Everything You Need to Know About Getting Botox for the First Time

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The first and only time I got Botox, I had a stress ball in my hand and I kept my eyes shut as the needle slid into my crow's feet. Suffice it to say that, despite the fact that Botox injections are among the most common procedures that many cosmetic dermatologists and plastic surgeons regularly do, it's still nerve-wracking to anticipate what will happen during the procedure and what the results will look like ahead of your first appointment.

To help ease any fears, however, experts are explaining what to expect when you get Botox, so that your first appointment can, quite literally, be smooth sailing.

Experts In This Article

What exactly *is* Botox?

Botox is an injectable found at the dermatologist's office that taps a neurotoxic protein called "bacterium clostridium botulinum," (say that three times fast) and is produced by the parent company called Allergan. Botox has become so synonymous with smoothing out fine lines that it's used as shorthand amongst many beauty enthusiasts, but there are also other neurotoxins that do the same thing, such as Dysport, Xeomin, and Jeuveau.

Though there are increasing uses for Botox in medical settings (jaw pain, migraines, to stop sweating in the armpits), when used in cosmetic settings, Botox is tapped to soften lines. "Botox works by preventing dynamic wrinkles by temporarily weakening the underlying muscle," says Dendy Engelman, MD, a board-certified dermatologic surgeon in New York City. Dynamic wrinkles are those caused by the movement of the underlying muscle, and, over time, these turn into a static line even at rest. "With Botox treatment, the muscle contraction is weakened and the overlying dynamic wrinkle is lessened. And with early and effective treatment, it can not only reduce the dynamic lines with movement but soften or eliminate static lines as well," she says.

Botox is commonly used on the frown lines (the area between the eyebrows), sides of the eyes (crow's feet), and forehead lines, but it can be used around the jaw, neck, and elsewhere, according to Dr. Engelman. Those are the basics about the cosmetic treatment—keep scrolling for intel on some of the most common questions about Botox, as explained by dermatologists.

What to expect when you get Botox

Is it safe?

Absolutely. It's FDA-approved, even, which is more than what many skin-care creams and serums can say. "Botox is safe and actually used to mitigate certain health issues, such as hyperhidrosis and migraines," says Dr. Engelman. That said, Botox should not be done on those who are pregnant or breastfeeding. And to really make sure that you're happy with the results of your treatment, it's vital to go to a trained professional. Getting Botox is a medical procedure, and it really should be treated as such, so make sure to thoroughly vet your practitioner ahead of seeing them in person.

What are the risks?

The most common risks of getting Botox are bruising or swelling, but Lesley Rabach, MD, a board-certified facial plastic surgeon and co-founder of LM Medical, notes that these don't happen that often. "The chance of infection in someone who's healthy is almost zero," she says. What could happen is that you experience asymmetry after the Botox sets in. "There's a slight chance of that, which isn't uncommon because usually, one side of someone's face is stronger than the other," she says. Oftentimes, your dermatologist will have you come back in for a check-up to even things out if necessary.

Most of these risks are mitigated if you see the right professional for the treatment. "It's important to go to a licensed dermatologist for treatment," says Dr. Engelman, stressing that it's key to not seek treatments based on cost alone. "There's an ethical component in the preparation of the product and a skill in the injection which can only be found in high-quality offices and with highly trained and certified injectors."

Does it hurt?

If needles make you nervous, know that Botox injections are done with a teeny, tiny one that's roughly the same type used for insulin shots. "Think of the needles that are used to get blood drawn—those are massive compared to the needles used for Botox," says Dr. Rabach. "These are very minor. If you're doing this for cosmetic use, it should be comfortable and pleasant."

I got Botox with Dr. Rabach, who held a very small vibrating tool near the spot that was being injected, which distracted my body from feeling the needle. As I clenched before my first injection, two seconds later, she had already finished putting the Botox into the left side of my face before I could even feel it. It's also common to get ice packs before and after the procedure to help slightly numb the area, which will again make the experience pretty comfortable (though everyone is different).

How long does it take to work?

The first thing you'll notice immediately after Botox injections are little bumps and dots of blood that look just like mosquito bites. These go away in 20 minutes to half an hour. But you won't notice the skin-smoothing effects between three to five days (and up to two weeks). "Cosmetic effects are not immediate, and it's not one and done," says Dr. Engelman.

Does it make you look really different?

Botox smooths your skin, but it's not going to fundamentally change your face and make you look like an Instagram filter  (especially if you're going to a responsible injector, who's giving you a small dose). "Your skin is going to look smoother, but you're going to look like yourself, just more refreshed," says Dr. Rabach. In my experience, I simply looked more awake, and my skin looked much smoother all over.

Is it permanent?

Ugh, no. Over time, Botox is metabolized by the body, and one treatment really only lasts between three to five months on average; however, there are a number of factors that can cause that to vary. "It depends on the individual, and how many units are injected, how the person's metabolism is, and how often you're vigorously exercising," says Dr. Rabach.

What happens after a Botox treatment?

There's no downtime after Botox. Dermatologists advise you to avoid excessive sweating or exercise for at least 24 hours post-treatment (the boost in circulation can spread the toxin to unwanted areas within the body), but you can continue your regular skin-care routine. It's also key to avoid touching your face where you had the injections so that the Botox can properly settle, and avoid too much sun exposure, as it can encourage bruising. Other than that, you're good to go.


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