Botox: The Ultimate GuidePublished on: 24 Sep 2019, 1:48 p.m.
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Botox is one of the most popular cosmetic treatments in the UK, with individuals of all ages opting to have the injections at some point in their lives. Although it is a fairly low-risk procedure, there are still some aspects to consider about whether it is the right treatment for you, possible side effects, and how to find the best person to administer it.
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Procedure time:5 to 10 minutes
Recovery time:Up to 24 hours
Full results:7 to 14 days
Average cost: Around £100 to £350 for each treatment
Botox injections are usually an in-office, non-surgical procedure, with many patients scheduling the treatments in lunch breaks as it usually only takes around 10 minutes.
During the procedure, the patient is usually seated or lay in a raised position. The areas being treated are cleaned with a non-alcohol cleanser, such as Hibiclens or Betadine. Some doctors will also numb the areas using anaesthetic (such as EMLA cream) or other numbing agents.
The Botox is then injected into the desired areas using very fine needles. Several injections are injected into the desired area. For example, it is recommended to inject 20 units of Botox for the forehead and between the eyes individually (4 units of Botox in one syringe, injected 5 times). However, some patients (especially first-time patients) may receive a lower dose.
It is common for pressure to be applied after the injection to control bleeding and bruising after the injection. There is usually very little discomfort during the procedure.
What is Botox Made From?
Botox is a drug that you can inject, made from botulinum toxin type A - it comes from a group of molecules that are created by the bacteria clostridium botulinum. The toxin directly affects the muscles by preventing nerve signals to them, temporarily paralysing them.
In large amounts, this toxin can be extremely dangerous as it can cause widespread muscle paralysis. However, when it is diluted, it can be used within a safe and effective procedure. Botox injections are made up of a mixture of botulinum toxin type A, human albumin, and sodium chloride.
Are Botox Injections Safe?
When used in small doses, Botox injections are considered safe and will not cause harm to your body. Choosing a reputable person to prescribe it is key in making sure the procedure is entirely safe and without any nasty side effects - this can be achieved through thorough research and making sure you’re asking any potential practitioner.
If you are noticing a few fine lines across your face, or wrinkles around your eyes and mouth, you may be looking into getting Botox. It can be particularly successful in reducing the appearance of frown lines and crow's feet. The muscles under your eyes and on your forehead are constantly moving as you display any facial expression - over time this can result in a tired and haggard appearance. Botox is regularly used to reverse this look. The lower area of the face can also be treated (such as the jaw, around the mouth, and chin) but these treatments are less common and require a more skilled practitioner.
However, Botox is not solely used for cosmetic purposes. Many people also turn to it to help some health conditions such as neck spasms, excessive sweating, and lazy eyes - it works by blocking the action of some of the nerves responsible for these conditions.
There are many things Botox can do, other than just lessening the appearance of wrinkles, some of them are:
Muscle contractions - Botox can be used to relax muscles for some neurological conditions, for example, cerebral palsy.
Chronic migraine - The exact way that Botox can relieve migraines is unclear, but it is believed Botox might relax the muscles around the head and thereby reduce blood pressure within the brain. Or Botox might reduce the nerves’ ability to send pain signals during a migraine.
Bladder dysfunction - Reduces the frequency of time needed to urinate.
Eye twitching - Botox injections can relieve the muscles responsible for causing twitches.
Managing acne - Botox can be injected into the problem areas reducing the amount of oil produced under the skin, and consequently reducing breakouts.
Getting a temporary face-lift - Botox can shape the jaw and nose, giving the appearance of a facelift.
Mimicking a nose job - Botox can lift the nose by relaxing the muscles that pull the nose down, giving the impression of a rhinoplasty.
Narrowing your chin and jawline - With age, your jawline can become wider, particularly if you grind your teeth. Botox can be injected into the area to reduce the muscle, narrowing the jawline.
Tightening the jawline - A little Botox can be used to tighten the muscles, giving the jawline a more defined appearance.
Lifting your lips - Injecting Botox along the upper lip border can cause the top lip to roll out, so it appears plumper.
Removing dimples - The quickest and simplest treatment available to correct the appearance of dimples.
As with many other procedures, the exact results will vary from person-to-person. It is important to discuss your expectations at length with the person administering the Botox where they will be able to say whether they are achievable.
