Botox 

What is Botox? Medical & Cosmetic Uses

Botox is used to smooth wrinkles and treat or prevent certain medical conditions, such as chronic migraines, severe underarm sweating, overactive bladder, strabismus, and muscle spasticity.

• Effects typically last for 3 to 4 months.
• Botox has a well-established safety profile when administered by a licensed provider.
• FDA-approved.

Botox Injection Uses

Botox Cosmetic is FDA-approved for use in Appearance Medicine for:

• Frown lines
• Crow’s feet
• Forehead wrinkles
• Neck bands

It may also be used off-label for bunny lines and jaw slimming .

Botox Therapeutic is FDA-approved for the following medical conditions:

• Overactive bladder (OAB) and urinary incontinence
• Chronic migraine prevention (15+ headache days/month)
• Muscle spasticity in adults and children 2+
• Cervical dystonia (neck muscle spasms)
• Severe underarm sweating (axillary hyperhidrosis)
• Eye conditions: blepharospasm, strabismus
• Neurogenic detrusor overactivity in children 5+.

Important Note: Although these formulations contain the same active ingredient, they are not interchangeable.

Pharmacist Tip

To ensure your Botox treatment is safe and effective, always get your injections from a licensed healthcare professional. This protects you from counterfeit Botox and minimizes side effect risks.

Results

Before and After Botox Cosmetic

What to Expect During Botox Treatment

Botox injections typically take just 10-30 minutes in your doctor’s office.

• Most people describe the sensation as a slight pinch, with minimal discomfort and no downtime.
• You’ll see initial results within 3-7 days, with full effects visible at 2 weeks.

How Much Does Botox Cost?

Botox Cosmetic treatments typically cost $300-$600 per treatment area and are not usually covered by insurance.

Botox Medical treatments are often covered by insurance when medically necessary for conditions like chronic migraine, overactive bladder, or cervical dystonia. Prior authorization may be required.

Financial support can be provided by AbbVie Patient Access Support in certain circumstances. 

Primary Medical Uses

• Overactive bladder (OAB) and urinary incontinence
• Chronic migraine prevention (15+ headache days/month)
• Muscle spasticity in adults and children 2+
• Cervical dystonia (neck muscle spasms)
• Severe underarm sweating (axillary hyperhidrosis)
• Eye conditions: blepharospasm, strabismus
• Neurogenic detrusor overactivity in children 5+

Primary Cosmetic Uses

• Frown lines (glabellar lines)
• Crow’s feet (lateral canthal lines)
• Forehead wrinkles
• Neck bands (platysma bands)

How Does Botox Work?

Botox (onabotulinumtoxinA) works by temporarily blocking nerve signals to muscles or sweat glands, relaxing them and providing cosmetic improvement for facial wrinkles and lines, and therapeutic relief from certain medical conditions.

For Medical Conditions:

• Relaxes overactive muscles (spasticity, dystonia)
• Improves bladder capacity (overactive bladder)
• Prevents migraine headaches (chronic migraine)
• Reduces excessive sweating (hyperhidrosis)
• Corrects eye alignment (strabismus)
• Controls muscle spasms (blepharospasm).

For Cosmetic Enhancement:

• Smooths forehead lines and crow’s feet
• Reduces frown lines between eyebrows
• Softens neck bands (platysma)
• Creates a refreshed, youthful appearance.

Side Effects

Common Side Effects

The most common side effects of Botox are:

• Mild injection site reactions (slight bruising, tenderness)
• Temporary headache 
• Mild fatigue.

These typically resolve within 24-48 hours.

Medical Use Specific Side Effects

Bladder Treatment:

• Urinary tract infections
• Painful urination
• Incomplete bladder emptying (may require temporary catheterization)
• Blood/bacteria in urine (pediatric patients).

Eye Treatment:

• Double vision or blurred vision
• Drooping eyelids (ptosis)
• Decreased eyesight
• Dry eyes
• Eyelid swelling

Serious Side Effects & Important Safety Information

Botox carries a Boxed Warning for distant spread of toxin effect.

Distant Spread of Toxin Effects (Boxed Warning)

Life-threatening botulism-like symptoms can rarely occur when onabotulinumtoxinA spreads away from the injection site. Seek urgent medical attention if you experience:

• Muscle weakness throughout the body
• Difficulty breathing or swallowing
• Vision problems: double vision, drooping eyelids
• Speech difficulties (dysarthria)
• Voice changes (dysphonia)
• Loss of bladder control.

Respiratory & Swallowing Problems

Respiratory and swallowing problems can occur hours to weeks after a Botox injection. People with pre-existing breathing/swallowing problems are at a higher risk. Severe cases may require a feeding tube, and rarely, death may occur if there are severe complications.

