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Botox Treatments

As widespread as Botox may be, it still remains somewhat misunderstood. Here’s what you need to know before scheduling your first appointment.

Botox is one of the safest and most flexible aesthetic treatments available, with an impressive range of cosmetic and medical applications. This has made it the most common non-invasive cosmetic procedure performed today.

Yet there’s a fair amount of confusion regarding the intricacies of what Botox feels like, its onset, and its longevity. Below are the answers to these and other frequently asked questions.

How does it feel when Botox first starts working?

Botox is a neuromodulator that relaxes the muscles and prevents them from working at full capacity. Once Botox begins to take effect, usually 3-5 days after treatment, you should feel no discomfort or abnormal sensations.

In cases where too much Botox has been injected into a muscle, patients may experience some heaviness at the injection site. This is more common in the forehead area due to the paralyzation of the frontalis muscle, which runs along the forehead and is used to raise the eyebrows.

As we age our eyebrows naturally drop as a result of gravity and the loss of tissue elasticity. To compensate for this, the frontalis muscle contracts to “re-elevate” the brows. Over time, this can cause forehead lines to develop. Injecting the frontalis muscle with Botox to eliminate these lines must be done with caution, as the brows could otherwise end up in a very low position.

It’s important to note that even when the right amount of Botox is injected into the forehead, the eyebrows can be affected and drop, causing a temporary “hooding” of the eyelids.

More pronounced Botox-induced eyelid drooping can also occur if the toxin is injected too low on the forehead, causing it to diffuse downward and affect the levator muscle, which is used to open and close the eyes. When this happens, medications such as Naphcon or Iodipine can be used to alleviate the drooping, but unfortunately nothing will reverse it completely other than waiting for the Botox to wear off.

Expert injectors tend to dose first-time users conservatively and then increase the dosage at later sessions if necessary. When performed by an experienced professional, you should feel no discomfort once the Botox sets in.

» If you’re curious about how Botox feels, read this patient’s account of her first Botox treatment.

Preventative Botox

RELATED: Preventative Botox — Is “Prejuvention” Right for You?

How long will it take before I see results?

Understandably, many first-time patients eagerly anticipate the results of their Botox treatment. Some feel disappointed when they learn that the effects are not immediate.

Most patients begin to notice an effect 3-5 days after their injections, with full results becoming visible after 14 days. This somewhat delayed onset is due to the time it takes for the body to start reacting to the botulinum toxin. For this reason, most surgeons recommend that first-time patients (and also regular users) come back after a fortnight has passed to check on their progress.

There are other factors that figure in the onset of Botox:

  • Individuals with particularly strong facial muscles may take longer to see and feel the treatment’s effects.
  • If the wrinkles in your skin are already deeply etched, or you are an older person being injected for the first time, it’s unlikely Botox alone will smoothen the lines completely. For very deep lines, it can take up to a year before the area starts to look relaxed. Sometimes a dermal filler may also be necessary to plump out the deep corrugations in the skin.

Most plastic surgeons start new Botox users with a minimal number of units and assess the effects at a follow-up appointment, topping up if necessary, usually 2-4 weeks after the first treatment.

First-time users are often compelled to undergo Botox to look their best for an important event or vacation—therefore plan to have your first consultation and injection session two to three weeks before the special occasion so you can enjoy optimal results.

» If you’ve been thinking about getting Botox in preparation for an important event, we can help you find a qualified cosmetic doctor near you.

How long does Botox last?

As a first-time Botox user, it’s important to be mindful that your first experience is not likely to result in optimal, long-lasting results.

Don’t be disheartened: it can take multiple Botox treatments before your muscles become conditioned and respond to the botulinum toxin. Results last longer after several sessions, because the skin has more time to regenerate the collagen it needs to fill in those lines and wrinkles.

When injected for cosmetic purposes, Botox lasts between four to six months on average, but you can expect the effects of your first treatment to wear off faster — two or three months later, you will most probably need to schedule another appointment.

As Botox varies in its onset in different individuals, so will it also vary in its longevity. There are several factors that can affect how long Botox lasts.

  • Dilution of the dosage

Typically, Botox is diluted with 1 to 3 ccs of saline solution. There can be variation in the dilution because of the area being targeted. A more concentrated solution results in a more exact treatment, while a more diluted treatment allows for some diffusion of the Botox into areas that could benefit from migration of the product, such as the forehead.

