What is Botox? Everything to Know About Uses, Results & Safety
Medically Reviewed by Arash Akhavan, MD, FAAD
Updated 6/26/25
Dr. Arash Akhavan is recognized as one of the most well-known Botox Cosmetic experts in the United States. As a member of the Allergan Medical Institute faculty, he plays a key role in training other physicians and providers in advanced injection techniques using Botox, Skinvive, and dermal fillers. With over 10,000 Botox treatments performed throughout his career, Dr. Akhavan has gained extensive experience and expertise in facial aesthetics.
Botulinum toxin type A, brand name, Botox® has become a household name synonymous with reducing the appearance of fine lines and wrinkles. As a board-certified cosmetic dermatologist, I frequently receive inquiries about what exactly Botox is and how it works. But the most frequent questions I am asked about Botox are are typically centered around what Botox is used for.
This post gives an in depth background review on Botox for informational purposes. If you are ready to book a procedure we invite you to visit our main Botox treatment page to learn about the procedure at our clinic.
What exactly is Botox anyways?
The Invention of Botox Cosmetic
Botox is a formulation of botulinum toxin type A, a neurotoxic protein produced by the bacterium Clostridium botulinum. The journey of Botox from a deadly toxin to a cosmetic miracle is fascinating. In the late 1970s, ophthalmologist Dr. Alan Scott first utilized botulinum toxin to treat strabismus (crossed eyes). His work paved the way for further research, leading to the discovery that botulinum toxin could also alleviate muscle spasms and, notably, smooth out wrinkles.
In 1989, the FDA approved botulinum toxin type A for treating certain medical conditions. By 2002, Botox Cosmetic received FDA approval for cosmetic use, specifically for temporarily improving the appearance of moderate to severe frown lines between the eyebrows (glabellar lines). Allergan, the company that produces Botox, markets the product under two different names: Botox, for medical uses, and Botox Cosmetic for cosmetic indications.
The Molecular Structure of Botox
The active ingredient in Botox is botulinum toxin type A. This neurotoxin is composed of a heavy chain and a light chain connected by a disulfide bond. The heavy chain is responsible for binding to nerve terminals, while the light chain acts as a protease, cleaving specific proteins involved in neurotransmitter release. This is how Botox works to decrease the nerve signal to the muscles.
Mechanism of Action
The mechanism of action of Botox Cosmetic is both intricate and highly effective. The botulinum toxin works by targeting the neuromuscular junction- the site where nerve endings meet muscle fibers. After the Botox in injected into the muscle, it binds to receptors on the nerve endings and travels into the nerve. The light chain of the toxin then cleaves SNAP-25, a protein essential for the release of acetylcholine. This cleavage disrupts synaptic vesicle fusion with the nerve terminal membrane, inhibiting neurotransmitter release and resulting in muscle relaxation.
Brands of Botox
At this point just about everyone has heard of Botox, but did you know that there are different brands of Botox that are used to treat wrinkles? We use the term Botox to refer to all of them, just how we use the brand name Kleenex to refer to all facial tissues.
The different brands act mostly the same as each other, but there are some subtle differences that are important to understand. The primary active molecule—botulinum toxin type A—is the same across all these brands. However, what sets them apart are the accessory proteins and stabilizing molecules included in the formulation. These differences may influence factors such as how quickly the product takes effect, how long the results last, and even how it diffuses within the skin and muscle.
At our office we offer Botox Cometic treatment, Daxxify, and Xeomin. Find out why we chose these three premium brands to use and not the others! You can also read about the differences of Botox vs Daxxify on our blog.
What is the Difference Between Botox and Fillers?
