle.  Even though the nerve continues to send the signal to contract the injected muscle fails to get the message and remains paralysed.   Wrinkles are softened and in some cases eliminated.

The wrinkle softening effect of botox is temporary as the toxin is broken down by enzymes in the body and eliminated over time. Further injections are then required to repeat the results.

Is botox safe?

The fact that botox is a toxic substance raises more safety concerns for users than any other anti aging procedure.  Just how safe botox is must be a big question for every first time user.  What follows is my interpretation of the data that exists on botox safety.

In many ways if you haven’t had botox before this point you are in a better situation than the early “pioneers” of the treatment since many millions of injections have been performed over the years.  Unfortunately there is a lack of proper studies into the side effects of botox use – especially over the long term.

What you do have is the simple fact that a huge number of injections have been carried out and – based on reports from medical professionals – very few serious side effects reported.  As an anti aging treatment botox seems to be one of the safest.

According to Dr Todorov at SmartSkinCare – “Botox has been one of the big successes of the cosmetic rejuvenation industry with high levels of customer satisfaction.” Dr Todorov only draws conclusions based on detailed research and has an expert’s eye view of anti aging treatments including botox.

Allergan safety information for botox

A good starting point for anyone concerned with the risks of botox is the Important Safety Information on the Allergan website.

Not surprisingly – it is a bit of a scary list including: problems with speaking, swallowing or breathing and problems caused by migration of the toxin to other areas causing overall muscle weakness, blurred vision and drooping eyelids.

The potential dangers of injecting botox according to Allergan “can be severe and result in loss of life” although they qualify this by saying that the risks are highest for those with related pre-existing medical conditions or weaknesses.

In addition to these serious side effects – the Allergan guidelines state that botox may cause localised allergic reactions including: skin redness, swelling, minor rashes and itchiness. Any reaction of this sort – although unpleasant – could be dealt with easily by stopping botox injections.

Of course Allergan are legally required to list all known botox side effects – as with any drug. So whilst it is something you need to be aware of – it doesn’t help you assess your real safety risk as a first time user of botox.

Botox safety statistics

To get a better picture of how safe botox is as a cosmetic treatment you need to look at what has actually happened – how many bad reactions have occurred and how many of them are serious?

According to Allergan when botox is used at the recommended dose to treat frown lines there has not been any confirmed serious case of toxin migration.

Migration or spread of botox away from the injection site is not good news – droopy eyes and other unflattering effects are the result. Note the manufacturer’s emphasis on frown lines. Cases of toxin migration have occurred and are more likely to arise when botox is injected into areas not covered by the original FDA approval. Poor injection technique and lack of knowledge increase the risk of similar side effects.

Trying to get to grips with the statistics on side effects and safety risks for botox as a cosmetic treatment is difficult since there is no general legal requirement for doctors to submit reports to any single body.

FDA statistics on botox

The FDA continues to monitor the safety of botox by examining “adverse reactions” which have been reported by the public, by Allergan and by medical professionals on a voluntary basis.  In 2008 in a move which caused quite a bit of press reaction –  the FDA issued a public notification of adverse reports relating to botox.

Their conclusion at the time was that most bad reactions had arisen from medical (not cosmetic) use of botox and they were largely related to the age and physical condition of the patients treated.  There was no evidence that there was a general risk to healthy people from cosmetic botox treatments.

DrugLib statistics on botox

DrugLib is a large and highly respected database of registered drugs and a source of information for medical professionals throughout the US. DrugLib collect adverse reaction reports on drugs including botox and their DrugLib records of adverse reaction reports for botox is based on their own data provided on a voluntary basis mostly by medical professionals.

A similar story emerges from their data.  They list 986 reports of an adverse event related to botox over a year from March 2009 to April 2010 – just under 500 were considered serious reactions and some 14 tragically resulted in death.

Again – this could be alarming for you as a potential first time botox user if it indicated a risk to healthy people getting botox injections for their wrinkles.

Look at the data in a bit more detail and it is clear that the great majority of the serious adverse events relate to medical botox treatments where the underlying condition of the patient was an issue – a young child with cerebral palsy or an elderly person with severe neck spasms for example.  I didn’t read every report but I failed to find one that related to a serious adverse reaction from a botox injection for wrinkles.

Conclusions on botox safety

So – to come back to what you really want to know – how safe is botox as a cosmetic procedure?

It seems to me that there are safety issues with botox but the risks relate more to the use of botox as a medical treatment for patients who are obviously not in good health to start with and who may be vulnerable as a result.  

As a wrinkle treatment for  normally healthy individuals in the right age range botox injections appear to be reasonably safe.

Based on the statistics – it seems most normally fit and healthy people in the 18-65 age range are unlikely to develop a serious (life-threatening) reaction from botox as an anti aging treatment.

In the long run a healthy person can overcome a less severe reaction to botox as the drug is broken down and eliminated by the body overtime.

If I was interested in a botox treatment for my wrinkles I would be satisfied that the procedure has a pretty good safety record but I would make sure I found a great doctor and I would take time to make the decision.  I would also think very carefully about which areas of my face were to be treated since FDA approval – based on Botox safety data and testing – only relates to injections for frown lines. Migration of the toxin may be more likely when injections are done outside this area and where your doctor is not sufficiently skilled.

In the end you have to assess the risk yourself and make your own mind up.

How long before botox takes effect?

Plastic surgeons report that one of the most common questions their patients ask is: “When will I see the effects from botox?” Many are disappointed by the answer which is the same one from all doctors.

You shouldn’t expect immediate results from botox injections. It usually takes between 2-14 days for the injection to take effect. Some people claim to see an immediate change but this is very unlikely and may be just wishful thinking.