Unfortunately, some less scrupulous injectors may over-dilute their dosage of Botox, meaning the patient does not receive the full benefits of the treatment. This is why it’s so important to have Botox administered by a reputable injector. Botox parties or beauty spas cannot guarantee the quality of the product.

  • Freshness of the product

Botox comes in a frozen powdered form to which saline solution is added. Ideally, Botox should be used within 24 hours of mixing, as it tends to be at its most potent when it’s fresh. However, it can be used for up to two weeks after it has been opened. The best practices will open and use vials of Botox on a daily basis, so patients get the best possible product.

  • Your metabolism

Athletes and very fit people tend to metabolize Botox at a faster rate and thus also eliminate it more quickly.

  • The area injected

Botox injected into areas with larger muscles (such as the frontalis muscle on the forehead) tend to last for a lesser period of time than areas such as the crows’ feet (where the muscles are shorter and more delicate). You can expect Botox administered to your forehead wrinkles to last up to three months, and Botox administered to the crows’ feet to last four months or longer.

  • The dosage in the region that has been injected

Conservative doses of Botox result in movement returning to the muscle more quickly than heavier doses. For first-time users, however, it’s better not to over-inject in order to avoid a heavy or frozen look in the face.

  • Your age

Older patients have less elasticity and decreased collagen production in their skin, and deeper wrinkling. The effects of Botox may therefore wear off more quickly for these patients.

In general, regular treatments yield optimal, longer-lasting results. A recent study revealed that administering Botox to a specific area on the face every four months for two years will cause the muscles to take an increasingly long time to recover.

  • Medical conditions

For certain medical purposes such as the treatment of headaches and other medical conditions, Botox may need to be administered with more regularity — your physician will determine this depending on your specific health concern.

» To see how Botox corrects lines and wrinkles, take a look these before and after images of Botox patients.

how long fillers last

RELATED: How Long Do Dermal Fillers Last?

Can I make my Botox injections last longer?

There are both long term and short term techniques to enhance the longevity of your Botox treatments.

Short term methods

Zinc supplements have recently been discovered to help extend the efficacy of your Botox treatment. In a 2012 study, Houston-based oculoplastic surgeon Dr. Charles Sopokar reported that 44 patients who took a zinc and phytase supplement called Zytase four days before their Botox injections experienced better and longer-lasting results.

The rationale behind the study is sound, since the botulinum toxin belongs to a group of enzymes that are zinc dependant. Sopokar estimated that up to 50% of the population could be deficient in zinc. Since phytase helps the body to absorb zinc, the study concluded that Botox preceded by a course of Zytase can extend the longevity of treatments by up to 30%.

Retin-A wrinkle treatments can also assist in extending the effects of Botox. The combination of Botox with a topical retinoid cream can decrease the need for additional Botox units per visit, and potentially prolong the time between treatments. Retinoids can also be applied to parts of the face not typically treated by Botox.

Avoid strenuous exercise for 24 hours after you receive Botox as it takes time before the proteins in Botox begin to affect the muscle in the treated area and properly diffuse. Vigorous exercise immediately following treatment may metabolize the product before it has had adequate time to take effect.

Moreover, exercising directly after a Botox treatment may increase the chance of swelling and bruising at the injection sites, or migration of the product.

Long term methods

When you receive your first Botox treatment, your muscles are at their strongest. This means you require more units and more frequent visits when you first start using Botox.

Over time and with regular use, your muscles will become weaker with each visit, eventually decreasing the number of units you require and the frequency of your injections.

The most effective long term way to prolong the effects of your Botox treatments is to remain constant, and receive injections before your previous treatment has entirely worn off. This will maintain the muscles in an atrophied state and keep wrinkles at bay.

Can I reverse the effects of Botox?

Sometimes, patients find that they prefer how they looked before Botox was administered, or experience unsatisfactory results due to poor injection technique.

Unfortunately, there is no way to accelerate the elimination of Botox from the system or reverse its effects. Botox must be metabolized at your body’s own natural rate.

If you are unhappy with your results because you feel they are unbalanced, you can receive injections to other muscles to even things out. Make sure you return to the injector who administered the Botox, and explain why you didn’t like the results. It’s often necessary to experiment until you achieve the outcome you are hoping for.

» If you have been contemplating the possibility of Botox but have not yet reached out to book a consultation with a plastic surgeon or dermatologist, you can conduct a free online virtual consultation with a Zwivel doctor.

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About The Author

Articles by

Emma Stone, PhD, is a contributing health and wellbeing writer for Zwivel.