Allergic Reactions

Allergic reactions may happen with Botox. Seek immediate medical attention if you develop:

• Itching, rash, hives
• Wheezing or asthma symptoms
• Dizziness or fainting.

Tell your healthcare provider if you have any side effects that bother you or do not go away. These are not all the possible side effects of Botox. For more information, ask your doctor or pharmacist. Call your healthcare provider for medical advice about side effects.

Before Receiving

Absolute Contraindications

Do NOT receive Botox if you have:

• An allergy to onabotulinumtoxinA or the other ingredients in Botox Cosmetic or Botox Therapeutic
• An active skin infection at the injection site
• A previous allergic reaction to other botulinum products such as:
  • Dysport (abobotulinumtoxinA)
  • Xeomin (incobotulinumtoxinA)
  • Myobloc (rimabotulinumtoxin B)
  • Jeuveau (prabotulinumtoxinA-xvfs)
  • Daxxify (daxibotulinumtoxinA-lanm)
  • Letybo (letibotulinumtoxinA-wlbg).

Caution Needed

Tell your healthcare provider about all your medical conditions, including if you have:

• Neuromuscular disorders: ALS, myasthenia gravis, Lambert-Eaton syndrome
• Breathing problems: asthma, emphysema
• Swallowing difficulties
• Bleeding disorders
• Planned surgery or recent facial surgery
• Drooping eyelids or facial asymmetry
• Pregnancy plans. It is not known if Botox or Botox Cosmetic can harm your unborn baby
• Breastfeeding plans. It is not known if Botox or Botox Cosmetic passes into breastmilk.

How is Botox Administered?

Before Treatment

You’ll meet with a certified provider for a consultation. They’ll review your medical history, check for allergies, evaluate the treatment area, and go over the consent process and what to expect.

During Treatment

Your provider will clean the injection sites and administer Botox using very fine needles. The process takes 5 to 30 minutes, depending on the treatment area. Discomfort is minimal, and anesthesia typically isn’t needed.

After Treatment

Don’t rub the injection sites. Stay upright for 4 hours. Avoid exercise and facial treatments for 24 hours. Your provider will schedule a follow-up as needed.

Results Timeline

Initial effects start within 24 to 48 hours. Noticeable improvement appears in 3 to 7 days. Results peak at 2 weeks and gradually wear off over 3 to 6 months. Repeat treatments can be done as needed, with at least 3 months between sessions.

Age Restrictions

Botox is not approved for those aged:

• <18 years with urinary incontinence, chronic migraine, or overactive bladder 
• <18 years for cosmetic purposes
• <5 years with NDO
• <16 years with cervical dystonia
• <12 years with strabismus or blepharospasm
• <2 years with spasticity.

Botox for Medical Use Has Not Been Established For:

• Episodic migraine (≤14 days/month)
• Severe sweating anywhere other than your armpits.

What should I avoid while receiving Botox?

Botox may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of receiving the injection. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Avoid exercise and facial treatments for 24 hours.

Botox Cosmetic FDA Approvals: Dosing Information

Frown Lines (Glabellar Lines)

• Dosage: 20 Units (5 injection sites)
• Target: Corrugator and procerus muscles
• Results: Smoother forehead appearance

Crow’s Feet (Lateral Canthal Lines)

• Dosage: 24 Units (6 injection sites total)
• Target: Orbicularis oculi muscle
• Results: Reduced eye wrinkles

Forehead Lines

• Dosage: 40 Units total (5 injection sites forehead + 5 injection sites glabellar)
• Target: Frontalis muscle
• Results: Smoother forehead wrinkles

Platysma Bands (Neck Bands)

• Dosage: 26-36 Units total (18-28 injection sites)
• Target: Platysma muscle
• Results: Reduced vertical neck banding

Off-Label Cosmetic Uses

While not FDA-approved, common uses include:

• Lip lines (perioral wrinkles)
• Bunny lines (nasal wrinkles)
• Masseter Botox (jawline slimming)
• Gummy smile correction.