Botox was the first drug to use botulinum toxin A but over time, other products have started to emerge. Some of these include Dysport, Xeomin, and Myobloc.
Each product is slightly different, especially when it comes to the dosage required. Your practitioner should discuss at length the type they will use with you and be able to answer why they have chosen it. Don’t be afraid to ask these questions during your consultation.
A more youthful appearance.
Getting rid of current wrinkles and preventing future wrinkles from arising.
Increased confidence and improvement in a patient's mental health.
Short procedure – approximately 10 minutes.
Quick results, short recovery time.
Botox used for functional reasons can help patients solve long to short term medical problems.
Non-permanent results. Many patients need treatment every 3-6 months to maintain their results.
Some patients do not receive the results they desire. Or require more than one treatment to achieve optimum results.
Botox can’t treat all signs of aging (e.g. saggy eyelids).
It can be more expensive than other injections.
Dysport is mainly used to treat wrinkles on the forehead and frown lines. Dysport is diluted using different substances to Botox, meaning different units need to be administered to achieve similar results.
Dysport is usually cheaper than Botox.
It yields quicker results than Botox.
Dysport affects only the targeted muscles, so the untreated facial muscles can still contract normally.
Botox typically lasts longer than Dysport. However, no head-to-head trials have been conducted.
Dysport can only treat patients with severe-moderate cases of wrinkles between the eyebrows. Moderate cases are discouraged from using Dysport.
More units are required. It takes a minimum of two times more units of Dysport to get the same effect as Botox.
Xeomin is approved to treat facial wrinkles such as around the mouth, between the eyebrows, and on the forehead. It is also used to treat adults with cervical dystonia and blepharospasm.
Unlike Botox, Xeomin is not mixed with any other substances; it is a “naked” neurotoxin and only contains the botulinum toxin A.
Often lasts longer than Botox.
Unlike others, Xeomin contains no additives and does not need to be refrigerated.
Patients are less likely to become resistant to Xeomin injections because of its purity.
Cheaper than Botox.
Xeomin can cause painful side effects when used to treat cervical dystonia and blepharospasms, such as muscle weakening and headaches.
Longer recovery - Xeomin takes up to 4 days to see initial results.
Used mainly for cervical dystonia in adults. Also used to prevent excessive sweating.
Unlike other treatments, Myobloc contains botulinum toxin type B. Some have suggested that Myobloc may help people who've become immune to Botox and Dysport.
Rarely used cosmetically, limited to functional reasons.
Dermal fillers are the second most common cosmetic procedure and account for 32% of non-surgical procedures in the UK.
Dermal fillers are used to "fill in" or plump areas that need extra volume for a smoother look such as facial wrinkles, dimples, etc.
Dermal fillers are injected, with four types of dermal fillers being medically approved. These include calcium hydroxylapatite, hyaluronic acid, poly-L-lactic acid, and polymethylmethacrylate beads.
Botox and fillers are often used together, to create the most successful results. Both contain different substances making them safe to combine.
Advantages of Fillers:
Longer lasting results than Botox – (polymethylmethacrylate dermal filler is permanent).
Can create a smooth complexion, filling out problem areas.
Can reduce the appearance of under-eye bags and dark circles (Botox cannot).
Botox relaxes wrinkles. Fillers can erase them altogether.
Can erase dimples and scars.
Disadvantages of Fillers:
Fillers are usually more expensive (£600-£1600 estimated costs per injection).
Filler carries more side effects.
When thinking about getting Botox, there are some areas you need to consider before booking your appointment. Undergoing any procedure is a major decision, so you need to take your time, do your research, and make sure it’s what you really want.
It’s important to manage your expectations when it comes to cosmetic procedures. They are usually carried out because the individual is unhappy with their appearance, deeming their natural forms to be unsatisfactory.
You need to be clear on the reasons behind undergoing this procedure, and what you expect to gain from it. There are a few questions you can ask yourself before getting Botox injections to make sure it’s right for you:
How long have I been considering Botox injections?
Why do I want this treatment?
What am I expecting from Botox?
Can I afford the cost of the procedure?
Am I doing it for myself or for someone else?
As well as the mental health aspects of deciding to get Botox injections, you need to consider whether Botox is right for you physically. Infections, some health conditions, and pregnancy can all cause adverse effects.