Botox and fillers are two of the most popular non-invasive cosmetic treatments in the world. They are similar in that they are both injected with needles, so they are in a category of cosmetic dermatology called "injectables". They are also often manufactured by the same pharmaceutical companies. For example, Allergan is the manufacturer for both Botox and Juvederm and Revance is the manufacturer for both Daxxify and RHA. But that is where the similarities end as Botox and fillers work in very different ways and treat very different aesthetic needs. Botox is a neuromodulator, also known as a wrinkle relaxer, that temporarily relaxes targeted muscles responsible for dynamic wrinkles—those caused by facial movements like frowning, squinting, or smiling. Fillers, on the other hand, are products designed to restore or add volume to the face. Made from substances like hyaluronic acid or other biocompatible materials, fillers can smooth out deep folds, enhance facial contours, and restore lost volume in areas like the cheeks, lips, and under the eyes.
Combining Botox With Other Treatments
At The Dermatology and Laser Group we can combine your botox treatments with other services we offer in order to get the best possible results for your personal goals. Botox treatments and facials such as the HydraFacial are some of the most popular treatments at The Dermatology and Laser Group. They are both easy, non-surgical procedures that can quickly and safely rejuvenate and refresh our face. Combining botox and facials can be a great combination.
Botox and dermal fillers work in complementary ways to deliver a more complete, natural-looking facial refresh. Botox softens the dynamic expression lines caused by repeated muscle movement (like frown lines, crow’s feet, and forehead creases), while fillers restore or enhance volume in areas affected by aging—smoothing static wrinkles, lifting contours, and refining features such as cheeks, lips, and nasolabial folds. When combined, relaxing the overactive muscles helps the filler sit more smoothly and can extend the longevity of results, since the treated muscles create less mechanical stress on the skin. The outcome is a balanced, smoother, subtly lifted appearance that still looks like you—often with fewer touch‑ups and a more harmonious overall result than either treatment alone.
Research and Clinical Evidence on Botox
Botox Cosmetic treatment is one of the most common aesthetic procedures in the world. Botox has been extensively studied since its approval for medical use in 1989 and its first approval for cosmetic use in 2002, proving it to be both a safe and effective treatment contrary to the botox myth that it is toxic and not safe. Why is it, then, that one of the most common questions patients ask during Botox consultations is: Is Botox Safe?
Since its introduction, Botox has been one of the most extensively studied treatments in both cosmetic and medical fields. Numerous clinical trials and scientific articles have evaluated its safety, effectiveness, and expanding range of indications.
Botox’s journey from laboratory discovery to mainstream use began with pivotal studies in the late 20th century, leading to its first FDA approval for medical use in 1989 and for cosmetic use in 2002. Since then, ongoing research has continued to refine dosing, techniques, and new applications. Published studies in leading medical journals have demonstrated Botox’s efficacy for conditions like chronic migraine, cervical dystonia, overactive bladder, and facial wrinkles, among others.
For those interested in the latest scientific findings or ongoing clinical trials, several resources provide up-to-date information:
- ClinicalTrials.gov lists ongoing and completed clinical studies involving botulinum toxin. This is a valuable resource for patients and providers interested in the latest research and experimental uses.
- PubMed/MEDLINE offers access to thousands of peer-reviewed articles, reviews, and case studies on Botox, covering both established and emerging uses.
- The FDA and professional medical societies regularly update guidelines and safety information based on the most current clinical evidence.
This robust body of research supports the continued use and development of Botox for both medical and cosmetic purposes, ensuring that treatments are grounded in scientific evidence and best practices.
Medical Uses of Botox
The cosmetic uses of Botox typically get the most media attention, but Botox was actually approved for medical uses first and has more FDA approved medical indications, as opposed to cosmetic indications.
- Chronic Migraine: Botox is approved for the prevention of chronic migraine in adults who experience 15 or more headache days per month, each lasting 4 hours or more
- Overactive Bladder: Botox is approved for the treatment of overactive bladder symptoms from neurological conditions and detrusor overactivity, such as urinary incontinence, in adults when other medications are not effective
- Upper Limb Spasticity: Botox is approved for the treatment of spasticity in the upper limbs in both adult and pediatric patients aged 2 years and older
- Cervical Dystonia: Botox is approved for the treatment of cervical dystonia, a condition characterized by abnormal head position and neck pain, in adults
- Blepharospasm and Strabismus: The first approval for Botox was for the treatment of blepharospasm (abnormal twitching of the eyelids) and strabismus (crossed eyes) in patients aged 12 years and older
- Primary Axillary Hyperhidrosis: Botox is approved for the treatment of severe primary axillary hyperhidrosis (excessive sweating) that cannot be managed with topical treatments
In addition to these FDA approved indications, Botox is also used off-label for other medical indications such as TMJ (Temporomandibular Joint) Disorder, trapezius Botox for tension, pyloric stenosis, and spasmodic dysphonia from spasm of the vocal cords. There are also several other surprising uses of botox.
