When it comes to an ice-skating-rink smooth forehead, few treatments rival the power of Botox. So it's hardly surprising that an estimated 900,000 Botox injections are carried out in the UK each year.
The fact is, people are curious about its wrinkle-reducing abilities, with shows like Love Island said to be some of the reasons behind the surge in popularity. Plus, experts are now able to use Botox to produce a wider range of results, meaning it is increasingly being used as an alternative to more invasive surgical procedures.
But every cosmetic procedure comes with risk and Botox is no exception. There are also currently safety concerns that under-30s are overdoing treatments in an attempt to recreate social media filters in real life.
So if you're thinking about Botox as a possible next step, the most important thing is to arm yourself with all the facts. What is Botox? How does it work? What are the risks and how long does it last?
Keep scrolling as some of the cosmetic industry's leading experts outline everything we should be aware of to make sure we're fully informed.
What is Botox and how does it work?
Botox is a trade name for Botulinum toxin, a neurotoxic protein that temporarily paralyses muscles when injected. “Botulinum toxins block nerve signals to the muscles,” says cosmetic doctor and skin ageing expert, Dr Anne Mendelovici. “As a result, injected muscles can’t contract reducing unwanted wrinkles. These effects are always temporary, and usually last about 3-6 months.”
Are there different types of Botox?
Yes, Botox is available in two forms.
- Type A. Type A is mainly used for treating facial wrinkles. “All cosmetically used botulinum toxins are type A (FDA approved) and have the same effect, which is temporary muscle paralysis,” Dr Mendelovici explains. “Common type A injections include Dysport®, Xeomin®, Azzalure® and Botox® – the latter being one of the most widely known brands of botulinum toxin injections. For the patient, there is no difference in the product that is used as the effect remains the same.”
- Type B. Type B is often the first choice for treating neck spasms. It's sold as rimabotulinumtoxinB (Myobloc).
Dr Mendelovici adds: “There are a lot of different brands of Botox out there, including some that aren’t FDA approved such as Meditoxin and Botulax. I therefore strongly recommend visiting a trusted certified aesthetic doctor.”
What is Botox used for?
Alongside its strong association with the cosmetics business, Botox has many other uses within modern medicine:
- Relax facial muscles - Botox shots block certain chemical signals from nerves that cause muscles to contract. The most common use for these injections is to relax the facial muscles that cause frown lines and other facial wrinkles.
- Teeth grinding - According to Dr Tijion Esho, UK cosmetic doctor and founder of the ESHO Clinic, Botox is approved for the treatment of Bruxism (teeth grinding). Injecting into the Masseter muscle relaxes it and people have found that their jaw clenching and teeth grinding is greatly reduced, resulting in fewer headaches.
- Neck spasms – To give this its technical name, cervical dystonia causes the neck muscles to contract in an uncontrolled way and the head to twist into a painful position. “Neck spasms can be very painful and uncomfortable," Dr Mendelovici says. “Botox injections in the neck help to relax the muscle and therefore prevent the spasms from happening. We usually inject cervical muscles with a higher dose than other areas of the face, anywhere from 140 units to 280 units.”
- Excessive sweating – Botox might be used for a condition known as hyperhydrosis, in which people sweat a lot even when they're not hot. According to Dr Esho, Botox blocks the nerves that control the sweat glands.
- Migraine – Botox injections have also been approved for treating chronic migraines. Treatment is needed about every three months to retain the benefit. “Botox can be used to treat chronic migraines by relaxing the frontalis, temporal and cervical muscles," Dr Mendelovici notes. "The recommended total dose of Botox for chronic migraine prevention is 155 Units administered into the muscle. This is given as 0.1 mL (5 Units) injections divided across 7 specific head and neck muscle areas, for a total of 31 individual injections per session. It is recommended to start with two treatments 12 weeks apart to assess the results, and then continue every 12 weeks if the patient notices an improvement.”
- Other muscle spasms - "Botox is effective in treating squints, unstable bladders, anal fistures and vocal chord spasms," Dr Esho adds.
What to expect during the procedure
“Prior to having Botox for the first time, potential patients should read up as much as possible and go to their initial consultation to ask as many questions and gain as much clarity on their procedure as possible,” says Dr Marwa Ali, advanced aesthetic doctor at The Wellness Clinic in Harrods.
“With regards to skin prep, patients don’t really need to do anything beforehand," she continues. "If a patient is prone to bruising or prescribed blood thinning medication, taking arnica pills may be useful. However, it’s highly unusual to get bruising from Botox as the needle is very small and injections are carefully placed.”
Most people also don't feel much pain during the procedure, but “numbing cream can be applied to make the procedure as comfortable as possible,” adds Dr Marwa.
What about after care - what should you not do after Botox?
“Following Botox, I always advise patients to remain upright for around four hours and to avoid any strenuous activity such as exercise, saunas, steam rooms, cryotherapy, facials and alcohol,” Dr Ali explains. “The idea is to avoid anything that might cause an increase in blood flow to the head and neck and to avoid migration of the carefully placed Botox injections.”
