Botox and other wrinkle-relaxing injections

What it is

• Botox's generic name is onabotulinumtoxinA, and it is sold as Botox and Botox Cosmetic.
• These products come as a powder that a doctor mixes with a liquid and injects.
• One brand or type of botulinum toxin cannot be swapped for another.

Sources: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): AbobotulinumtoxinA Injection: MedlinePlus Drug Information ↗

How it's thought to work

When Botox is injected into a muscle, it blocks the nerve signals that cause the muscle to tighten and move. Dysport is also described as working by blocking nerve signals to muscles.

Sources: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): AbobotulinumtoxinA Injection: MedlinePlus Drug Information ↗

What people use it for

• Botox Cosmetic is used to temporarily smooth frown lines between the eyebrows in adults 18 and older.
• Botox Cosmetic is also used to temporarily smooth crow's feet, the wrinkles near the outer corner of the eye.
• Botox Cosmetic is also used to temporarily smooth forehead lines.
• Dysport is used to temporarily smooth frown lines.
• Xeomin is used in adults to temporarily smooth lines on the upper face.
• Botox is also used to prevent headaches in some adults with chronic migraine.
• Botox is also used for severe underarm sweating in people who cannot be treated with skin products.

Sources: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): AbobotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): IncobotulinumtoxinA Injection: MedlinePlus Drug Information ↗

What the research has found so far

The page says Botox Cosmetic has not worked as well for crow's feet, forehead lines, or frown lines in people 65 and older as in younger adults.

Source: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗

On Botox and other wrinkle-relaxing injections and aging, PubMed lists 279 trials in people, 241 studies that watched people over time, 9 animal and lab studies. See the counts and searches

Side effects and risks

• Botox can cause pain, tenderness, swelling, redness, bleeding, or bruising where it is injected.
• Botox side effects also include tiredness, headache, dry mouth, nausea, constipation, and anxiety.
• Symptoms of spread can happen within hours of an injection or as late as several weeks after.

Source: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗

Who should be careful, and drug interactions

• The risk of spread is probably highest in children treated for spasticity and in people with swallowing or breathing problems.
• The medicine is not injected into an area that is infected.
• Doctors should be told about pregnancy, plans to become pregnant, or breastfeeding.
• Doctors and dentists should be told about the injection before any surgery.
• Doctors should know about any botulinum toxin injections in the past four months.
• Dysport may interact with nonprescription allergy and cold products.
• Xeomin may interact with nonprescription or herbal products for allergies, colds, or sleep.
• Botox may cause muscle weakness or impaired vision, and people with these symptoms are told not to drive or use machinery.

Sources: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): AbobotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): IncobotulinumtoxinA Injection: MedlinePlus Drug Information ↗

Approval and legal status

The page notes that Botox is given by a doctor, and describes a Medication Guide that comes with each treatment.

Source: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗

• FDA: DailyMed - BOTOX COSMETIC- onabotulinumtoxina injection, powder, lyophilized, for solution ↗

What to expect: sessions, results and recovery

• Botox for wrinkles is given by a doctor as an injection into a muscle or the skin.
• For wrinkles and several other conditions, extra injections may be given every 3 to 4 months, depending on how long effects last.
• A numbing cream, cold pack, or eye drops may be used before the injection.
• Before treating wrinkles, the doctor examines you to see if the medicine is likely to work.

Source: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗

What studies and labels describe

What studies or labels describe, not a recommendation.

Dosing may be changed to find the dose that works best. For Xeomin, doctors will probably start with a low dose and adjust it gradually.

Sources: MedlinePlus (NIH): OnabotulinumtoxinA Injection: MedlinePlus Drug Information ↗ · MedlinePlus (NIH): IncobotulinumtoxinA Injection: MedlinePlus Drug Information ↗

Roughly what it costs

We don't have prices for this yet.

Questions to ask your doctor

• Is Botox and other wrinkle-relaxing injections a sensible option for me, given my health and the medicines I take?
• Could Botox and other wrinkle-relaxing injections interact with any medicine or supplement I already take?
• What side effects should I watch for, and when should I stop or call you?
• How would we tell whether it is helping, and when should we review it?