A Beginner’s Guide To Botox

Botox has been used to treat wrinkles for over two decades, but it's suddenly a hot topic. If it seems like everyone in your group chat is talking about injectable treatments, you're onto something: A report by the American Society of Plastic Surgeons found that nearly 9.5 million people got cosmetic neurotoxin treatments in 2023, a nine percent increase from the previous year. Anecdotally, it seems like Canada is following suit.

Whether you're thinking about trying Botox for the first time or have a standing appointment with your injector, there's a lot to consider when it comes to cosmetic treatments. We asked Dr. Renita Ahluwalia, lead dermatologist at the Canadian Dermatology Centre, and Dr. Leah Smith, founder and medical director at My Beauty Doctor in Toronto, our many questions. Keep reading for the ultimate, no-BS guide to Botox.

How does Botox work?

Botox is the brand name of a popular neurotoxin, but it's often used to refer to any neurotoxin injection that reduces the appearance of existing wrinkles and slows the formation of new ones. It works by temporarily blocking the nerve signals that tell muscles to contract.

Botox was officially approved for treating glabellar lines (the so-called elevens between the eyebrows), crow’s feet and frown lines on the forehead in 2001, though it’s also used to treat other cosmetic concerns. In her practice, Ahluwalia uses injectable neurotoxins to lift the brows, alter the shape of the nose, prevent chin dimpling and make lips appear fuller via a trending procedure called a "lip flip."

Botox is also used to treat medical conditions, including chronic migraines, excessive sweating and overactive bladder.

Aside from Botox, there are four other Health Canada-approved neurotoxins on the market: Dysport, Xeomin, Nuceiva and Letybo. They are all slightly different at the molecular level but work the same way. Which one you should choose comes down to your personal preference, or your provider's.

When is the right time to start Botox treatments?

It depends on your aesthetic goals. In recent years, there’s been growing demand for “preventative Botox” from people in their early 20s and 30s who want to stop fine lines and wrinkles before they form. Ahluwalia also sees patients in their 40s and beyond who are trying Botox for the first time.

It’s never too late to start treatments, though both Ahluwalia and Smith say it’s important to manage your expectations. “The results depend on the depth of the lines, and how long they’ve been there,” says Smith. “We may be able to soften them with Botox—but not get rid of them completely—once they’re fully set in.” In those cases, Ahluwalia recommends pairing neurotoxins with laser resurfacing treatments.

“I always recommend coming in so we can take a look at your muscle movement, take a look at the depths and severity of the lines, and then make recommendations on when to start treatment,” says Smith.

How fast will you see results from Botox?

Results are visible quickly but not instantaneously. “Most people start to see a little less movement around day three, but the peak onset is two weeks,” says Ahluwalia.

Around the two-week mark, both Ahluwalia and Smith book a follow-up with first-time clients in case adjustments are needed, and they recommend looking for a provider who does the same. “Botox is not one-size-fits-all,” says Ahluwalia. “We try to map out how you’re going to respond, but sometimes something unexpected happens and those little things can be corrected.” 

If you want to get Botox before a big event, Ahluwalia stresses the importance of thinking ahead. “I like to see someone at least once before [I inject them for a big event] to learn how their muscles react and make sure it’s perfect,” she says.

How long does Botox last?

It varies by person and depends on the area injected. On average, results last three to four months, except in spots where there’s more movement, like around the mouth, where it only lasts six to eight weeks. “Often, it’s just genetics,” notes Ahluwalia.

The good news is that if you don’t like the results, they don’t last forever. The bad news is that, unlike dermal fillers, they can’t be instantly reversed with another injection. “If you got too much Botox, move the muscles a lot—the more you move, the quicker it will metabolize,” Ahluwalia recommends. But first, be sure to touch base with your provider, who can determine if adjustments are possible.

Anecdotally, people who work out often tend to metabolize Botox faster, though it’s not fully understood why.

How often should you get Botox?

As a rule, it’s time to get in touch with your provider when you see lines at rest that you’re unhappy with. 

Treatments should be spaced at least three months apart, though it’s a good idea—for your body and your wallet—to go a little longer between top-ups. “There’s more and more evidence that you don’t want to overload the neuroreceptors, which can potentially cause Botox resistance,” says Ahluwalia. (Resistance happens when the body creates antibodies to fight the neurotoxin, leading it to stop working as intended.)