Who Is a Good Candidate for Botox?
As Botox is so commonly used and relatively low-risk, many people are excellent candidates for the treatment. An ideal candidate is a healthy man or woman who wants to erase wrinkles that appear when they are showing some facial expressions or are looking for a more rested appearance.
It is important to remember that Botox will not erase deep-set wrinkles, but instead relaxes them. As a general rule of thumb, it will not get rid of lines that are present even when your face is at rest but can work towards minimising them. Because of this, a good candidate for Botox is someone who is realistic about their expectations, is clear in what they want to achieve, and has researched the procedure extensively.
Who is a Bad Candidate for Botox?
As with any procedure, there are people who are bad candidates for Botox due to health (both physical and mental) conditions. Some of these are permanent conditions, while others are temporary.
Botox injections are not recommended if:
You have a skin infection
You are pregnant or breastfeeding
You are under the age of 18 years
You have previously reacted to the Botulinum toxin A
To treat Ptosis (drooping eyelids)
There are other people who can have Botox, but should be cautious and discuss their conditions at length with their practitioner, they are:
People at risk of bleeding, including people with blood clotting disorders, or who are taking medications that can thin the blood
People with extreme weakness or wasting in muscles e.g. patients with a history of Strokes.
People with breathing problems
Very thick facial skin
Deep facial scars
It is not just physical conditions that practitioners and individuals considering Botox need to be aware of. Mental health issues such as depression can negatively impact people’s image of themselves and this may drive them to get Botox for the wrong reasons. These conditions are harder to spot by those administering the injections so an in-depth consultation is a must before any treatment starts.
A well-trained practitioner could be the difference between getting the results you love, or ending up on a ‘Botox gone wrong’ list. They should have years of experience and up to date training in Botox, and be ready to show you evidence of this.
Even though it isn’t as pricey or invasive as a lot of other cosmetic procedures, getting Botox is still a huge investment and will not just make an impact on your savings account, but can also affect your body and overall health.
Before deciding on a practitioner, make sure you read through reviews from previous customers. Most reputable administrators will have a detailed website with a section dedicated to testimonials from people they have already treated, talking about their experience with them. However, it’s important to note that these will be largely positive and hand-picked to showcase their own service.
The best way to get a true review is through word of mouth. With Botox being one of the most common cosmetic treatments in the UK, it is likely that a member of your wider friend or family group has had it done before. They will be able to tell you whether their practitioner was attentive, skilled, and informative - they may even be able to show you before and after pictures too!
Look at Their Portfolio
Talking about pictures, all Botox practitioners should have an extensive portfolio that shows their previous work. Most of the time, this is on an online platform and you will be able to leisurely browse through all of their examples.
A good tip is to look for a person who had similar concerns to you, this could be wrinkles under their eyes, prominent frown lines or wrinkles by their mouth. You can then see what kind of results you can expect if you choose to go with that practitioner. Remember though, results will vary depending on the individual so you may not see the exact same effects.
Botox should only be done by a medical practitioner who is registered (e.g. with the British Association of Aesthetic Plastic Surgeons), to show they meet set standards in training, skill, and insurance.
Any practitioner must have a minimum of a Level 6 and Level 7 qualification to legally administer Botox. Botulinum toxin can only be prescribed after a face-to-face meeting (not through a video call) with the person who will administer the treatment - don’t settle for having the initial consultation with another team.
With the ever-increasing popularity of cosmetics treatments due to social media platforms like Instagram or Snapchat, more and more under-qualified people have started offering Botox. Images on their pages are edited to depict better results and to lure in new customers.
Don’t be tempted by individuals who are offering abnormally low prices but have either completed no training at all or have only attended a short training course. Not only will you not get the desired aesthetic, but shoddy administration of Botox can cause some long-term health problems.
Make sure you have a consultation with your practitioner before agreeing to any treatments. This allows you to get a feel for them as a person, learn more about their expertise, find out about their individual approach, and get some answers to burning questions.
There are a number of things you need to know before Here are some examples of questions you can ask them about:
The amount of training, experience, and qualifications the practitioner has.
The name of the product they will use if it’s licensed, and where/how they will source the product from.
The risks and side effects.
What will happen if things go wrong - will you be able to contact them and how quickly will they be able to see you.
Has something ever gone wrong?