Preparing For Your Botox Visit
- To prepare for your botox visit you will first be brought back to the room and offered the opportunity to take photographs of the areas to be treated by Botox. These can serve as reference "Before" images, so you can see evidence of the rejuvenating effect that Botox has over time when done properly.
- Dr. Akhavan will then come to the room and examine and mark your muscles, checking for your individual facial movements and needs. When we mark the face we ensure that all muscles are treated in balance with each other and that there is no risk that the effects of muscle will lead to either an unnatural appearance or aging effects.
- Dr. Akhavan will then plan the perfect number of units to be used in each area and inject using a highly specialized needle from TSK called The Invisible Needle, the most comfortable needle available for injections.
- We will hold light pressure on the areas injected and give you your post-Botox procedure instructions.
Results & Effectiveness of Botox
When Will Botox Work?
Botox is one of the most popular cosmetic procedures available, in part because it is a quick and minimally invasive option for smoothing wrinkles and rejuvenating your appearance. But exactly when will Botox work?
Botox treatments provide consistently excellent results when performed by an experienced injector. For cosmetic uses, patients typically see smoother skin and softened expression lines within 7 days after treatment, with full results visible by two weeks. These effects generally last 3 to 6 months depending on the product used, though with regular maintenance treatments, results can be prolonged and enhanced over time.
For medical uses such as treatment of TMJ, chronic migraines, or hyperhidrosis, patients often experience relief within the first two weeks, with results lasting 3 to 9 months depending on the indication. Many of our patients at The Dermatology and Laser Group report not only a noticeable reduction in symptoms but also an improved quality of life.
Results may vary based on dosage, treatment area, and individual response, but when administered correctly, Botox remains one of the most reliable and effective treatments in cosmetic dermatology.
Botox Aftercare
One of the reasons Botox Cosmetic is so beloved is that it delivers great results with minimal aftercare and no downtime. Most patients are able to return to their normal activities immediately after treatment, making it an ideal option for those with busy schedules. For the first 24 hours Botox aftercare includes advice to not put pressure on the treated areas, do not lie face down or on your side and avoid exercise until the following morning. After the first 24 hours, Botox aftercare is extremely low-maintenance, allowing you to enjoy your normal routine without restrictions.
Risks and Side Effects of Botox
While Botox is a safe and FDA-approved treatment with decades of clinical use, it’s still a medical procedure and should be performed by a trained, experienced professional. The vast majority of patients experience no significant side effects. However, some mild and temporary effects can include:
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Bruising or swelling at the injection site
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Mild headache after botox or flu-like symptoms
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Temporary drooping of the eyelid or brow (rare)
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Dry eyes or excessive tearing (when treating around the eyes)
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Asymmetry or undesired muscle weakness (usually resolves as the product wears off)
- Bad Botox: This occurs when the treatment leads to unwanted effects like asymmetry, drooping eyelids, or a stiff, unnatural appearance. These issues are often the result of poor technique, incorrect dosage, or lack of knowledge of facial anatomy. When Botox is not performed by an appropriately trained professional, you could end up with botched Botox results. Unfortunately, botox can not be reversed so before visiting a dermatologist for your botox treatment find out more about how to avoid bad botox results.
Severe reactions are extremely rare, especially when treatment is administered properly. At our office, we take great care to thoroughly assess each patient’s anatomy and medical history before treatment. This minimizes any risk and ensures optimal results.
If you ever experience something unexpected after treatment, we’re here to help evaluate and address it promptly.