If you decide to stop getting Botox, nature will take its course—you’re not preventing the skin aging process from happening, but rather slowing it down. “But you're not causing any harm to your skin or to your overall health if you choose to discontinue the treatment,” says Ahluwalia.

How much Botox should you get?

Again, there’s no one answer here—it depends on your body and aesthetic goals. “I don't believe in the cookie-cutter technique, where everyone gets the same dose,” says Smith. “Not everyone has the same goals, not everyone has the same muscle strength and not everyone is starting from the same place.” For example, men typically require higher doses of neurotoxins as they tend to have stronger facial muscles.

It’s important to find a provider you trust, who offers an initial consultation, during which they can assess your underlying facial structure and muscle strength and talk about desired outcomes and budget.

Ahluwalia tends towards the conservative side, though she cautions that it’s important to trust your provider to make the best possible recommendations for you. “People often ask for the minimum amount possible because they’re nervous,” she says. “But if you just inject one muscle group without injecting the one to balance it out, that’s a telltale sign that you’ve had Botox."

Are there any risks to Botox?

Botox is derived from the botulinum toxin, which causes botulism, but it’s diluted and sterilized to make it safe for cosmetic use. It’s generally well-tolerated, according to Ahluwalia, though it’s not safe for those with neuromuscular junction disorders and not recommended for pregnant people.

Side effects are most often cosmetic. For example, if injected in the wrong muscle, Botox can create facial asymmetry or eyelid drooping. If used too often, it can also lead to muscle atrophy or temporary resistance to the treatment.

There might be some light bleeding immediately after and bruising at the injection site, which can last a few days. Ahluwalia notes that some people experience light headaches after their first couple of treatments, likely due to the fact that they’re trying to move a muscle that’s frozen. That said, there’s no loss of sensation or numbness associated with neurotoxins. 

Botox injections are a cosmetic procedure and should be done by a professional in a sterile environment. Botox parties—a.k.a. any setting outside of a clinic—are a huge no-no. “The product has to be stored under very specific conditions, and it has to be reconstituted with exact dosing,” warns Smith.

Do Botox injections hurt?

Most people don’t find Botox injections painful, but those who are squeamish around needles probably won’t enjoy the experience. The injections themselves are quick and feel like nothing more than a sharp pinch. Some spots are a little more delicate, such as around the brow bone and the upper lip.

What is Botox prep and aftercare like?

Botox injections are considered a lunchtime procedure—there’s no prep and no down time, save for some temporary redness and possible bruising. Avoid blood thinners (like Advil and aspirin) and alcohol for 72 hours before the injections, as well as immediately after.

Afterwards, you should also avoid vigorous exercise, saunas and hot tubs for 24 hours to minimize the risk of diffusion and bruising.

Ahluwalia recommends not lying flat on your face (while napping or getting a massage, for example) for a few hours, while Smith asks her clients not to lie down at all for about four hours after the procedure. “Also try to avoid touching or washing your face during that time,” she adds.

How do you find a Botox provider?

In Canada, neurotoxin injections are performed by medical professionals, including dermatologists, physicians, plastic surgeons and nurses.

“Who does the treatment? What are their credentials? Is there a medical director on-site? What type of product do you use? Where do you get the product from? Those are all reasonable questions to ask for your safety,” says Ahluwalia. 

When it comes to finding a provider who understands your aesthetic goals, it’s worth asking people you trust and whose work you like. Smith notes that, in her experience, before-and-after photos don’t always tell the whole story as they can be altered, so real-life examples of a provider’s work and personal recommendations are a safer bet.

How much does Botox cost?

While injectables are becoming mainstream, they're also expensive. Prices vary based on your location, how experienced your provider is and how much Botox you’re getting. Cosmetic Botox injections aren't covered by provincial health care or private benefits.

Injections are either priced by units (which is how the product is measured) or by treated areas. On average, the cost ranges from $10 to $15 a unit; treating the forehead alone might require up to 60 units. A full facial treatment could cost up to $1,000.

This type of treatment is a luxury—Smith stresses that you should feel comfortable having an open conversation with your provider and never feel pressured to go ahead with injections if you’re not 100 percent sure it’s right for you and within your budget.