The Basics of Botulinum Toxin (BT)

Why You Should Not be Afraid of Botulinum Toxin

Botulinum toxin (BT) is a safe neuromodulator agent that has been used for over three decades to treat not only wrinkles, but also ailments in several other areas of medicine. Neurologists use BT to treat headaches, dentists use it to treat the temporomandibular joint, and pediatric specialists use hundreds of units of BT for children with muscular dystrophy and cerebral palsy. That said, BT’s use in aesthetics has proven to be safe and effective for treating and preventing wrinkles that come from our daily facial expressions. I often tell my patients that skin is like cardboard...the more it creases over time, the deeper the lines become. BT softens that muscular activity and can provide a natural, soft look; minimizing wrinkles while still allowing for expressive movement. 

Immediately after the injections, there may be a localized, but temporary, swelling. I usually tell patients to avoid looking in the mirror for 5 minutes after treatment. These injection site reactions look like little mosquito bites and are usually gone by the time the patient leaves the office to return to their car. No one should be able to tell if someone received BT, which makes it a common “lunch break” procedure.

We also ask that patients avoid exercise and lying down for one hour after treatment. We used to instruct patients to actively use their facial muscles after injections to distribute the treatment evenly throughout their faces. However, we no longer recommend this, as studies have shown that even diffusion of the toxin occurs naturally, regardless of a patient’s attempt to use his or her facial muscles. 

Bruising is rare, but most often occurs around the eyes, where the skin is thin and has superficial vessels. Nevertheless, with a skilled injector, bruising should still be minimal despite your anatomic features. If you’re concerned about bruising, avoiding certain foods and supplements for ten days before your treatment can decrease the risk of bruising. These foods and supplements include, but are not limited to, ibuprofen (Advil), indomethacin (Aleve), fish oil, flaxseed oil, vitamin E, and aspirin. However, we do not advise that you stop blood-thinning agents if they have been prescribed by your doctor.

How Quickly Does BT Work and How Long Does it Last?

BT typically lasts three months, but in some lucky individuals, it can last longer (up to 4-6 months). Those who exercise regularly often burn through their BT faster than others, and athletic patients with fast metabolisms will start to see the effects of BT wearing off between 2 to 3 months. In addition, the onset of the wrinkle reduction effect varies from person to person. Some patients start to see the effects within hours of treatment, while for others it may be two weeks before the aesthetic effects of BT are noticeable.

This two week wait period becomes important when you’re thinking of “adding more” BT. Given this possible lag between treatment and visible results, we often tell patients to wait at least two weeks before adding more BT, if desired. The reason behind this is that if more BT is added, say, at one week post-treatment, the results from the initial treatment plus the newly added BT could be too much.

The variability in the length of time of both the onset and duration of the BT effects may depend on other factors as well. Things like diet, stress levels, exercise, and even menstruation may lead to disparities in a person’s response to BT. Further, a very small percentage of patients are thought to have built up a tolerance to BT. If this occurs, and the effects of BT start lasting 2 months, when they used to last 3 months, the answer is to try switching to a different BT. For instance, a patient who has been using onabutulinumtoxinA (Botox®) consistently for years starts to notice a longer onset and shorter duration. That patient should now try another brand, like abobotulinumtoxinA (Dysport®) or incobotulinumtoxinA (Xeomin®), for his or her next session to generate a faster onset and/or longer duration. When a person becomes “resistant” to BT, it’s not that the product is metabolized by your body faster, but rather because your body gets better at growing new nerves into the treated muscles, “re-innervating” the relaxed muscle.