Botox is a drug that temporarily paralyzes muscle. In small doses, it can reduce skin wrinkles and help treat a range of medical conditions, including eyelid spasms, Raynaud’s disease, and some types of migraine.

Botox is a protein made from Botulinum toxin, which the bacterium Clostridium botulinum produces. This is the same toxin that causes botulism.

Botox is a toxin, but when doctors use it correctly and in small doses, it can have benefits. It has both cosmetic and medical uses.

As a cosmetic treatment, Botox injections can reduce the appearance of skin wrinkles.

Also, the Food and Drug Administration (FDA) have approved it as a treatment for various health issues, including eyelid spasms, excessive sweating, some bladder disorders, and migraine.

What is Botox?

Botox derives from C. botulinum bacteria, which are present in many natural settings, including soil, lakes, forests, and the intestinal tracts of mammals and fish.

Naturally occurring C. botulinum bacteria and spores are generally harmless. Problems only arise when the spores transform and the cell population increases. At a certain point, the bacteria begin producing Botulinum toxin, the deadly neurotoxin responsible for botulism.

Manufacturers make Botox injections with very small doses of Botulinum toxin. The drug can temporarily paralyze muscles, which can benefit people with various muscle or nerve disorders.

Commercial preparations of Botulinum toxin include:

 

onabotulinumtoxin A (Botox)

abobotulinumtoxin A (Dysport)

incobotulinumtoxin A (Xeomin)

rimabotulinumtoxin B (Myobloc)

prabotulinumtoxin A (Jeuveau)

People casually use the term “Botox” to describe all of these products, though Botox is a registered trademark that one company owns.

 

How does it work?

Botox is a neurotoxin. These substances target the nervous system, disrupting the nerve signaling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis.

In order for any muscle to contract, the nerves release a chemical messenger called acetylcholine at the junction where nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the cells to contract, or shorten.

Botox injections prevent the release of acetylcholine, which stops the muscle cells from contracting. In this way, the toxin helps the muscles to become less stiff.

 

Cosmetic uses

The primary use of Botox is reducing the appearance of facial wrinkles.

According to the American Board of Cosmetic Surgery, Botox injections are the most popular cosmetic procedure nationwide. In 2016, over 7 million people had Botox treatments.

The effects are temporary, lasting 3–12 months, depending on the type of treatment.

People often request the injections in the following areas of the face:

wrinkles between the eyebrows, called frown lines, glabellar lines, or elevens

wrinkles around the eyes, known as crow’s feet

horizontal creases in the forehead

lines at the corners of the mouth

“cobblestone” skin on the chin

However, the FDA have only approved the injections for use around the eyes and on the forehead.

Research has not shown whether Botox could improve dark circles under the eyes. Learn more here.

 

Some people also try Botox to improve the appearance of their hair. There is little evidence that this works, however. Find out more here.

Medical uses

Healthcare professionals also use Botox to treat a variety of medical conditions, most of which affect the neuromuscular system.

The FDA have approved Botox for the following uses. Unless otherwise specified, the approval is for use in people 18 or older:

upper limb spasticity, in anyone older than 2 years

crossed eyes, or strabismus, in those older than 12 years

severe underarm sweating, or hyperhidrosis

preventing migraine in people whose migraine headaches last at least 4 hours on 15 or more days per month

reducing symptoms of an overactive bladder due to a neurological condition if anticholinergic medications do not help

eyelid spasms, or blepharospasm, due to dystonia

a neurological movement disorder called cervical dystonia that affects the head and causes neck pain

Other conditions

According to a 2017 reviewTrusted Source of existing evidence, other issues and medical conditions that may benefit from off-label Botox use include:

facial redness and flushing, including during menopause

keloids and scars from wound healing

hidradenitis suppurativa, an inflammatory skin disease

blistering lesions due to Hailey-Hailey disease, a rare genetic disorder

However, confirming that Botox is safe and effective for off-label uses will require more research. Scientists must also establish the appropriate ways to deliver treatment in each case.

 

Procedure

Clinicians use Botulinum toxin by diluting the powder in saline and injecting it directly into neuromuscular tissue.

It takes 24–72 hoursTrusted Source for the toxin to take effect. Rarely, it can take as long as 5 days for the full effects to show. They may last 3–12 months, depending on the treatment.

 

People should avoid using Botox during pregnancy or breastfeeding, or if they have ever had an allergic reaction to the drug or any of its ingredients.

Cost, time, and effectiveness

The cost of Botox depends on various factors, including:

whether it is for medical or cosmetic purposes

who provides the treatment

where the treatment takes place

the number of Botox units involved

For cosmetic use, The American Society for Aesthetic Plastic Surgery noted in 2016 that, on average:

the cost of a Botox treatment for frown lines or crows’ feet was $575

the procedure lasted 30 minutes

the improvement appeared in 1–5 days

repeat treatments were necessary every 4–6 months

the person could return to work at once

Medicare covers the cost of Botox for medical purposes that doctors deem necessary. However, due to the potentially high cost, it is important to confirm that the treatment is covered before the appointment.

When considering Botox for any reason, it is crucial to make sure that the provider is a qualified professional with the appropriate training.

 

Risks and side effects

People generally tolerate Botox injections well, and side effects are uncommon.

However, depending on the reason for the injections and the person’s response, Botulinum toxin can cause some unwanted effects, including:

dry eye, following cosmetic uses

an upset stomach

numbness

mild pain, swelling, or bruising around the injection site

a headache

temporary eyelid drooping

temporary unwanted weakness or paralysis in nearby muscles

urinary problems after treatment for urinary incontinence

a worsening of neuromuscular disorders

spatial disorientation or double vision after treatment for strabismus

corneal ulceration after treatment for blepharitis

cardiovascular events, such as arrhythmia and myocardial infarction

People should not use Botox if they have:

a sensitivity or allergy to it

an infection at the injection site

Depending on the type of treatment, there are concerns that the effects of Botox may extend beyond the injection site, possibly leading to symptoms such as difficulty breathing.

This is more likely to occur in some individuals than others, and genetic factors may play a role.

Also, some people receiving injections of Botulinum toxin type A develop antibodiesTrusted Source to the toxin that make subsequent treatments ineffective.