Updated January 30, 2023

What exactly is Botox®?

Botox is an injectable prescription medication cosmetic treatment derived from a neurotoxin (a toxin that affects nerves) generated by the bacteria Clostridium botulinum.

If this bug sounds familiar, it is because it carries the same toxin that causes botulism, a potentially fatal form of food poisoning.

However, this toxin has numerous medicinal and cosmetic applications in tiny quantities, specifically promoting a youthful appearance.

How does the Botox® injection work?

The neuromuscular system comprises motor neurons, sensory neurons (which respond when the body contacts something hot, for example), and skeletal muscles.

When the brain transmits a signal to a nerve, the signal is sent to the motor neuron. In the narrow area (synaptic cleft) between the neuron and the muscle fiber, acetylcholine, a crucial neurotransmitter, is released.

Acetylcholine is a transmitter that instructs nearby muscle fibers to contract and move.

Motor neuron connecting to muscle fiber. A neuromuscular junction allows the motor neuron to transmit a signal to the muscle causing contraction. It is affected by toxins and diseases

Botox works by blocking these nerve signals in the injected muscle. As a result, the facial muscles cannot receive the signal to contract. Then, they may relax. When muscles are relaxed, the skin becomes more supple, and fine lines and wrinkles are diminished in appearance.

Of note, Botox treatments do not affect your capacity to make facial expressions. These treatments will not influence your ability to maintain relationships with friends and family.

Where can Botox be used?

Botox treats moderate to severe frown lines, crow’s feet, and wrinkles around the mouth.

Additionally, the neck, jaw, chin, and nose are treated.

Furthermore, Botox can be used to treat the following medical conditions:

• Recurrent migraines
• Overactive bladder
• Excessive underarm perspiration (hyperhidrosis)
• Crooked eyes (Strabismus)
• Eyelid muscle spasms
• Neuromuscular disorders such as cervical dystonia
• Upper extremity (limb) spasticity

Possible side effects from Botox injections

When administered by a competent and experienced practitioner, Botox injections are relatively safe and have few side effects.

Among the probable adverse effects of using Botox for cosmetic purposes are the following:

• Bruising, pain, and swelling around the Botox injection sites
• Mild headache
• Flu-like symptoms
• Either excessive tear production or dry eyes may be present
• Drooling
• Droopy eyelid

Botox aftercare

Avoid contact with the injection site! No rubbing or massaging for at least twenty-four hours following an injection (some doctors recommend three days).

Doing so may cause the poison to travel away from the treated location and into other parts of the body, resulting in significant adverse effects.

If you have any of the following symptoms hours to weeks after receiving the injection, you must contact your doctor immediately:

• Problems seeing
• Loss of bladder control
• Difficulty in breathing
• Muscle weakness
• Problems swallowing or speaking

Additional Botox aftercare instructions

• Avoid excessive activities and strenuous exercise for the remainder of the day; instead, unwind and maintain a low heart rate and blood pressure
• Avoid heat exposure – (sun, hot tubs, saunas, very hot showers, and tanning beds for at least four hours (24 to 48 hours is best) – these enlarge your blood vessels, which increases blood flow and bruising
• To minimize the risk of infection, keep your face clean
• Avoid facials, chemical peels, and microneedling for at least 24 hours after treatment to allow for maximal absorption of the Botox
• Vitamin E, fish oil supplements, St. John’s Wort, Ginkgo Biloba, Ginger, and Ginseng, can thin the blood and increase your risk of bruising
• Alcohol, like vitamin E, increases the risk of bruising. Avoid alcohol for at least 24 hours after Botox injections
• Use a cool, not cold, compress for bruising – an ice bag wrapped in a towel

Can you take ibuprofen (Advil ) after Botox?

You may wonder if you can take pain medication right after the surgery to alleviate discomfort or suffering.

The majority of individuals consider ibuprofen (Advil and Motrin), naproxen (Aleve), other nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen (paracetamol outside of the US).

NSAIDs reduce inflammation and pain but also delay blood coagulation, causing you to bleed for longer. If you are already experiencing bruising due to an injection, using an NSAID may worsen the problem.

What if you are prescribed an NSAID for arthritis, such as Celebrex? You may be susceptible to the same adverse effect as previously mentioned.

Taking Lovenox®, Plavix®, aspirin, or other blood thinners prescribed by a doctor can pose the same risk.

If any of the scenarios described above apply to you, you must inform your doctor or plastic surgeon BEFORE the injection operation. Your doctor will evaluate your medical history and provide specific instructions about your medications.

Under NO circumstances should you stop taking prescription anticoagulation or blood-thinning drugs on your own to receive a Botox treatment!

ALWAYS follow your doctor’s instructions!

If you are hospitalized because you failed to take your life-saving meds, that Botox injection will do you no good!

If you do not have a medical condition that puts you at risk for bleeding or bruising, you should wait at least 24 to 48 hours before taking an NSAID such as ibuprofen to treat pain or a headache.

On the other hand, you can take Tylenol (acetaminophen) immediately after Botox injections safely. 

This is because acetaminophen does not affect blood platelets the way NSAIDs do. There is no bleeding risk with acetaminophen.

Summary

• Alcoholic beverages should not be consumed for at least 24 hours following a Botox treatment
• On the first day of treatment, avoid strenuous activity or vigorous exercise
• Use cool, not cold compresses, towel-wrapped, to reduce bruising
• Vitamin E will raise your chance of bruising, so avoid taking it
• Do not touch the Botox-treated area for at least 24 hours (3 days preferable)
• Sun exposure, saunas, hot tubs, and tanning beds should be avoided for at least four hours (24 to 48 hours preferable)
• Due to their blood-thinning properties, NSAIDs and other anti-inflammatory medications such as ibuprofen or naproxen will increase bruising
• DO NOT quit taking NSAIDs or other blood-thinning medications your doctor prescribes unless instructed! Tell your doctor before beginning Botox treatment