Eligibility and Patient Selection for Botox
Botox is not suitable for everyone. Determining who is an appropriate candidate involves considering both medical and cosmetic factors. Generally, adults in good overall health who wish to address specific concerns such as muscle stiffness, certain chronic conditions, or the appearance of fine lines may be considered for treatment. However, several criteria must be assessed before proceeding:
- Age: Most providers recommend Botox for adults aged 18 and older. There is no strict upper age limit, but individual health status is more important than age alone.
- Medical History: Patients should disclose any neuromuscular disorders, allergies to botulinum toxin ingredients, or history of breathing or swallowing difficulties. These conditions may increase risks or contraindicate treatment.
- Pregnancy and Breastfeeding: Botox is not recommended for individuals who are pregnant or breastfeeding, as its safety has not been established for these groups.
- Realistic Expectations: Candidates should have clear, realistic goals and understand what Botox can and cannot achieve. A consultation with a qualified provider is essential to determine suitability.
- Previous Reactions: Anyone who has had an adverse reaction to Botox or similar products should avoid further treatment.
A thorough medical evaluation and discussion of your goals with a trained healthcare provider will help determine if you are a good candidate for Botox treatment.
Cosmetic Uses of Botox
The FDA cleared cosmetic indications of Botox Cosmetic are more limited, although there are many off-label areas where the product is injected.
- Treatment of Glabellar Lines: Botox Cosmetic was first approved in 2002 for the temporary improvement of moderate to severe frown lines between the eyebrows (glabellar lines) in adults
- Crow's Feet: Botox Cosmetic is also approved for the temporary improvement of crow's feet lines, also called smile lines. These are the wrinkles that occur to the side of the eyes and sometimes extend under the eyes.
- Forehead Lines: Botox Cosmetic is approved for lines on the forehead.
- Platysma Bands (Vertical Neck Lines): The newest FDA clearance for Botox is for treatment of vertical neck lines caused by the platysma muscle.
In addition, Botox is used off label to improve used to treat gummy smile, to create a lip flip as an alternative to lip fillers, to treat marionette lines around the mouth, as well as in the masseter muscle to produce facial slimming.
Baby Botox or preventative botox is another popular term you may use in relation to botox treatments. By using smaller amounts and carefully targeting specific facial muscles, Baby Botox offers a way to soften fine lines while preserving natural facial expressions and movement. With its emphasis on subtlety, this treatment provides a solution for those who want to look refreshed and radiant without making a drastic change. If you are wondering what age to start botox, consult with us about when baby botox might be a good option for you.
Botox FAQs
Botox FAQs
Botox injections are generally well-tolerated, and most patients describe the sensation as a quick, mild pinch rather than pain. The needles used for Botox are extremely fine, which helps minimize discomfort. Additionally, at The Dermatology and Laser Group, we use advanced techniques to ensure a comfortable experience, such as applying a topical numbing cream or using a vibrating device that helps distract from the sensation of the injection.
The treatment itself is very quick, usually taking only a few minutes. While some patients may feel slight pressure or a mild stinging sensation during the injection, any discomfort typically subsides immediately afterward.
Patients who are concerned about pain should know that Botox is one of the most comfortable cosmetic procedures available. Many first-time patients are surprised by how easy the process is and how minimal the discomfort feels. Learn more about our Botox procedure and why so many patients trust us for their cosmetic treatments. If you are in Manhattan and interested in Botox near you we encourage you to visit us!
Botox treatment typically begins to show results within 5 to 7 days after treatment, with the full effect becoming visible around 10 to 14 days. The timing can vary slightly depending on individual factors such as muscle strength, metabolism, and the area being treated. By the two-week mark, you will see the optimal results: smoother skin and a more refreshed, youthful appearance.
We offer an optional follow-up visit about two weeks after your treatment to ensure you are satisfied with your results and to make any minor adjustments if needed. For those seeking longer-lasting outcomes, regular treatments every 3 to 4 months help maintain the effects and can even prevent new wrinkles from forming over time.
