Botox is a drug that weakens or paralyzes muscle. In small doses, it can reduce skin wrinkles and help treat some muscle conditions.

Botox is a protein made from botulinum toxin that the bacterium Clostridium botulinum produces. This is the same toxin that causes botulism.

Botox is a toxin, but when people use it correctly and in small doses, it has a number of medical and cosmetic uses.

Botox injections are probably best known for reducing skin wrinkles. Botox can also help treat crossed eyes, eyelid spasms, excessive sweating, and some bladder disorders.

In this article, we will explain how Botox works, its uses, possible risks, and side effects.

a man having a botox injection in his foreheadShare on Pinterest
Botox may help reduce skin wrinkles.

Botox derives from a bacterium called Clostridium botulinum. This bacterium is present in many natural settings, including soil, lakes, forests, and in the intestinal tracts of mammals and fish.

Naturally occurring Clostridium botulinum bacteria and spores are generally harmless. Problems only arise when the spores transform and the cell population increases. At a certain point, the bacteria begin producing botulinum toxin, the deadly neurotoxin responsible for botulism.

Botulinum toxin is extremely toxic. In fact, some scientists have estimated that 1 gram (g) of crystalline toxin could kill 1 million people and a couple of kilograms could kill every human on earth.

However, according to the American Osteopathic College of Dermatology, (AOCD), Botox is safe and has few side effects when used in a therapeutic context.

Manufacturers make Botox injections from very small doses of botulinum toxin. The drug can temporarily paralyze muscles, which can benefit a range of muscle- and nerve-related disorders.

Commercial versions of Botulinum toxin include:

  • Botox (onabotulinumtoxin A)
  • Dysport (abobotulinumtoxin A)
  • Xeomin (incobotulinumtoxin A)
  • Myobloc (rimabotulinumtoxin B)
  • Jeuveau (prabotulinumtoxin A)

People use the term Botox interchangeably for these various products, though “Botox” is the registered trademark of Allergan Inc.

Botox is a neurotoxin. These substances target the nervous system, disrupting the nerve signaling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis.

In order for muscles to contract, nerves release a chemical messenger called acetylcholine at the junction where the nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the muscle cells to contract or shorten.

Botox injections prevent the release of acetylcholine, which stops muscle cells from contracting. The toxin reduces abnormal muscle contraction, allowing the muscles to become less stiff.

The primary use of Botox is reducing the appearance of facial wrinkles.

According to the American Board of Cosmetic Surgery, Botox injections are the most popular cosmetic procedure nationwide. In 2016, over 7 million people had Botox treatments.

The effects of Botox are temporary, lasting 3–12 months, depending on the treatments.

Common facial areas people use Botox on include:

  • frown lines, also called glabellar lines or “elevens”
  • wrinkles around the eyes, known as crow’s feet
  • horizontal creases in the forehead
  • lines at the corners of the mouth
  • “cobblestone” skin on the chin

Research has not shown whether Botox could improve dark circles under the eyes. Read more here.

Some people also try Botox to improve the appearance of their hair. There is also little evidence that this works. Read more here.

Beyond cosmetic applications, healthcare professionals use Botox to treat a variety of medical conditions related to muscles.

According to the AOCD, the Food and Drug Administration (FDA) has approved Botox for the following uses:

According to an article in the journal Toxins, evidence shows that Botox can help treat an overactive bladder.

Some people also use Botox injections for off-label, or not approved, uses, including:

  • alopecia
  • psoriasis
  • dishidrotic eczema
  • post-herpetic neuralgia
  • vulvodynia
  • Raynaud syndrome
  • achalasia, an issue with the throat that makes swallowing difficult
  • anismus, a dysfunction of the anal muscle
  • sialorrhea, a condition where the body produces too much saliva

People use Botulinum toxin by diluting the powder in saline and injecting it directly into neuromuscular tissue.

It takes 24–72 hours for botulinum toxin to take effect. Rarely, it may take as long as 5 days for the full effects to take place.

The effects may last for 3–12 months, depending on the treatment.

People should avoid using Botox during pregnancy or breastfeeding, or if they have had a previous allergic reaction to the drug or any of its ingredients.

Read about the safety of having Botox when breastfeeding here.

People generally tolerate Botox injections well, and side effects are not common.

Along with its intended effects, botulinum toxin may cause some unwanted effects. These can include:

  • mild pain, swelling, or bruising around the injection site
  • flu-like symptoms
  • a headache
  • an upset stomach
  • temporary eyelid drooping
  • numbness
  • malaise, or feeling generally unwell
  • temporary unwanted weakness or paralysis in nearby muscles

In rare cases, the person may have a genetic predisposition that results in a mild, transient unusual response to the drug.

Some people receiving injections of botulinum toxin type A develop antibodies to the toxin that make subsequent treatments ineffective.

Botox is a drug that, in small doses, can reduce skin wrinkles and help treat certain muscle-related disorders.

If someone wants to try Botox, they can speak to their healthcare provider about the safety, risks, costs, and other considerations.