Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2014;90(3):online

See related article on botulinum toxin injection for facial wrinkles.

What is cosmetic botulinum toxin?

It is a product used to reduce or get rid of wrinkles. Small amounts of it are injected into specific muscles in the face. This relaxes the muscles, which smoothes wrinkles. Botox, Dysport, and Xeomin are some common forms of botulinum toxin.

What areas of the face are usually treated?

Frown lines, forehead lines, and crow's feet are the most commonly treated areas.

Who is a good candidate for treatment?

People with dynamic wrinkles (that are seen when muscles contract to make expressions) have the most improvement with treatment. People with static wrinkles (that are seen when the face is relaxed) also have improvement, but the results are slower.

When will I see the results?

It takes about two weeks to see the botulinum toxin's full effects.

How long do the results last?

Results last three to four months. The next botulinum toxin treatment is recommended when the muscles in the treated area start to contract again.

How should I get ready for treatment?

You should not take aspirin, ibuprofen, or naproxen for two weeks before treatment to help prevent bruising. Be sure to tell your doctor about any herbs or dietary supplements you are taking, because these may also increase the risk of bruising.

Who should not get treatment?

If you are pregnant or breastfeeding, you should not get treatment. If you have a disease of the nerves or muscles you also may not want to get treatment; your doctor can evaluate you to see if you are a candidate.

What are the side effects?

Side effects are rare, but can include drooping of the upper eyelid or eyebrow. These symptoms go away on their own or can be improved with medicated eye drops or botulinum toxin injection in nearby muscles. Some bruising and swelling can also occur. Ice may be applied for 10 to 15 minutes every few hours until bruises go away.

What should I do after treatment?

Do not lie down for four hours right after treatment. On the day you receive treatment, do not massage or apply heat to the treated areas, and do not do activities that cause flushing (for example, drink alcohol, exercise heavily, or sit in a hot tub).

Where can I get more information?

Your doctor

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