Ask to see their portfolio of pictures to see how experienced they are in the specific area you’re looking to change and ensure that you like their work.
The most important thing is that you trust your gut feeling and make sure you are comfortable with your practitioner. If you are not entirely comfortable with them then you should carry on searching.
There’s not a great lot you can do to change the outcome of Botox prior to your treatment outside of following a balanced diet and having a healthy lifestyle. However, there are some specific steps you can follow to make sure you’re getting the most out of the treatment and minimising the side effect, such as:
Stop taking medication containing fatty acids around 3-7 days before treatment. such as Aspirin and Cod Liver Oil, as these medications can increase bruising and/or bleeding.
Avoid consuming high levels of salt and sugar, refined carbohydrates, and very spicy foods, 24 to 48 hours before and after your treatment. Alcohol and smoking should also be avoided. These factors can increase your chance of bruising and swelling.
It is recommended to stop taking Retin-A (often used to treat acne) 2-3 days before treatment to avoid any increased redness and irritation.
Make sure you consult with your doctor before stopping any prescribed medication and to discuss activities/exercises that may not be recommended.
After the injections, patients are usually asked to sit upright, or at least semi-upright for a few minutes. This is to ensure that the patient is feeling well enough to leave. Botox requires little recovery time, taking approximately 48 hours to fully recover.
Botox is slightly invasive, as the needle penetrates your skin, so there is always a chance of infection. Make sure you keep the injection area clean and try not to touch it with your hands. If you have any concerns during your recovery period, make sure you get in touch with your practitioner.
Your practitioner should discuss all the things you need to do following the treatment, so make sure you follow their advice. Their aftercare instructions will vary depending on the areas you have had treated but there are a few tips we can give to hurry up the recovery process.
Top tips for speedy Botox recovery:
Move and contract the areas treated, such as frowning and lifting the eyebrows to allow the Botox to reach all the desired muscles.
Do not touch or rub the treated area to prevent the treatment from moving.
Avoid strenuous exercise, sunbathing (including using sunbeds), the sauna or other activities that can make you hot for at least 2 days.
Don’t put alcohol-based products on the treated areas for 48 hours.
Don’t drink alcohol and smoke until healed.
Apply your anti-inflammatory medication to reduce any bruising. Bruises should heal within one to two weeks post-treatment.
Take pain relief such as Paracetamol to reduce any pain/discomfort.
Wait around 3 months before having Botox again. Botox can stop working if you have it too often.
Try not to lie down for at least 4 hours after Botox.
Avoid eating fatty acids for at least 3 days to 1 week after treatment, to prevent increased bleeding and bruising.
Don’t drink caffeine or eat highly salty, spicy and/or sugary foods for 24-48 hours after your treatment- to prevent swelling or irritation.
Avoid the use of Retin-A or similar products for 2 days after treatment to avoid increased irritation or redness.
It is recommended not to wear makeup for around 24 hours. If you do need to wear makeup, try to use good quality mineral makeup to avoid any skin breakouts.
Do not wear headbands or hats immediately after treatment.
There are often horror stories floating about online of Botox ‘gone wrong’ and botched procedures that result in an unnatural look. However, Botox is generally a safe procedure, and serious side effects rarely occur. It is not as invasive as cosmetic surgery, so the chance of any infection is relatively low.
Possible side effects of Botox include:
Headache and flu-like symptoms are common, especially in the first 24 hours.
Eye dryness or watering (for facial injections)
A frozen look – if too much Botox is injected you may not be able to move your muscles in your face (facial injection).
Temporary weakness and droopiness in your face (facial injections)
Nausea: Around 45% of patients experience some nausea. This is normal as Botox is a foreign material and your body may not welcome the toxin at first.
In rare circumstances, Botox can cause serious side effects, such as:
Blurred or double vision
Loss of bladder control
It is important to note that serious side effects are very rare and if you experience any of these symptoms contact your doctor immediately. It is vital for you to be aware of the potential risks but not scared, as getting Botox is usually a very safe procedure.
Although Botox injections are low-risk, there are always exceptions and they can go occasionally wrong.
If you’re not happy with the results following your recovery, you should contact your practitioner immediately. They may be able to rectify the situation and give you the look you were hoping for instead by doing a few more injections.
However, if there’s a serious problem, like difficulty breathing, after getting Botox, you should call 999 and ask for an ambulance.
