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How Is Botox Injected?

Botox injections are primarily used to reduce the appearance of facial wrinkles and treat other conditions related to muscle spasms. This article will discuss how Botox is injected, including what Botox is, how it works, what to avoid after Botox injections, and frequently asked questions about Botox.

Botulinum toxin (Botox) is a neurotoxin produced by the Clostridium botulinum bacterium. Botox injections induce temporary muscle weakness, usually lasting up to about three months. The toxin now plays a significant role in cosmetological applications and several medical conditions, especially those linked to the neuromuscular system. Botox injections are generally well tolerated with a few common side effects, such as bruising, swelling, bleeding, and redness which subside within a few days after the injection. Botulinum toxin inhibits the transmission of neurotransmitters at the neuromuscular terminals causing what many call temporal muscle “paralysis”. Botox injections require 3 to 5 days to take effect, reflecting the time needed to disrupt nerve-signalling processes responsible for muscle contraction. Peak results usually show 10 to 15 days later after receiving Botox.

What Is Botox?

Botox is a trading name for Botulinum toxin (type A), derived from the bacterium Clostridium botulinum (C, botulinum). C. botulinum occurs naturally in environmental settings such as lakes, forests, soils, and the intestinal tracts of some animals. The bacterium C. botulinum is not harmful. However, as it matures, its cells and spores transform into botulinum toxin, which is extremely poisonous. Botulinum toxin is the neurotoxin responsible for the deadly disease botulism. Dutta et al. (2016) indicated that a single gram of botulinum toxin evenly dispersed and inhaled could kill over one million people. However, manufacturers of Botox use minute quantities of Botulinum toxin, which, when used in therapeutic contexts, is safe and effective.

Botulinum toxin is available in various formulations, most of them approved by the Food and Drug Administration (FDA) for cosmetic and medical uses. According to Samizadeh & De Boulle (2018), some of the FDA-approved formulations of Botulinum toxin available include:

  • Onabotulinum toxin-A (Botox)
  • Abobotulinum toxin-A (Dysport)
  • Incobotulinum toxin-A (Xeomin)

Botox is a temporary cosmetic treatment for deep facial wrinkles and fine lines. It reduces wrinkles and leaves the skin looking smooth and refreshed for up to 3 to 6 months. However, the FDA has approved Botox only for deep horizontal, glabellar, and lateral canthal lines. Botox has a few common side effects like any other medical treatment. They include bruising, bleeding, swelling and redness, which subside within a few days after receiving the injection. There is no downtime needed after a Botox injection. Patients can return to their daily work routine right after the procedure. However, they must adhere to the doctor’s aftercare instructions for the best-looking results.

How Botox Works

The brain normally sends signals to the muscle cells to contract and make dynamic movements. These signals are transmitted by a chemical substance known as acetylcholine. Acetylcholine is the neurotransmitter responsible for muscle contraction. It binds to the receptor at the neuromuscular junctions causing muscle cells in that area to contract and shrink. Nunez (2022) showed that Botox works by stopping the release of acetylcholine, resulting in reduced muscle movements and contractions. It means muscle movements causing wrinkles to form stop temporarily until the effects of Botox start to wear off. Some people refer to the effect of Botox at the injection areas as causing a temporal “paralysis”. Patients with other medical conditions, especially those linked with the neuromuscular system, can also benefit from Botox injections. For example, patients with an excessive sweating disorder or hyperhidrosis can temporarily manage their condition with Botox injections. Botox inhibits the release of the neurotransmitter, causing excessive sweating in the sweat glands.

How Botox Is Injected        

Once the patients arrive at the clinic, the aesthetic practitioner issues them some documentation to go through that is related to the treatment. Everything about Botox treatments and the clinic services is always covered in that document. Once the patient gets into the treatment room, the aesthetic practitioner takes them through a consultative session where the practitioner recaps the procedure to ensure that everything is clear. During this session, the patient can ask any questions regarding the treatment. Once the consultation session is over, the patient signs a consent form for the procedure.

