Give Online: Help shape patient care for generations to come.
Cleveland Clinic Logo

Treatments & Procedures

Botulinum Toxin Injections

(Also Called 'Botox Injections')

BOTOX® is the brand name of a toxin produced by the bacterium Clostridium botulinum. In large amounts, this toxin can cause a form of muscle paralysis known as botulism, which is generally associated with food poisoning. Despite the fact that one of the most serious complications of botulism is paralysis, scientists have discovered a way to use it to human advantage. Small, diluted amounts can be directly injected into specific muscles, causing controlled weakening of the muscles.

The FDA approved such usage in the late 1980s upon the discovery that BOTOX® could stop ailments such as blepharospasm (uncontrolled blinking) and strabismus (lazy eye). Cosmetic physicians have been using BOTOX® for years to successfully treat wrinkles and facial creases.

BOTOX® is approved for treatment of glabellar furrows and axillary hyperhidrosis (increased sweating of the armpits). Within the past few years, new products that have similar preparations have been introduced into the U.S. market and have been well received by patients. We will refer to the toxin as BOTOX® from here on out, but please know that this includes all of the formulations:

  • BOTOX®: OnabotulinumtoxinA
  • Dysport®: AbobotulinumtoxinA
  • Xeomin®: IncobotulinumtoxinA (not currently available)

How does BOTOX® work?

BOTOX® blocks the signal from the nerve to the muscles. The injected muscle can no longer contract as forcefully, which causes the wrinkles to relax and soften. It can be used on the forehead lines, frown lines, crow’s feet (lines around the eye), bunny lines (lines in the nose), chin (for dimpling), and around the mouth (for smoker’s lines and down-turned corners of the mouth). Wrinkles caused by sun damage and gravity often will not respond to BOTOX®.

How is the BOTOX® injection procedure performed?

The procedure takes only a few minutes and no anesthesia is required. BOTOX® is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to seven days to take full effect. It is best to avoid alcohol at least one week prior to treatment. Aspirin and anti-inflammatory medications should be stopped two weeks before treatment (if given permission by a physician) in order to reduce bruising.

How long does a BOTOX® injection last?

The effects of BOTOX® will last four to six months. As muscle action gradually returns, the lines and wrinkles begin to reappear and will need to be re-treated to maintain the effect. After repeated injections, the lines and wrinkles will often appear less severe because the muscles are being trained to relax.

What are the side effects of BOTOX®?

Temporary bruising is the most common side effect. Headaches, which resolve in 24 to 48 hours, can occur, but this is rare. A very small percentage of patients may develop eyebrow or eyelid drooping, drooping of the corner of the mouth, or inability to use a straw, depending on where the BOTOX® is injected. For this reason, one should not rub the treated area for 12 hours after injection or lie down for three to four hours. No serious adverse effects have been noted when using BOTOX® at the dermatologic doses.

Who should NOT receive BOTOX® injections?

Patients who are pregnant, breastfeeding, those who have a neurological disease, or those allergic to albumin or a constituent of the preservative should not use BOTOX®. As BOTOX® does not work for all wrinkles, a consultation with a doctor is recommended.

Will my insurance pay for a BOTOX® injection?

BOTOX® is not generally covered by insurance when used for cosmetic purposes. Check with your insurance carrier for coverage details.


© Copyright 1995-2015 The Cleveland Clinic Foundation. All rights reserved.

Can't find the health information you’re looking for?

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/15/2015...#8312