How long until Botox injections begin working?
“In general, you can see the effects of Botox as early as three to four days following treatment but you should wait the full 14 days to see the maximum results," Dr Mendelovici notes, adding that she offers all patients a complementary top-up two weeks post treatment if there is still too much movement.
What are the common side effects of Botox?
“The most common side effects of Botox are redness and some swelling from the needle penetrating the skin, but both are short lived and should only last a few minutes,” says Dr Ali. Sometimes patients bruise, but applying an ice pack and arnica cream immediately after the injections can avoid this from happening.
What are the risks of Botox?
While Botox has been deemed safe, no medical or aesthetic procedure is without risks.
"Some are purely due to the needle, such as bleeding, bruising and infection," explains Dr Esho.
Other risks, however include a brow drop. “This is due to Botox migrating, causing a neighbouring muscle to relax,” Dr Ali explains. “It tends to happen if too much Botox is injected or if it’s injected too deep. Going slow and injecting smaller doses can help to avoid this.”
Dr Esho maintains that even though the results don't last forever, there could be long term consequences. "Overuse of the toxin, repeatedly, can result in excessive thinning and weakening of the muscles involved," he says. Therefore, it's important to wait until the toxin has completely worn off before having more injected, and to seek out a skilled and experienced practitioner who is careful about the amounts they use.
It is also worth noting that Botox has the potential to cause an allergic reaction in some individuals. Symptoms of an allergic reaction following Botox treatment may be mild or severe and can include itching or a rash.
How long does Botox last?
"Botox is self limiting and normally lasts between four to six months," notes Dr Esho.
What age should you start Botox?
According to Dr Mendelovici, the average age for people to receive their first Botox treatment is in their 30s, as most people begin noticing a few fine lines around their eyes or on the forehead at this age. "It is important to note, however, that Botox is approved for patients over 18 years old only," she adds.
Can preventative Botox age you?
“No, preventative Botox does not age you,” says Dr Ali. “It relaxes certain muscle groups preventing the skin from creasing and developing wrinkles in the first place. Many patients opt to prevent the development or deepening of existing lines with the idea that prevention is better than cure.”
For cosmetic doctor Dr Michael Prager the focus of preventative Botox is to "subtly lift key points using small amounts of Botox to create a fresher appearance," he says. "All the muscles and structures of the face are linked, so you have to consider how they move together in order to create a natural look."
As well as wrinkles, Dr Esho note that Botox has further cosmetic abilities that you may not be aware of. "Botox can be used to raise the eyebrow, the lip and the tip of the nose. It is also used for the treatment of a gummy smile and to slim the jawline by treating masseter hypertrophy [a condition where the jawline muscles are enlarged]."
How can you correct a case of bad Botox?
We've all seen the images or heard horror stories of botched Botox. “There is an art to injecting Botox to ensure there are no telltale signs,” Dr Ali explains. “You also need to ensure that there is balance to the surrounding muscles in order to avoid complications or unwanted outcomes such as “brow ptosis”, where the brows become heavy after having too much Botox injected in the forehead.”
Once in the face, Botox can't be ‘uninjected’ but a skilled medical professional will know if it’s possible to balance out your features by strategically adding more Botox or fillers to other parts of the face. “However, in some instances, unfortunately, the only option for a patient may be to wait until the Botox wears off over time to reverse the unwanted effects,” says Dr Ali.
Can you have Botox when pregnant?
“No, it is contraindicated to get Botox if pregnant or breastfeeding,” says Dr Mendelovici, largely because there is little known data around the effect on the foetus of injecting a toxin.
How much does Botox cost?
Depending on where you have the Botulinum toxin injected, which clinic you attend and how much is used, the prices can vary dramatically from around £100 to £500.
As a rule of thumb, you should not automatically choose the cheapest clinic – a low price shouldn't be the deciding factor when considering where to go. Your decision should be based on finding a qualified practitioner with adequate medical experience.
“Make sure you are seeing a medical practitioner,” warns Dr. Esho. "Unfortunately, in the UK, non-surgical aesthetics like Botox and fillers are unregulated, meaning that anyone, including you, could inject it with no legal consequences."
What are the alternatives to Botox?
If the idea of injectibles freaks you out, or you're simply unsure, there are some Botox alternatives to consider (which don't require needles).
EmFace is currently the buzziest of these as it uses both radiofrequency and electromagnetic stimulation to lift the face. In other words, a 20 minute appointment (there's no downtime) can improve wrinkles and skin texture as well as contour because the device works both on the skin's surface and on the facial muscles underneath.
Ultratherapy uses ultrasound technology to send energy into the deeper levels of the skin to stimulate collagen and elastin and tighten muscles. Chemical peels, address fine lines and wrinkles, while smoothing the skin's texture. And, at-home treatments like microneedling and retinol will help to smooth subtly over time when used regularly.
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