Botulinum toxin is a prescription injectable treatment used to temporarily soften expression lines caused by repeated facial movement. It works by relaxing selected muscles beneath the skin, allowing wrinkles to appear smoother while preserving natural movement in untreated areas.
The Dermatology Clinic offers three botulinum toxin products: BOTOX® Cosmetic, Dysport®, XEOMIN® and DAXXIFY®. Each product works in a similar way, but its formulation, dosing, approved treatment areas, onset and duration may differ. Your provider will recommend the option best suited to your facial anatomy, muscle activity and desired results.
How does botulinum toxin work?
Facial expressions such as smiling, squinting, frowning and raising the eyebrows repeatedly contract the muscles beneath the skin. Over time, these movements can create lines that remain visible even when the face is relaxed.
Botulinum toxin temporarily reduces the nerve signals that cause selected muscles to contract. As the muscles relax, the overlying skin gradually appears smoother and expression lines become less noticeable.
Treatment does not add volume beneath the skin. Lines caused primarily by volume loss, sun damage or changes in skin texture may require dermal fillers, laser treatment, skin resurfacing or another service.
What concerns can botulinum toxin improve?
Depending on the product selected and your provider’s treatment plan, botulinum toxin may be used to improve:
- Frown lines between the eyebrows
- Horizontal forehead lines
- Crow’s feet around the eyes
- Vertical neck bands
- Other expression-related lines and areas of excessive muscle activity
Some treatment areas may be considered off-label, meaning the product is being used in a way that has not been specifically approved by the U.S. Food and Drug Administration. Your provider will explain which treatments are appropriate and whether a recommended use is off-label.
What is BOTOX Cosmetic?
BOTOX Cosmetic contains onabotulinumtoxinA and is used to temporarily improve selected expression lines in adults. It works by reducing activity in the muscles responsible for creating the treated lines.
Patients may begin noticing changes within the first few days, with the full effect developing gradually. Results can last up to approximately four months, although individual experiences vary.
What is Dysport?
Dysport contains abobotulinumtoxinA and is approved to temporarily improve moderate to severe frown lines between the eyebrows in appropriate adults.
Dysport is placed into specific muscles between and above the eyebrows, allowing untreated facial muscles to continue moving normally. Some patients begin noticing improvement within two to three days and results may last up to approximately five months.
What is XEOMIN?
XEOMIN contains incobotulinumtoxinA and is used to temporarily improve moderate to severe upper facial lines in adults. Like other botulinum toxin products, it reduces the signals responsible for selected muscle contractions.
Your provider may recommend XEOMIN based on your treatment history, facial anatomy, goals and response to previous products.
What is DAXXIFY?
DAXXIFY contains daxibotulinumtoxinA-lanm and is FDA-approved to temporarily improve moderate to severe frown lines between the eyebrows in adults. Like other botulinum toxin products, it reduces the nerve signals that cause selected facial muscles to contract, helping the treated lines appear smoother.
DAXXIFY features a proprietary peptide formulation and may provide longer-lasting improvement for some patients. In clinical studies, more than half of treated patients continued to have no or only minor frown lines six months after treatment. Results vary and your provider will determine whether DAXXIFY is appropriate based on your facial anatomy, muscle activity, treatment history and desired results.
Are the products interchangeable?
BOTOX Cosmetic, Dysport, XEOMIN and DAXXIFY are separate prescription medications. Their units, formulations, dosing and approved uses are not interchangeable.
A certain number of units of one product does not equal the same number of units of another. Your provider will calculate the appropriate amount based on the specific product and the muscles being treated.
What happens during treatment?
Before treatment, your provider will evaluate your facial movement, muscle strength, symmetry and areas of concern. You may be asked to make expressions such as frowning, smiling, squinting or raising your eyebrows so the active muscles can be identified.
The treatment areas are cleansed and a very fine needle is used to place small amounts of the selected product into specific muscles. The number of injections depends on the areas being treated and the results you would like to achieve.
Most appointments are brief and can be completed without anesthesia.
Is botulinum toxin treatment painful?
Most patients describe the injections as a quick pinch, sting or feeling of pressure. Discomfort is generally mild and lasts only a few seconds at each injection point.
Ice or another cooling method may be used before treatment. A topical numbing product may also be considered for patients who are particularly sensitive to injections.
Will I still look natural?
Botulinum toxin treatment should soften unwanted lines without eliminating every facial expression. Untreated muscles continue to move normally, allowing you to smile, laugh and express yourself.
Natural-looking results depend on careful product selection, dosing, placement and an understanding of facial anatomy. Your provider will customize the treatment rather than applying the same injection pattern to every patient.
When will I see results?
Botulinum toxin does not produce its final effect immediately. Some patients begin noticing improvement within the first several days, but the full result may take approximately two weeks or longer to develop.
The onset varies according to:
- The product used
- The area treated
- The strength of the muscles
- The amount injected
- Your individual response
- Whether you have received previous treatments
Avoid judging the final result too early. Your provider may recommend waiting approximately two weeks before assessing whether a follow-up evaluation is needed.
How long do the results last?
Results commonly last approximately three to four months, although the duration differs among patients and products. Some patients experience a shorter response, while others may maintain improvement longer.