Why Your Botox Might Go Wrong:
One of the most common reasons for Botox going wrong is down to the person administering it. It can be due to a lack of experience, expertise, or choosing a low-quality product. Your Botox practitioner should always be a licensed professional who has completed training in giving these injections and has a vast repertoire of previous work.
Another reason may be inadequate aftercare. If you do not look after yourself and your body in the days following the procedure, there is a chance that the Botox will migrate into another area and ruin the effects.
In some rare cases, your body may react negatively to Botox and you will further medical attention. If the side effects are not too pressing, you can get in touch with the person who administered it and ask for an urgent appointment. But if they are overwhelming side effects, you need to get yourself to A&E to be examined by a doctor.
While available on the NHS for certain medical conditions, Botox is not funded for purely cosmetic reasons so it is up to you to pay for any treatments you want.
There may be a lot of variation in the cost of Botox. The cost depends on the number of injections required, the areas that are to be injected, and the product used. It will also depend on the experience of the injector, the clinic facilities, and location.
According to the NHS website, Botox can cost between £100 and £350 per treatment, but this can be dramatically different if you’re having a large amount in a number of different places.
Botox for facial wrinkles is usually the cheapest form of Botox, in comparison to Botox for the body. The most expensive part of the body to treat is usually the armpits, at around £400.
Warning: Most clinics will add about 2-3ml of other liquid to the Botulinum toxin (that gives you the desired effect). However, there is a common scam by less reputable practitioners where they add more liquid to make patients believe they are getting more Botox than they actually are.
Clinics that charge units by a certain amount of pounds, are often diluting the Botox, to dramatically increase the price you are paying. Be aware of this and ask exactly how much Botulinum toxin will be in the dosage you are being given. If you have any doubts that they are not being truthful then do not carry on with the treatment, leave and start to search for another person to administer the Botox.
The results of Botox are not noticeable immediately, so do not feel dismayed as you leave the clinic. Results start to appear around 2-3 days post-treatment, and by around 2 to 3 weeks you should be able to see the full effects. Be patient.
Often patients do not recall how they looked before the procedure and are amazed at the difference. To help you gauge the exact results, make sure you take a comparison photo before and after the procedure. It’s a useful way of not only seeing the difference Botox has made but also keep track of any worrying side effects.
Some patients may require additional work, such as dermal filler, to fill in the wrinkles that are now relaxed. Or additionally, 2 or 3 more Botox sessions may be required to create the best results - this is especially true when treating deep wrinkles.
Usually, results will last for around 3-6 months but this will vary within individuals.
Although you can help increase how long your results last by avoiding smoking, consuming alcohol and/or long exposure to sun or heat. These activities can cause collagen to break down faster, reversing the effects of Botox.
Before and After Photographs
Here are some examples of what facial Botox can look like:
As well as all of the information on this page, there are some other areas of getting Botox that you should know.
You will most likely need a follow-up appointment - Booking in to see your practitioner after the initial treatment is a good thing. It not only gives them a chance to give a top-up if necessary after seeing the results but also gives you a chance to discuss any concerns. Make sure you have both the initial and the follow-up appointment booked in to avoid any delays.
There’s not necessarily a right or wrong age to start - Although it seems that recently a lot of younger people have started to get Botox as a preventative measure, it does not mean getting it when you’re older is useless. While it is true that it does not work on deep-set wrinkles, it will still make a difference where you can see results. Likewise, if you’re in your 20s and are afraid of being criticised for it, remember you are in a great position to help prevent the onset of fine lines.
Supplements and medication can affect the initial results - Your everyday supplements aren’t likely to interfere with the Botox and the effects, but some medications that thin your blood can increase the chance of bruising. While this won’t make it less effective, it is something to consider if you’re planning on popping out during your lunch break to get Botox. Other supplements or medications that can affect Botox are fish oil, vitamin E, muscle relaxants, ginseng, and Ibuprofen.
There are some side effects that are not well documented online - If you get it injected between your eyebrows, you may experience what some people are calling the ‘Botox buzz’. This is a period of dizziness that can last up to 10 minutes and be accompanied by a painful headache.
Generally speaking, the effects of Botox last for 3 to 4 months before they start to wear off. Of course, there will be times where they last longer, even up to 6 months, but this depends on the individual themselves.