Botox Medical FDA Approvals: Dosing Information

Overactive Bladder (OAB) Treatment

• Indication: Adults with inadequate response to anticholinergics
• Dosage: 100 Units (5 units across 20 injection sites)
• Benefits: Reduces urgency, frequency, and incontinence

Neurogenic Detrusor Overactivity

• Adult dosage: 200 Units (6-7 units across 30 injection sites)
• Pediatric dosage (≥5 years): Weight-based dosing
• Conditions: Spinal cord injury, multiple sclerosis

Chronic Migraine Prevention

• Indication: Adults with 15+ headache days/month
• Dosage: 155 Units divided among 7 head/neck muscles
• Injection sites: 31 sites total
• Effectiveness: Reduces migraine frequency and severity
• Not approved for episodic migraine (≤14 days/month)

Muscle Spasticity Treatment

• Adult upper limb: Up to 400 Units
• Adult lower limb: 300-400 Units
• Pediatric spasticity (≥2 years): 3-8 Units/kg
• Conditions: Post-stroke, cerebral palsy, brain injury

Cervical Dystonia (Torticollis)

• Average dose: 198-300 Units split between affected muscles
• Benefits: Reduces abnormal head position and neck pain
• Duration: 3-4 months between treatments

Severe Axillary Hyperhidrosis

• Dosage: 50 Units per armpit (split over 10 to 20 sites per armpit)
• Indication: Inadequate response to topical treatments
• Effectiveness: Significantly reduces underarm sweating
• Not approved for severe sweating anywhere other than your armpits.

Eye Conditions

Blepharospasm (Eyelid Spasms)

• Dosage: 1.25-2.5 Units per site (3 sites per eye)
• Age: Adults and children 12+

Strabismus (Crossed Eyes)

• Dosage: Dosage varies based on prism diopter correction or previous response.
• Age: Adults and children 12+

Botox vs. Other Treatments

Treatment	Duration	Best For	FDA Approved
Botox	3-4 months	Wrinkles, migraines, spasticity	Yes
Dysport	3-4 months	Similar to Botox	Yes
Xeomin	3-4 months	Cervical dystonia, wrinkles	Yes
Daxxify	6-9 months	Facial wrinkles	Yes
Dermal Fillers	6-18 months	Volume loss, deep lines	Yes

What other drugs affect Botox?

Tell your doctor about all your medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using Botox with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received Botox in the past. Especially tell your doctor if you:

• Have received any other botulinum toxin product in the last four months
• Have received injections of botulinum toxin, such as Myobloc (rimabotulinumtoxinB), Dysport (abobotulinumtoxinA), Xeomin (incobotulinumtoxinA), Jeuveau (prabotulinumtoxinA-xvfs), Daxxify (daxibotulinumtoxinA-lanm), or Letybo (letibotulinumtoxinA-wlbg) in the past. This may not be a complete list of all botulinum toxin products. Be sure your doctor knows exactly which product you received
• Have recently received an antibiotic by injection
• Take muscle relaxants
• Take an allergy or cold medicine
• Take a sleep medicine
• Take antiplatelets (aspirin-like products) or anti-coagulants (blood thinners).

Ask your doctor if you are not sure if your medicine is listed above. Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.

Ingredients

Botox Therapeutic Ingredients

Active ingredient: onabotulinumtoxinA

Inactive ingredients: human albumin and sodium chloride.

Available as 100 Units or 200 Units as a vacuum-dried powder in a single-dose vial.

Botox Cosmetic Ingredients

Active ingredient: onabotulinumtoxinA

Inactive ingredients: human albumin and sodium chloride.

Available as 50 Units or 100 Units in a vacuum-dried powder in a single-dose vial for reconstitution.

Manufacturer

Botox is made by AbbVie, which acquired the previous manufacturer, Allergan, in 2020. AbbVie is headquartered in North Chicago, Illinois, USA.

Common Questions About Botox

What is Botox?

Botox is a cosmetic treatment used to reduce the appearance of facial wrinkles and treat medical conditions like migraines and excessive sweating.

How much does Botox cost?

The price varies, but most providers charge between $10 and $25 per unit. A typical session costs between $300 and $600, depending on the area being treated.

How long does Botox last?

Results typically appear within 1 to 2 weeks and last about 3 to 4 months, though this can vary.

What are the side effects of Botox?

Common side effects include mild bruising or redness. Serious side effects are rare but may include drooping eyelids or difficulty swallowing.

Will I look frozen or unnatural?

When properly administered by a skilled provider, Botox provides natural-looking results while maintaining facial expression

Can I get Botox while pregnant?

Safety in pregnancy is unknown; discuss with your healthcare provider.

Botox Biosimilars

Biosimilar and interchangeable products are biological products that are highly similar to and have no clinically meaningful differences from the reference product.

Reference products

These are biological products that have already been approved by the FDA, against which biosimilar products are compared. There are 2 for Botox.Botox (onabotulinumtoxinA) – AbbVie Inc.

Formulation type	Strength
Single-Dose Vial	100 units
Single-Dose Vial	200 units
Single-Dose Vial	50 units Discontinued

Botox C