There's no denying that Botox injections are more popular now than ever before. According to the American Society of Plastic Surgery, botulinum toxin injections (Botox being the most popular brand name, though there are others such as Dysport and Xeomin) were the most popular minimally-invasive cosmetic procedure in 2019, with nearly 8 million patients receiving the treatment—a nearly 900% increase since 2000. Point being, lots of people are getting Botox. That being said, if you're someone who hasn't yet gone under the needle—but are thinking about doing so—you probably have some questions (one of which being, "Does it hurt?!"). Ahead, Chicago dermatologist Dr. Jordan Carqueville and Dr. Janet Allenby, a dermatologist in Delray Beach, Florida, answer everything you've always wanted to know about Botox injections.
What Is Botox?
Simply put, "Botox is a quick, relatively painless, injectable treatment that helps reduce stubborn lines and wrinkles," says Allenby. As mentioned, Botox is the most popular brand name of botulinum toxin. It (and its counterparts, such as those other brands we mentioned) are considered neuromodulators, injections that work by affecting the way your muscles behave, explains Carqueville. "Botulinum toxin is a protein that cleaves another protein, preventing the release of a neurotransmitter so that the muscles can't contract," she says. Translation: Botox minimizes how much your muscle can move (contrary to popular belief, it doesn't paralyze them completely, just relaxes them), which in turn smooths out wrinkles.
First and foremost, your doctor will determine if you're a good candidate for Botox, because not all wrinkles are created equal, and Botox is best for treating dynamic wrinkles, or those caused by muscle movement. (The most common examples are the "11" wrinkles that show up in-between your brows when you frown or crows' feet that crop up around your eyes when you smile.) If you're starting to notice that those lines are apparent even when you're not making expressions and your face is at rest, Botox can be a good solution, says Carqueville.
As far as where Botox can be injected, for cosmetic purposes, Botox is FDA-approved for treating glabellar lines (those "11s"), forehead wrinkles, and crows' feet around the eyes, though it is used off-label on many other areas of both the face and body. It's also FDA-approved for various medical needs, such as treating migraines and reducing excess sweating.
If you and your doctor decide that Botox injections are in fact the way to go, they will asses your face, both at rest and in motion, to determine exactly how much is needed, says Allenby, who adds that sometimes photos are taken as well. The area being injected will be cleaned off with an antiseptic and then it's time for the needle.
Does Botox Hurt?
In short, no. On a scale of one to 10 (10 being something as painful as, say, child birth), Allenby says it falls at a three. "The needles are very small and thin so there really shouldn't be that much discomfort," explains Carqueville, who rates the pain level at a two. It feels like a quick and tiny pin-prick that lasts for a second or two. Depending on how deep it's being injected, you may sometimes hear a quiet, crunching-type sound as the needle goes into the muscle, but again, each injection takes a second or two. For those with a super low pain tolerance, numbing is always an option. In this case, a topical numbing cream would be applied 10 to 15 minutes prior to the injections, says Allenby—and then you really don't feel anything.
According to Allenby, the most common side effects are slight bruising or redness at the injection site. What's more problematic (but much less likely) is an incomplete absorption of the Botox that can cause asymmetry, or diffusion into unwanted areas that can cause things like drooping eyelids, adds Carqueville. That being said, these are largely mitigated when you see a licensed, experienced injector, so make sure to do your due diligence to ensure that whoever is administering your Botox injections is a professional with a strong knowledge of the injectable.
Botox truly is a lunchtime procedure—you can be in and out in half an hour, and there really is no downtime. A small red bump at the injection site is common, but normally dissipates within an hour or two and can be covered with makeup in the meantime, says Carqueville. Still, there are a few important things to keep in mind afterward. Both dermatologists we spoke with agree that it's important to keep your head upright and to avoid laying down for four to six hours after the treatment in order to ensure the Botox reacts with the muscle exactly where it's supposed to. (So put off napping, a massage, or even downward dog-ing.) Similarly, avoid strenuous exercise for four to six hours as well, since the increased blood flow that comes with a cardio workout can potentially increase the likelihood of the Botox diffusing or spreading to a place where it shouldn't go, notes Carqueville. Allenby also suggests limiting your alcohol intake for a day or so afterward to minimize the risk of bruising.
But while the procedure itself is fast and easy, don't expect the results right away. It varies, but most people start to see the effects kick-in after about five to seven days, with full results after two weeks. The two week-mark is also when most doctors will have you come back in for any minor touch-ups in the event you haven't yet reached your desired result.
Botox isn't permanent; the duration varies based on the individual and where and how much was injected, but results usually last for three to four months. So, if you love how it looks, just keep in mind that you will ultimately need to go back for more injections. And if you don't love it? Unlike with injectable (hyaluronic acid) fillers, there's no way to "undo" Botox, so you'll have to wait it out until it wears off.
Up next: Should you be Botox underdosing?