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Today, Botox injection is frequently used to smooth out facial wrinkles and create a younger look. Wrinkles created between eyebrows or on the forehead by crossing eyebrows, and wrinkles around the eye that appear when laughing greatly disappear with Botox injection. These wrinkles are largely caused by subcutaneous muscle contractions. Botox injection reduces contraction ability of these muscles, which leads to reduced wrinkles.

What is Botox?

Botulinum toxin A, commercially available as Botox, is a complex protein secreted from a bacteria called clostridium, can cause severe food poisoning. Pure and sterile form of this product is processed for injection use in medical applications.

How does Botox work?

After injection, Botox is absorbed into the muscle, and is deployed at nerve endings that control muscle contractions, where it prevents release of a chemical called acetylcholine that is responsible for muscle contraction. Thereby, it intercepts contraction commands to the muscle, and causes a kind of temporary paralysis of the muscle, lasting 3 to 6 months. Loss of subcutaneous muscle contraction leads to disappearance of skin wrinkles covering the muscle.

How is Botox injected?

Botox injection is usually carried out in the doctor’s office or clinic, as outpatient, and does not require hospitalization. Since injection is performed with very fine needles, it is not painful and does not require anesthesia. After disinfecting facial skin, using insulin syringe, physician injects small amounts of Botox above the eyebrows, forehead, and around the eyes. Possible mild irritation and redness at injection site resolve within a few hours. After injection, it is best to avoid lying down and rubbing injection site, until Botox is fully absorbed into the muscle.

Wrinkles begin to disappear one or two days after injection. This effect lasts 3 to 6 months, and after that Botox effect is gradually lost and wrinkles begin to reappear. Injection may be repeated, if so wished.

Botox complications

Since Botox is primarily absorbed into the injection site muscles, and only negligible amounts enter the blood circulation, no important systemic complication is caused by the dosage used to remove wrinkles. However, like any other injection, it may cause mild irritation and redness, but they will disappear within a few hours. In some people, Botox injection may cause mild headache, nausea, or symptoms of cold, which will improve within 2-3 days.

The more serious complication that may occur due to Botox injection is drooping of the eyelid. Fortunately, this is rather rare, and occurs in less than 3% of cases. Drooping of the eyelid normally occurs a week after injection and gradually improves after 2-3 months. Luckily, all Botox complications are transient, and spontaneously resolve within 6 months, at most.

Limitation and prohibition cases of use

Although there are no reports of any particular complications due to use of Botox during pregnancy and lactation, it is suggested that women avoid using Botox injection in these periods.

You should tell your physician about your diseases or medications. Botox injection can cause severe muscle weakness in people with neuromuscular disease. Additionally, use of some medications (antibiotics of gentamicin family) may intensify effect of Botox. 

Alternative treatments to Botox

As discussed earlier, Botox injection primarily affects wrinkles induced by subcutaneous muscle contractions. Impact of Botox is more prominent in young and middle-aged people, and less affects older people.

Botox injection has little effect on superficial fine wrinkles caused by solar radiation. To prevent these wrinkles, regular use of sunscreen creams is recommended. Superficial peeling of the skin using special creams or surgical techniques is recommended to remove them.

When drooping of the eyebrow, eyelid, or the cheek has caused aging, Botox injection cannot help (it may even intensify drooping of eyelid and eyebrow, and worsen appearance of the person). In such cases, plastic and reconstructive surgery (pulling the skin and lifting eyebrow and eyelid) often produce better results.

Another technique used to remove wrinkles is injection of such substances as: lipid, silicon, or collagen that can be performed alone or along with Botox injection.

Injection of Botox is a simple, inexpensive, and low-risk method of facial wrinkle removal. Physicians can advise on effectiveness and suitability of this method for individuals.

Other applications of Botox

Besides cosmetic surgery, Botox has other important medical applications, including:

  • Treatment of strabismus (crossed eyes)
  • Treatment of belpharospasm (involuntary frequent closing of the eyelid)
  • Treatment of involuntary head and neck muscle contractions
  • Treatment of tension headaches and migraines
  • Treatment of excessive perspiration


Final word:

Although Botox injection is a simple, low-risk, and efficient method, it is an invasive procedure that must be performed with access to first aid and compliance with sterilization principles. To prevent any serious complication, Botox injection should be avoided in places like hairdressers, gyms, and beauty institutions, and should be performed by a physician.