Botox and Anti-Wrinkle Injections: How They Work, What They Cost, and Who Should Skip Them

Thinking about Botox but not sure what to expect? You may be wondering whether it will still look natural, how much it costs, or what could go wrong. Botox is widely used: the American Society of Plastic Surgeons reported 9.88 million neuromodulator injections in 2024, up 4 percent on the year before. This guide puts the practical questions first and sticks to what the FDA, medical groups and clinics’ own published price lists say.

If you are preparing for a first appointment, our first-appointment guide covers the week before and the day after. This one goes deeper: how the drug works, what the trials say about results, what you should expect to pay in 2026, and when Botox is the wrong choice.

What Botox is, and how neuromodulators work

Botox is a brand name for onabotulinumtoxinA, a purified protein made by the bacterium Clostridium botulinum. In the US, the FDA-approved cosmetic product is called Botox Cosmetic. Botox temporarily blocks the nerve signal that tells a muscle to contract. As the muscle relaxes, expression lines can soften.

Many wrinkles are made by muscles. Every time you frown or squint, the muscles under the skin fold it in the same place, and over years the fold becomes a line that is there at rest. Relax the muscle and the line softens. The effect is temporary; the nerve ending recovers over a few months.

Botox is not the only product in this class. Dysport (2009), Xeomin (2011), Jeuveau (2019), Daxxify (2022) and Letybo (2024) are all botulinum toxin type A products with FDA approval for frown lines. Those years refer to their US frown-line approvals. They differ in formulation and in how their units are measured, so the dose or price per unit of one brand cannot be directly compared with another.

Botox is also not a filler. Fillers add volume beneath the skin; neuromodulators relax muscle. If your concern is thin lips, flat cheeks or hollows under the eyes, ask whether dermal fillers or another treatment might be more suitable.

The areas Botox is approved to treat

The FDA has approved Botox for temporarily improving the appearance of moderate to severe lines or bands in four areas of adults:

• Glabellar lines, the vertical ”11s” between the eyebrows, made by the corrugator and procerus muscles (approved 2002)
• Lateral canthal lines, or crow’s feet, made by the orbicularis oculi (2013)
• Forehead lines, made by the frontalis muscle (2017)
• Platysma bands, the vertical cords in the neck (October 2024)

The FDA label gives the studied Botox doses: 20 units across five sites for frown lines, 24 units across six sites for crow’s feet, and 20 units across five forehead sites given together with the frown lines, for a total of 40 units. All three upper-face areas together is 64 units. These are labeled treatment doses, not a prescription for everyone. Your injector should explain the areas, planned units and total price for you.

Many popular treatments are off-label. A “lip flip”, masseter injections to slim the jaw or ease clenching, “bunny lines” on the nose, a dimpled chin and a gummy smile are not FDA-approved Botox uses for those purposes. That does not automatically make them inappropriate, but the evidence and risks differ by treatment. Ask what benefit to expect, what the uncertainties are, and whether another option would be better.

What an appointment looks like

A good appointment starts with a conversation, not a syringe. Expect your injector to ask about your concerns, watch how your face moves, and review your medical history. Mention neuromuscular conditions, previous reactions to botulinum toxin, pregnancy or breastfeeding, medicines and supplements, breathing or swallowing problems, and botulinum toxin treatments in the previous four months. Do not stop prescribed medicine unless your prescriber advises you to.

The injections themselves usually take about 10 to 15 minutes with a fine needle. Most people describe a quick pinch and can return to normal activities the same day.

Before leaving, ask for aftercare instructions, when to review your result and whom to contact if you have concerns. More preparation and aftercare detail is in the first-appointment guide.

When results start, and how long they last

The FDA label says the effect typically begins one to two days after injection and builds through the first week. The American Academy of Dermatology puts the visible result at three to seven days, although the full result may take around two weeks to assess. If you look at day three and see nothing, it may simply be too early. Follow the review plan your injector gives you.

Duration is where expectations most often go wrong. For frown lines, the FDA label for Botox describes the effect as lasting approximately three to four months. In the pivotal trials, investigators rated frown lines as none or mild in about 80 percent of patients at day 30, 48 percent at day 90, and 25 percent at day 120. The Dysport label says its effect “may last up to four months.” For Botox, treatment more often than every three months has not been evaluated; Dysport’s label advises waiting at least three months. Discuss timing with your injector.

Daxxify is another option with a different duration profile. In two manufacturer-sponsored frown-line trials, the median time patients maintained no or mild lines was about 24 weeks, based on both clinician and patient ratings. Individual results varied. These trials did not directly compare Daxxify with Botox.

What Botox costs in 2026

Botox is priced per unit, or per area with a set number of units included. Neither method tells you the full cost until you know what is included. These US clinics published the following prices on their own websites:

Some practices use a flat fee instead; The Dermatology and Laser Group in Manhattan lists $750 for the first area and $200 for each additional area.