Getting Botox is a unique experience and will affect individuals in different ways, but there are some steps you can follow to (hopefully) prolong the effects, such as:
Avoiding direct sunlight and sunbeds - Long-term exposure to sunlight can cause a whole host of problems, one of them being premature wrinkles. As Botox is often used to relax these wrinkles, going on to either a sunbed or sunbathing would be counterproductive.
Stopping smoking - Smoking can also cause wrinkles and rapidly ages your skin, alongside shortening your life. The physical act of smoking, such as pursing your lips, will contribute to deep wrinkles forming around your mouth - the type that may not be helped by Botox.
Following a balanced diet - Eating healthily revitalises the skin - your diet affects the health and appearance of it. Try to avoid eating a large amount of processed and high-sugar foods following the procedure in order to maintain a healthy weight. However, bear in mind that extreme weight loss on your face can sometimes result in slightly sagging skin and reduce the effectiveness of Botox.
Avoiding excessive heat in the first 24 hours - Try to put off going to a sauna or participating in hot yoga immediately following your Botox procedure. This is because exposure to excessive heat can make the Botox migrate to other areas of your face that you don’t want - sometimes causing a dropping lip or facial paralysis.
Taking zinc supplements - Some studies have been carried out that suggest a link between taking zinc supplements and preventing wrinkles. One particular research project found that zinc played a meaningful role in increasing the effectiveness of Botox.
Only using an experienced practitioner - To ensure Botox is utilised effectively and for the longest amount of time, it must be used correctly. An experienced practitioner will know exactly what techniques to use and what areas to tackle in order to get the best out of it.
First-time users of Botox may notice that it wears off quickly, but will find it lasts longer after their second and third rounds.
You should always follow the instructions of your practitioner in the time immediately after getting Botox, they will tell you what you should expect during your recovery and what you can do to get the best results.
But, generally speaking, you should wait at least 4 hours before doing gentle exercise and 24 hours before engaging in any strenuous exercise.
However, one type of exercise that is usually recommended is facial exercises. Slowly smiling, frowning, raising your eyebrows, and flexing other muscles in your face can help the Botox work better - just make sure you don’t use your hands near the injection sites.
Why isn’t exercise recommended?There are a few reasons as to why exercise is not recommended after getting Botox. First of all, it increases the blood flow and gets your heart really pumping which can cause the Botox to stray away from the intended site. Exercise can also put a lot of pressure on the injection site through the regular wiping away of sweat. Lastly, it usually results in a lot of head movement which is advised against following a Botox treatment.
This, again, depends entirely on the individual but you can expect to see the full results of your Botox 7 to 14 days after the initial injection. Variables like the dosage, area of the injection, and frequency can all affect how long it takes for it to work as well as your own health.
Because there is such a discrepancy in time different people have to wait to see results, skilled practitioners should discuss these factors with those getting Botox.
Yes, you should be able to smile after Botox if a professional practitioner has administered Botox correctly. Incorrectly administering Botox (such as administering too much) can lead patients to look ‘frozen’.
Ultimately, Botox done by trained practitioners should allow patients to smile, leaving them with a fresher and younger appearance.
A common fear amongst those considering Botox is that it will make them look older in the long-run after the effects wear off. However, this is not true. Your skin will not start to develop wrinkles at a heightened rate if you choose to have Botox, but would instead age at a normal speed.
On the other hand, if you grow accustomed to seeing your face with relaxed wrinkles and then decide to stop having Botox, you may believe you look older as you get used to your normal aging process.
Although Botox does contain a toxin, which can cause paralysis and food poisoning, it is not dangerous when used correctly. When it is injected by a fully trained practitioner, Botox is a safe procedure.
Trained professionals will only inject a small amount of Botox, making it a low-risk treatment with no long or short-term harm.
Baby Botox is the term used when a smaller dose of Botox is injected in order to treat moderate to fine wrinkles. Those who do not want to commit to a large amount, or only want minimal effects can utilise this technique.
Baby Botox doesn’t last as long as regular Botox (approximately two months).
When Botox starts to work you may experience a heavy or tight feeling in the treated areas. Your expression may also be slightly limited or stiff whilst the Botox settles into the areas.
Once healed, you should not feel anything on your face. If you do, make sure you get in touch with the person who administered it.