As the medication gradually wears off, muscle movement returns and expression lines may slowly become more noticeable. Repeat treatment can be performed when appropriate, but appointments should be spaced according to your provider’s recommendations and the product’s prescribing information.
Is there any downtime?
Botulinum toxin treatment generally requires little to no downtime. Most patients can return to work and resume regular daily activities shortly after leaving the office.
Temporary effects may include:
- Redness at the injection sites
- Mild swelling
- Tenderness
- Pinpoint bleeding
- Bruising
- Headache
- A feeling of tightness or heaviness
Small raised areas may be visible immediately after the injections but usually flatten quickly.
How should I prepare for treatment?
Before your appointment:
- Tell your provider about all medications and supplements you take
- Discuss medicines or supplements that may increase bleeding or bruising
- Report any previous reaction to a botulinum toxin product
- Tell your provider when and where you last received botulinum toxin
- Report any infection, rash, inflammation or open wound near the treatment area
- Discuss previous facial surgery, fillers, threads or other cosmetic procedures
- Tell your provider if you have difficulty swallowing, speaking or breathing
- Report any condition that affects your nerves or muscles
- Tell your provider if you are pregnant, planning a pregnancy or breastfeeding
- Arrive with clean skin and minimal makeup when possible
Do not stop aspirin, blood thinners or another prescribed medication unless the healthcare professional who prescribed it tells you to do so.
How should I care for the treated areas?
Follow the personalized instructions provided by your injector. You may generally be advised to:
- Avoid rubbing or massaging the injection sites
- Avoid pressing tightly against the treated areas
- Remain upright for the period recommended by your provider
- Avoid strenuous exercise for the remainder of the day
- Avoid saunas, hot tubs and excessive heat temporarily
- Wait before receiving facials, massages or treatments that place pressure on the face
- Apply makeup gently when the injection sites have closed
- Contact the office before undergoing another facial procedure
Do not repeatedly manipulate the treated muscles in an attempt to make the medication work faster.
What are the possible side effects?
Most side effects are temporary and limited to the injection area. Possible reactions include:
- Pain or tenderness
- Redness
- Swelling
- Bruising
- Headache
- Temporary muscle weakness
- Eyelid or eyebrow drooping
- Facial asymmetry
- Dry eyes or excessive tearing
- An uneven smile
- Temporary changes in facial expression
The likelihood of a particular side effect depends on the product, dose, injection location, anatomy and individual response.
What serious symptoms require medical attention?
All FDA-approved botulinum toxin products carry a boxed warning regarding the possible spread of toxin effects beyond the injection area. Although uncommon, symptoms can occur hours to weeks after treatment and may include widespread weakness, double or blurred vision, drooping eyelids, hoarseness, difficulty speaking, loss of bladder control or difficulty swallowing or breathing.
Seek immediate medical attention if you experience:
- Difficulty breathing
- Difficulty swallowing
- Difficulty speaking clearly
- New or widespread muscle weakness
- Double or blurred vision
- Severe drooping of the eyelids
- Loss of bladder control
- Symptoms of a serious allergic reaction
Tell your provider before treatment if you already have swallowing, breathing, nerve or muscle problems, as these conditions may increase the risk of complications.
Who is a good candidate for treatment?
Botulinum toxin may be appropriate for adults who want temporary improvement in expression-related lines and have realistic expectations about the results.
Good candidates generally:
- Are in good overall health
- Have lines caused or worsened by muscle movement
- Prefer a nonsurgical treatment
- Understand that results are temporary
- Can follow preparation and aftercare instructions
- Have no infection in the planned injection areas
Your provider will examine both your facial movement and your lines at rest to determine whether botulinum toxin alone can provide the improvement you want.
Who should not receive botulinum toxin?
Treatment should not be performed if you have an infection at the planned injection site or a known allergy to the selected product or any of its ingredients.
Treatment may also need to be postponed or avoided if you:
- Are pregnant or breastfeeding
- Have certain nerve or muscle disorders
- Have significant difficulty swallowing or breathing
- Have experienced a serious reaction to another botulinum toxin product
- Have recently received another botulinum toxin injection
- Are taking medications that may interfere with neuromuscular function
- Have an active rash, wound or inflammation in the treatment area
- Recently underwent facial surgery or another procedure that has not healed
Provide a complete medical and treatment history so your provider can determine whether injections can be performed safely.
Can botulinum toxin be combined with other treatments?
Botulinum toxin may be combined with dermal fillers, Sculptra®, laser treatments, microneedling, chemical peels and other aesthetic services as part of a comprehensive facial-rejuvenation plan.
Botulinum toxin primarily addresses muscle-related expression lines, while other treatments may improve volume loss, pigmentation, scars, skin laxity or surface texture.
Some procedures can be performed during the same appointment, while others should be spaced apart. Your provider will recommend the safest treatment sequence based on your goals and medical history.
Schedule a botulinum toxin consultation
Botulinum toxin offers a quick, minimally invasive way to soften expression lines while maintaining a natural-looking appearance. The Dermatology Clinic can evaluate your facial movement, discuss the differences between BOTOX Cosmetic, Dysport, XEOMIN and DAXXIFY and create a personalized treatment plan based on your anatomy and aesthetic goals. Contact us today to get scheduled.