The aesthetic practitioner may ask the patient to make a series of facial expressions to mark the areas that will be injected. The areas to be injected are then cleaned with a non-alcoholic cleanser. A Botox injection is administered directly into the muscle cells under the skin. The injection is felt as sharp pricks. The practitioner will administer approximately five injections depending on the area being treated and the severity of the wrinkles. Botox injected during each session often varies from patient to patient. In most cases, the dose depends on factors such as muscle mass, depth of wrinkles and the area being injected. The session only takes a few minutes, usually 15 to 30 minutes.

Things to Avoid After Botox Injections

Extreme Heat

Avoid overexposure to sunlight and any environmental setting that could increase the body temperature. Avoid saunas, tanning beds, hot tubs, steam rooms and other sources of extreme heat until the initial swelling and bruising subside.

Strenuous Physical Activity

Most aesthetic practitioners always recommend avoiding vigorous activity, including intense workouts, to their patients. High-intensity exercises and strenuous activities increase heart rate and blood flow throughout the body, especially at the injected site. Besides, these vigorous movements may put pressure on the injected site and jeopardize the ultimate results.

Alcohol and Blood Thinning Medicines

Alleyne &Dopico(2021) explained that alcohol is a vasodilator and dehydrating agent. It dilates the blood vessels and causes increased blood flow. It should be avoided at least one week before and after the treatment. Blood-thinning drugs such as aspirin and ibuprofen should also be avoided.

Touching Your Face

Avoid touching the face to prevent bacterial infections in the injected area. It includes massaging or washing your face right after the treatment. The pressure on the injected area may spread the injectable to unintended areas in the face, which may lead to adverse effects.

Other Things to Avoid       

  • Other aesthetic treatments include facials, lasers, micro-needling, and chemical peels.
  • Applying make-up on the injected area. Stay make-up free for at least 6 hours after the injection.
  • Lying or sleeping in the injected area. Patients should sit upright and avoid any position that could cause pressure on the injected areas.
  • Using flight for at least one week after Botox.
  • Washing your face immediately after having a Botox injection.

Frequently Asked Questions about Botox

Is Botox Permanent?

Unlike surgical cosmetic procedures, Botox is not permanent. Botox injections last for 3 to 6 months, depending on the volume of Botox used and the depth of your wrinkles. Maintaining Botox results requires top-up treatments at least once every 3 to 6 months after the injection.

Where on the Face Can Botox Be Injected?

Botox works effectively in several areas of the face including; forehead lines, crow’s feet, frown lines, gummy smiles, glabellar lines, brow lift and bunny lines.

Is Botox Painful?     

Aesthetic practitioners use tiny needles that resemble prick pins when injecting Botox into the muscle tissues. The injection is not painful, but you may feel minor discomfort. However, the discomfort usually subsides within a short time. Some patients may have slight heaviness and tight sensation, but it is nothing much to worry about.


Botox injections have significantly changed the face of cosmetic treatments in recent years. The injectable is cosmetically used to treat facial wrinkles and fine lines. Botox injections have also been effective in improving other medical conditions. The practitioner administers injections directly into the muscle cells in the treated area. Most patients return to their normal work routines right after the injection. However, aestheticians recommend several aftercare tips that are followed for the best-looking results. Ensure that you get treatment from a reputable and highly qualified practitioner to minimize the risks of adverse risks and complications after Botox.


Alleyne, J., & Dopico, A. M. (2021). Alcohol use disorders and their harmful effects on skeletal, cardiac and smooth muscle contractility. Advances in drug and alcohol research1, 10011.

Dutta, S. R., Passi, D., Singh, M., Singh, P., Sharma, S., & Sharma, A. (2016). Botulinum toxin the poison that heals: A brief review. National journal of maxillofacial surgery7(1), 10.

Núñez, F. D. R. G., de Castro, F. N., & Núñez, R. M. G. (2022). Medical Applications of Botulinum Toxin: Spasticity.

Samizadeh, S., & De Boulle, K. (2018). Botulinum neurotoxin formulations: overcoming the confusion. Clinical, cosmetic and investigational dermatology11, 273.

Barbara Santini
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