Most plastic surgeons say the minimum time for botox to take effect is around 2 days and that most people will have seen the full results they are going to get by 14 days.  The delay in seeing results is due to time it takes for the bocy to start reacting to the toxin.

People respond differently to the injection depending on their age, the degree and depth of wrinkling and the underlying strength of their muscles.

Your facial muscle may be particularly strong in the area treated and it may take longer to see and feel the effect.  If you have very deep lines where botox is injected then the injection is unlikely to cause the deeper lines to flatten out completely to start with – especially if you are older when you start botox.

Many good plastic surgeons will start with a minimum number of injections on a new patient and assess what the effects are – topping up if necessary at the 4 week stage.  If you see no results at all by the second week (14 days) then the dosage may need adjusting.  Remember as a first timer – it will take up to a year of treatments for your doctor to get to know how well you respond and what dosage works for you.

How long will botox last?

Botox injections typically last from 3-6 months before the effects are no longer seen.  Over time enzymes released by the the body break down and eliminate the toxin and at the same time new receptors and neurotransmitters are created.   The result is that muscle movement gradually returns and the old wrinkles start to reappear.

Based on the comments of many experienced plastic surgeons replying to questions on the RealSelf website – the staying power of botox is a very individual thing. Several factors influence how long botox will last for you:

1. Rates of metabolism – some people metabolise the toxin quicker than others
2. Strong facial muscles mean the effects of botox may wear off more quickly
3. Hard cardio exercise can reduce the time botox stays effective
4. Repeated treatments weaken muscles and extend botox effects
5. First time users may  find botox lasts less time as muscles are at their strongest
6. The skill of the person doing the injections impacts how long botox lasts
7. Careless storage of botox solution or excessive dilution reduces botox effects

Do I need a doctor to inject botox?

A one word answer would do here – YES!  

There are so many reasons you should use a properly qualified and experienced doctor that they are almost too many to mention but biggest reason above all is your health and safety.

Go back to what the makers of botox say – according to Allergan “The safe and effective use of Botox Cosmetic depends upon proper storage of the product, selection of the correct dose, and proper reconstitution and administration techniques.” The muscle structure of the face is complex and you need someone with a detailed knowledge of how it works.

Only a board certified medical professional with a lot of experience in giving botox injections can oversee the safety of this procedure properly and deliver the results you are looking for.  

If you go outside the medical world to a spa or botox party you are more likely to get scammed – dilution ratios or storage of botox may not be correct and you may get little or no effect for your money.  Worse you may get a bad reaction from an incompetent and unqualified person.

Find a board certified plastic surgeon with aesthetic experience – someone who regularly does cosmetic surgery and rejuvenating treatments.  Use the American Society of Plastic Surgeons referral service or RealSelf have a list of board certified plastic surgeons by location.

Before you take that first step though – take time to read and research botox as much as possible including the articles on this site.  Whatever decision you make you need to feel confident about it and that only comes from making an informed choice.

About Eileen

I am the publisher of Simply Anti Aging and a web author researching and writing on all aspects of anti aging. I'd love you to connect with me on


  1. Does Botox injection look worse before it gets better? I just recently had some injections right around my eys like Sunshine and when I woke up the fat pads are more pronounced and the wrinkles seem to be more noticeable as well. Even though it hasnt been 5 days – the few other times I had botox I dont remember waking up the next day looking worse. Will this most likely smooth out as the days go by? Is is normal to look a bit worse the day or 2 after before the botox starts to kick in?

    • Donna – you need to go back to the place you had your botox injections and talk to them about what has happened. They are really the only ones who can help reassure you. If you need to you could also get a second opinion but make sure you find a reputable and experienced botox professional surgeon. Good luck!

  2. I am sure that botox freezes the face. How long will the individual suffer from lack of face expression? That is the common funny story of Botox. Can you at least give an estimate of the effects of “freeze”, meaning number of days that the person may not be able to display any emotions or whatever is associated to it?

    • Eileen Gravelle says:

      Shirley – the frozen expression you refer to with botox comes from getting your injections from an inexperienced or unqualified person. You should avoid this if you choose an aesthetically trained facial plastic surgeon with a lot of experience in doing botox injections. The effects of botox are not long lived but if it goes wrong then you may need to wait 3-4 months for the effects to be reduced unless you get further treatment to remedy the mistakes. In the end it is up to you whether you want to opt for this type of procedure – my point is you should make an informed choice.

  3. Hi I got botox 2 weeks & 5 days ago. I recieved 36 units around my eyes for crows feet, 10 of them were done under each eye. After 5 days my lower eyelid became weaken & I got bags under my eyes from the muscle weaken & my fat pads buldging out, my tear troughs are terrible on one side they are deep & long. I look older & tired & am scared half to death this will not wear off & I will not look like I did before. I had eye pain & saw another dr he gave me drops & said it was because the whites of my eyes were showing under my eyes making my eyes dry out. I have read terrible stories where people have had this happen & they never looked normal again. I am only 36 and never had bags or deep tear troughs before. I know botox wears off but will the bags & tear troughs go back to the way the were. I have no self confindence and feel so ugly and depressed. Please I need answers and would love to know if I can do anything to get this back to normal. Thank you!!!!

    • Eileen Gravelle says:

      Sunshine – what a terrible story – botox for some can go badly wrong. Your first stop is the doctor responsible for your botox injections but if you don’t want to go back there you need to find an experienced skilled doctor to help. Look on the website – you can register and ask questions about botox and there are a range of professionally qualified people to offer advice/correction.

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