Broader published figures help put these examples in context, but they are not a live national survey. RealSelf puts the typical US range at $10 to $15 per unit, with some practices charging $25 or more, and an average spend of $586 per treatment across 448 patient reviews (updated July 2024). The American Society of Plastic Surgeons reported an average physician fee of $435 for neuromodulator injections in its 2023 statistics report.

To turn a per-unit price into a bill, multiply the quoted Botox unit price by the number of Botox units in your treatment plan. At $14 a unit, the labeled 20-unit frown-line treatment is about $280, crow’s feet at 24 units about $336, and all three upper-face areas at 64 units roughly $900. Your plan may differ, so ask for the full quote before agreeing.

Three things to watch when comparing prices:

• Units are not interchangeable between brands. A lower price per Dysport unit does not automatically make Dysport a cheaper treatment. Ask how many units of the actual product will be used and what the total will cost.
• Daxxify’s low per-unit price can be misleading on its own. Its labeled frown-line dose is 40 Daxxify units, compared with 20 Botox units. That is not a conversion formula. Compare the total cost for the same treatment area.
• Loyalty programs may help with the cost. Allē (from the maker of Botox) and ASPIRE Galderma Rewards offer points or savings on eligible treatments. Check current terms and whether your clinic participates.

An unusually low price is a reason to ask more questions, not proof of a bargain. In 2024 the CDC investigated 17 people in nine states who developed harmful reactions after botulinum toxin injections; 13 were hospitalized. Some had received counterfeit or unverified product, or injections from people not following state or local requirements. The FDA’s alert described counterfeit vials labeled as 150 units, a size the manufacturer does not make, with the active ingredient listed as “Botulinum Toxin Type A” rather than onabotulinumtoxinA. Genuine Botox Cosmetic comes in 50-unit and 100-unit vials. Ask your clinic which product it uses and whether it came from an authorized supplier.

Side effects, and the warning on the label

Most side effects are minor and local: a little bruising, swelling or tenderness, and sometimes a headache. In trials of Botox for forehead and frown lines together, 9 percent of Botox patients reported a headache versus 5 percent on placebo.

Another possible side effect is a drooping eyelid or brow. In the trials behind the label, eyelid ptosis affected 3 percent of patients treated for frown lines and 2 percent treated for forehead and frown lines together, and brow ptosis affected 2 percent of that combined-treatment group. Drooping can happen when nearby muscles are affected. It is usually temporary, but it deserves a call to your injector. The label recommends treating forehead lines together with frown lines to reduce the chance of a dropped brow.

Like other botulinum toxin injections, Botox carries an FDA boxed warning about the possible spread of toxin effects beyond the treated muscles. In severe cases, this can cause problems with swallowing or breathing. The label says the risk appears greatest in children treated for spasticity and that no confirmed serious cases of distant spread have been reported at recommended doses for the approved cosmetic areas. That is reassuring, but it does not mean the risk is zero.

Get medical help immediately if you develop trouble swallowing or speaking, blurred or double vision, or new widespread muscle weakness after an injection. Call 911 for breathing difficulty. Symptoms can begin hours to weeks after treatment.

Rarely, antibodies can reduce how well treatment works. In the label’s crow’s-feet trials, 1.5 percent of 916 patients developed binding antibodies and none developed the neutralizing kind. If Botox stops taking effect for you, tell your injector rather than asking for more.

Who should not have Botox

The label lists two contraindications: a known allergy to any botulinum toxin product or to the ingredients in the formulation, and an infection at the planned injection site.

It also flags groups who need caution or a physician’s input first:

• People with neuromuscular disorders such as myasthenia gravis, Lambert-Eaton syndrome or ALS, who “may be at increased risk of clinically significant effects,” including difficulty swallowing or breathing
• Anyone pregnant or breastfeeding. Pregnancy safety data are insufficient. Breastfeeding is different: small studies have found no or only tiny amounts of Botox in breast milk, and limited reports have not identified harm to infants. These findings are reassuring but not definitive, and they do not apply to every brand or dose. Talk with your prescribing clinician about your circumstances.
• People taking aminoglycoside antibiotics or muscle relaxants, which can increase muscle weakness. Some other medicines, including anticholinergics, may also increase side effects. Bring your full medication list and ask the prescriber to check it.
• Anyone with a previous reaction to Botox, Dysport, Xeomin, Jeuveau, Daxxify or Letybo

Botox is also a poor fit for some wrinkles. It cannot restore lost volume or reverse sun damage, and it will not lift sagging skin. Lines visible when your face is relaxed may still soften with Botox, but you might benefit from a different or combined approach. Ask whether a filler or a skin treatment such as microneedling is appropriate after an assessment.

