Botox injections are increasingly being administered by non-medical practitioners. However, the U.S. Food and Drug Administration (FDA) recommends that patients interested in receiving Botox consult a qualified physician (often a dermatologist) because results may vary depending on who administers the injections.

The physician will compile a complete medical history, including a list of current medications and allergies, to determine if the patient is a good candidate for Botox injections (e.g., does not have droopy eyelids, neurological, muscular disease). If the patient is deemed an appropriate candidate, the physician will describe the procedure in detail. It is important that the physician inform patients about the capabilities of Botox so they do not have unrealistic expectations going into the procedure.

Although Botox can temporarily relax certain facial lines (wrinkles), it cannot actually erase them. This means that superficial facial lines will practically disappear, and deeper facial lines will appear shallower after treatment. Botox may also help prevent new facial lines from forming. A photograph may be taken at this time for comparison after the procedure.

Before Botox injections are administered, the patient is placed in an upright position on an examination table. The patient may be asked to contract the muscles in the area being treated. This enables the physician to determine the correct location for the injection. The future injection sites are cleansed with a nonalcoholic solution, and a topical anesthetic may be applied to the skin. In some cases, the area to be injected can be iced to decrease the discomfort associated with skin penetration by the needle. The physician then injects the Botox directly into the muscles that cause the facial lines. Typical patterns of Botox injection include two or three areas around each eye and four to five areas on both sides of the patient’s forehead. Depending on the skill of the physician, the type of wrinkles present and the desired effect, additional areas may be injected. If a site appears to bleed after injection, pressure may be applied to the affected area.

Discomfort during Botox injection is typically brief and minimal, and the entire procedure normally takes approximately 10 minutes. After the procedure, the patient will usually be instructed to lay semiupright or upright on the examination table for approximately two to five minutes to ensure that the injections did not produce any ill effects. It is recommended that patients avoid lying down for up to four hours after Botox injections have been administered.

There is no downtime required after the procedure and patients can immediately return to work and resume normal daily activities. To avoid or reduce bruising, patients should refrain from using aspirin and related products (e.g., ibuprofen), clopidogrel and warfarin after the procedure. They should also avoid manipulation in the treated area for several hours. This reduces the movement of Botox, which can cause ptosis (eyelid droop). Patients can apply make-up to the area after treatment.

Some physicians recommend that patients work the injected area several times in the days that follow the procedure, whereas others instruct patients to avoid using the affected muscles for several days after the injections. To date, no studies have been conducted to determine which course of action produces the most desirable results.

In some cases, patients have additional procedures (e.g., chemical peels, wrinkle fillers, laser resurfacing) to plump up newly-relaxed wrinkles, and some individuals with deeper facial lines may have two or three Botox sessions in close proximity to achieve optimal results. Results of Botox are typically apparent within three to 10 days of the procedure, according to the FDA. However, it can take up to two weeks for the final results to occur after the injections. The results can last up to 180 days, but typically last 90 to 120 days. Over time, muscle function will slowly return to normal. Repeated treatments may result in muscle atrophy (shrinkage), which typically yields longer-lasting results.

It is important to note that Botox is not always effective. In rare instances, people may experience no improvement after treatment.