Botox treatment works by temporarily relaxing the muscles responsible for creating wrinkles, resulting in smoother, more youthful-looking skin. It is most commonly used to soften dynamic wrinkles, such as crow’s feet, forehead lines, and frown lines between the eyebrows. By blocking nerve signals to the targeted muscles, Botox prevents them from contracting, which helps reduce existing lines and prevent new ones from forming. In addition to its cosmetic benefits, Botox can relieve symptoms of TMJ, reduce excessive sweating, and even alleviate chronic migraines. We have been one of the top Botox providers for people searching for "Botox Near Me" for for over 15 years.
Botox injections are a popular and versatile treatment known for both its cosmetic and medical applications. Cosmetically, it is most commonly used to smooth dynamic wrinkles caused by repetitive facial expressions. Areas frequently treated include forehead lines, frown lines between the eyebrows (glabellar lines), and crow’s feet around the eyes. Botox can also perform subtle enhancements, such as a lip flip, which creates the appearance of a fuller upper lip, or jawline slimming, which reduces the size of the masseter muscles for a more contoured face.
Beyond its cosmetic uses, Botox has several important medical applications. It is an effective treatment for TMJ disorder, relieving jaw tension and reducing teeth grinding. Botox is also FDA-approved for chronic migraines, helping patients experience fewer and less severe headaches. Additionally, it can reduce excessive sweating (hyperhidrosis) by blocking overactive sweat glands, offering relief in areas such as the underarms, palms, and feet.
Botox is an FDA-approved cosmetic treatment that uses a purified form of botulinum toxin to temporarily relax facial muscles and reduce the appearance of fine lines and wrinkles. It is most commonly used to smooth forehead lines, crow’s feet, and frown lines between the eyebrows. In addition to its cosmetic benefits, Botox can also be used for medical purposes, such as treating TMJ, migraines, and excessive sweating. At The Dermatology and Laser Group, our expert providers, led by board-certified dermatologist Dr. Arash Akhavan, deliver natural-looking results that help you maintain a refreshed and youthful appearance.
If you are looking for the best Botox near you, we are one of the top providers in Manhattan.
No, Botox does not dissolve in the way that dermal fillers do. Instead, over time, the effects of Botox wear off as your body naturally metabolizes the botulinum toxin, gradually restoring normal muscle function.
The results of Botox treament in our NYC office typically last between 3 to 4 months, depending on factors such as your metabolism, the area treated, and how frequently you receive treatments. As the Botox breaks down, muscle movement returns, and wrinkles may gradually reappear. However, with regular treatments, many patients notice that their lines become less pronounced over time due to muscle training.
In the rare chance that you are unhappy with your Botox results, patients choose to adjust or enhance their results with a follow-up appointment, which we recommend about two weeks after your initial treatment.
Interestingly, Botox is actually FDA-approved to treat chronic migraines, making it a therapeutic option for individuals who suffer from frequent, debilitating headaches. When injected into specific areas around the head, neck, and shoulders, Botox can reduce headache frequency and severity by relaxing muscle tension and blocking pain signals.
Arash Akhavan, MD is founder and owner of The Dermatology and Laser Group, one of the top centers for cosmetic procedures in New York City for over a decade. Arash Akhavan, MD, FAAD is a Board Certified Dermatologist and an Associate Professor at The Mount Sinai School of Medicine. Dr. Akhavan is a Castle Connolly Top Doc, New York Magazine Best Doctor, and Super Doctor featured in The New York Times. Dr. Akhavan is a key opinion leader that has been featured on hundreds of media publications including The New York Times, Allure, Marie Claire, Women’s Health, Cosmopolitan, ABC News, Fox News, Fox 5, NY1, WPIX, and more. He has been featured on nationally syndicated television programs such as The Doctors.
Dr. Akhavan serves as an educator and lecturer for multiple aesthetic device and injectable companies. This allows his office access to newer technologies at an earlier date than other offices, as well as a higher level of expertise in the use of these devices. This, in turn, translates to more effective and safer treatments for our patients.
By Arash Akhavan, MD, FAAD | | Categories: Botox, Face and Neck