How to choose a cosmetic injector

Botox is a prescription drug and injecting it is a medical procedure. The American Academy of Dermatology advises having treatment from a board-certified dermatologist or a trained member of the doctor’s medical staff, with the doctor immediately available. Rules about who can inject and what supervision is required vary by state. These questions help you check that a clinic is the right fit:

1. Who will be injecting, and what is their license? Ask about training in facial injections and the supervision required in your state. You can check a clinician’s license through the appropriate state medical or nursing board.
2. Which product, and where did it come from? Ask to see the vial and box. The CDC’s advice after the 2024 counterfeit cases: confirm the product is FDA-approved and from an authorized supplier, and “if in doubt, don’t get the injection.”
3. Is this a medical setting? The AAD lists non-medical spas, parties, salons and someone’s home as places never to be injected, and notes that long-term muscle paralysis, Bell’s palsy and permanent eye damage have occurred with product from unregulated sources.
4. Is there a consultation first? A walk-in injection without a medical history and a discussion of goals is a red flag.
5. Can they show their own before-and-after photos of real patients?
6. What happens if something goes wrong? Ask whom to contact after hours, who will assess a complication and whether a follow-up, often around two weeks, is included.

You can compare Botox providers near you on AuraVenu, including ratings, published starting prices and the treatments each clinic offers.

For a fuller checklist, including how to look up a license and check the medical director, see how to check a med spa is legitimate.

Frequently asked questions

How many units of Botox will I need?

The FDA-studied Botox doses are 20 units for frown lines, 24 for crow’s feet and 40 for forehead and frown lines together. Those are labeled doses, not a one-size-fits-all recommendation. Your injector should explain the product, areas and planned units before treatment.

How long does Botox take to work?

The muscle starts to relax within one to two days, most people see a change at three to seven days, and it can take around two weeks to assess the full result.

How long does Botox last?

Botox usually lasts about three to four months for frown lines, according to the FDA label. In Daxxify’s frown-line trials, the median time with no or mild lines was about 24 weeks, based on assessments by patients and clinicians. Results varied, and those trials did not compare Daxxify directly with Botox.

Does “preventative” Botox work?

The evidence is thinner than the marketing. A published report followed a pair of identical twins for 19 years. One had regular Botox, while her sister had only four treatments over that time; the twins showed different degrees of visible facial lines. That is two people, not a controlled trial, and it cannot tell us the right age to start Botox or prove that people without visible lines need treatment.

Can I get Botox while pregnant or breastfeeding?

For pregnancy, adequate safety data are lacking, so cosmetic treatment is generally deferred. For breastfeeding, the limited evidence on Botox is reassuring, but not conclusive for every situation or product. Ask your prescribing clinician to help you weigh the available information.

Will my face look frozen?

Not necessarily. The amount of movement you keep depends on your anatomy, the dose and where it is injected. If a natural-looking result matters to you, say that at your consultation and ask what is realistic.

Related guides

• What to know before your first Botox appointment
• Dermal and lip fillers: types, how long they last and the risks
• How to check a med spa is legitimate before you book
• Find Botox providers near you

This guide is general information, not medical advice. Whether Botox is right for you depends on your health history, your anatomy and what you hope to change. Book an in-person consultation with a licensed provider before you decide.

Sources

• FDA / DailyMed, BOTOX Cosmetic (onabotulinumtoxinA) prescribing information, revised October 2024
• FDA, Dysport prescribing information, revised January 2023; Daxxify prescribing information, 2022
• Merz Aesthetics, FDA approval of Xeomin for glabellar lines, press release, July 21, 2011
• Revance, DAXXIFY clinical studies for healthcare professionals (manufacturer data)
• Carruthers JD, Fagien S, Joseph JH, et al. DaxibotulinumtoxinA for injection for the treatment of glabellar lines: results from each of two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). Plast Reconstr Surg. 2020;145(1):45-58
• American Society of Plastic Surgeons, 2024 Plastic Surgery Statistics Report, p. 12; 2023 Plastic Surgery Statistics Report, average physician fees
• American Academy of Dermatology, Botulinum toxin therapy: overview, preparation and FAQs
• NIH, Drugs and Lactation Database (LactMed), Botulinum toxins, therapeutic, revised September 15, 2026
• CDC, Harmful reactions to counterfeit or mishandled botulinum toxin injections, 2024 investigation, updated December 17, 2024; MMWR 73(27), July 11, 2024
• CDC, How to stay safe when getting botulinum toxin injections, updated April 22, 2026
• FDA, Counterfeit version of Botox found in multiple states, April 2024
• Rivkin A, Binder WJ. Long-term effects of onabotulinumtoxinA on facial lines: a 19-year experience of identical twins. Dermatol Surg. 2015;41 Suppl 1:S64-6
• RealSelf, How much does Botox cost?, updated July 4, 2024
• Clinic price lists checked October 16, 2026: New Horizons Med Spa, Chandler AZ; Hiatus Spa + Retreat, TX; KORA Aesthetics, Scottsdale AZ; Viva Day Spa + Med Spa, Dallas TX; Skin Pharm, Chicago IL; Northwest Medical Arts, University Place WA; Neaman MediSpa, Salem OR; Selfie House, New York NY; Claytor Noone Plastic Surgery, Bryn Mawr PA; Trifecta Med Spa, New York NY; The Naderi Center, Chevy Chase MD / Reston VA; The Dermatology and Laser Group, New York NY
• Hiatus Spa + Retreat, med spa price list, Botox price rechecked October 21, 2026: $14 per unit