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Dr. Fishman’s TOP 5 Most Commonly Asked Questions About Botox

dr. inessa fishman injects botoxBotox is a popular treatment, and becoming more so.  According to the American Society of Plastic Surgeons, Botox treatments were performed nearly 5 million times in 2020, and have increased 28 percent in the 20 to 29-year-old age patient group since 2010.  While Botox and Dysport injections make up the most popular non-surgical treatment in our practice, lots of our patients are new to these injectable medications and their benefits.  Our facial plastic surgeon Dr. Inessa Fishman discusses some of the most common questions she fields about Botox from new patients.


1.  What is Botox, and how does it work?

Botox is an injectable medicine which relaxes muscles, says Dr. Fishman.  There are 4 medications–Botox, Dysport, Jeuveau, and Xeomin–which are FDA-approved for the treatment of cosmetically bothersome wrinkles in the United States, and they all work in the same way by preventing the treated muscles from contracting quite as hard as they normally would.  Relaxed muscles have a tougher time creasing or folding the skin above them, and this smooths the associated wrinkles and lines.  Besides affecting muscle, Botox also decreased the production of sweat and is used for the treatment of excess or unwanted sweating.


2.  What is the difference between Botox and dermal fillers?

While Botox relaxes muscles and thus prevents the formation of wrinkles above the muscle, dermal fillers (like Restylane and Juvederm) add volume.  Dr. Fishman relates fillers to plumping gels, which she uses to fill is superficial wrinkles, add volume to lips, temples, cheeks, and jawlines, and stimulate collagen production in the skin.

“Dynamic lines, or wrinkles that appear with expression, are usually better treated with a neurmodulator–another term for a muscle relaxant like Botox or Dysport,” says Dr. Fishman.  Static lines, or wrinkles apparent at rest, can be softened with Botox, but require other treatments–fillers, lasers, microneedling–for more significant improvement.  

While dermal fillers and neuromodulators come in multiple “flavors” at our practice, Dr. Fishman says they all have their place.  “I love educating my patients about different treatment options,” she says, “and injectable treatments are great tools in the aesthetic toolbox.”  


3.  Does Botox treatment hurt?  How long does treatment take?

Botox treatments are not significantly uncomfortable for the average person, Dr. Fishman says.  “It is normal to feel the tiny beesting sensation of the needle, but the Botox medication itself feels like nothing,” she relates.  It is also common to feel or hear tiny crunchy sounds, especially when injecting the thin tissues of the forehead.  Patients will commonly feel “sneezy” when injecting the frowning muscles between the brows.  Every patient has a different sense of what is truly painful or momentarily uncomfortable, and “my staff and I do our best to distract patients during Botox injections,” says Dr. Fishman.  While most patients tolerate Botox treatment with cold compresses only, we offer topical numbing medicine, distracting vibration, and laughing gas to patients who need extra support during treatment.


4.  When can I see results from Botox injections, and how long do they last?

Botox does not work immediately; while it takes 4 hours to bind to its site of action, Botox starts to show its effects over 2-4 days after injection, and shows 100% efficacy for 100% of treated patients at 2 weeks. The results of Botox start wearing off at 6-8 weeks, which is when most patients see movement of treated areas come back.  “It is normal to see expression lines reappear at 6-8 weeks post-treatment, and a lot of patients are surprised by this,” says Dr. Fishman.  “While some movement at this time is normal, the clinical effects of Botox last 3-4 months, and I prefer to retreat patients at this time interval.”


5.  What are the side effects of Botox?

The most common side effects of Botox treatment, like any other injections, are bleeding and bruising; the bruising associated with Botox injections are usually small (about the size of a pea) and can take about a week to resolve.  These side effects can be lessened by avoiding blood-thinning medications before and after injections, and foregoing very strenuous exercise for 12 hours after injections.  

Infection and allergy-like responses are exceedingly rare with Botox, says Dr. Fishman.  Approximately 15% of treated patients will develop a headache for a day or two after treatment.  Heavy, drooping brows as well as a complication called ptosis (or a drooping eyelid) are small risks as well, and like the other effects of Botox, these are temporary.


The well-educated and prepared patient generally has a smoother treatment course and experience, and Dr. Fishman and our staff take pride in providing our patients with helpful, high yield information pertaining to any and every treatment.  Want to learn more about Botox?  Contact us to schedule your consultation today.

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