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Botox Cosmetic

onabotulinumtoxinA
Used for Facial Wrinkles
Used for Facial Wrinkles

Brand name Botox Cosmetic (onabotulinumtoxinA) is a treatment used to temporarily improve the appearance of lines on sites on the forehead and around the eyes. It's only available as an injection into the muscles by a healthcare provider. Side effects of Botox Cosmetic (onabotulinumtoxinA) can differ depending on where you've received the injection and they include headache and droopy eyelids. The recovery time after treatment tends to be quick. Typically, you can return to your normal daily activities right away.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Connie Zheng, PharmD
Last reviewed on April 11, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Botox Cosmetic (onabotulinumtoxinA)?

What is Botox Cosmetic (onabotulinumtoxinA) used for?

  • Temporarily improves the appearance of frown lines, forehead lines, and crow's feet lines in adults

How Botox Cosmetic (onabotulinumtoxinA) works

Botox Cosmetic (onabotulinumtoxinA) is a neuromuscular blocker. It's a toxin made from bacteria (Clostridium botulinum) that temporarily lowers muscle activity by stopping a chemical called acetylcholine from being released in your muscle. This helps to relax the muscles that cause frown lines, forehead lines, and crow's feet lines around your eyes.

Are you looking for information on non-cosmetic Botox (onabotulinumtoxinA) for medical conditions, such as migraine or bladder problems instead?

Drug Facts

Common BrandsBotox Cosmetic
Drug ClassNeuromuscular blocker
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

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What are the side effects of Botox Cosmetic (onabotulinumtoxinA)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Frown lines
  • Drooping eyelids (3%)
  • Facial pain (1%)
  • Trouble moving parts of the face (1%)
  • Muscle weakness (1%)
Crow's feet
  • Eyelid swelling (1%)
Forehead lines
  • Headache (9%)
  • Drooping eyelids (2%)
  • Drooping eyebrow (2%)
  • Skin tightness (2%)

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Trouble breathing or swallowing

Source: DailyMed

More on Botox Cosmetic (onabotulinumtoxinA) side effects

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The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Dryness or irritation of the eyes, eye pain, change in vision, sensitivity to light
  • Spread of botulinum toxin effects—unusual weakness or fatigue, blurry or double vision, trouble swallowing, hoarseness or trouble speaking, trouble breathing, loss of bladder control

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

pros-and-cons

Pros and cons of Botox Cosmetic (onabotulinumtoxinA)

thumbs-up

Pros

Can use to treat frown lines, crow's feet lines, and forehead lines at the same time

Might start to see results within 1 to 2 days

Can last up to 4 months for moderate-to-severe frown lines

Quick recovery time after injections (can return to daily activities right away)

thumbs-down

Cons

Needs to be injected by a healthcare provider

Injections can be uncomfortable

Effects aren't permanent and requires repeat injections

Not available as a generic medication

pharmacist-tips

Pharmacist tips for Botox Cosmetic (onabotulinumtoxinA)

pharmacist

  • Botox Cosmetic (onabotulinumtoxinA) injections can feel like a pinch. To make you feel as comfortable as possible, your provider might numb the treatment area with ice or a numbing cream n the day of your injections. Talk with your provider ahead of time if you're concerned about pain or discomfort from the injections.

    • The amount of Botox Cosmetic (onabotulinumtoxinA) injections you'll receive will depend on the areas you're treating. If you're receiving treatment for for crow's feet, you can expect to receive injections in 3 areas around each eye. If you're receiving treatment for frown lines or forehead lines, you can expect to receive 5 injections for either one of the procedures. Ask your provider to walk you through the injection procedure before your appointment so you'd know what to expect.

      • One side effect of Botox Cosmetic (onabotulinumtoxinA) is droopy eyelid. If you experience droopy eyelids after your injection and it affects your vision, avoid driving or doing other activities where you need to see clearly. Keep in mind that droopy eyelids are usually temporary and this side effect tends to go away after 3 to 4 weeks.

        • Botox Cosmetic (onabotulinumtoxinA) can cause dry eyes. If your eyes are dry, you can consider using lubricating eye drops to ease the discomfort.

          • Though rare, Botox Cosmetic (onabotulinumtoxinA) can cause vision problems. Talk with your provider right away if you notice eye pain or changes in your vision, such double vision or light sensitivity.

            • Let your provider know if you develop any unusual symptoms after your Botox Cosmetic (onabotulinumtoxinA) injection. These can include trouble swallowing or speaking. If you have trouble breathing, get medical attention right away.

              • The effects of Botox Cosmetic (onabotulinumtoxinA) can last up to 4 months. Once you stop getting injections, your lines will slowly return. If you want a longer-lasting treatment, talk with your provider about other options.

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                faqs

                Frequently asked questions about Botox Cosmetic (onabotulinumtoxinA)

                When will I see results from Botox Cosmetic (onabotulinumtoxinA)?
                Botox Cosmetic (onabotulinumtoxinA) starts working within 1 or 2 days after it's injected, and you can continue seeing improvement in your lines during the first week after injection. Most people see the full results in a month days.
                How long does Botox Cosmetic (onabotulinumtoxinA) last?
                How long the effects of Botox Cosmetic (onabotulinumtoxinA) last can differ from person to person. Research shows that it can last up to 4 months for moderate to severe frown lines. Talk about your results and goals of treatment with Botox Cosmetic (onabotulinumtoxinA) with your provider. They can help you plan your appointments based on your discussion.
                How often can I use Botox Cosmetic (onabotulinumtoxinA)?
                You're recommended to wait at least 3 months in between treatments with Botox Cosmetic (onabotulinumtoxinA). There aren't any well-designed studies to see whether Botox Cosmetic (onabotulinumtoxinA) is safe and will continue to work well if you get the injections more often. But there's a risk that doing so can raise your risk of serious side effects.
                Can I use Botox Cosmetic (onabotulinumtoxinA) to treat multiple lines on my face at the same time?
                Yes, you can use Botox Cosmetic (onabotulinumtoxinA) to treat frown lines, forehead lines, and crow's feet at the same time. Your provider will make sure you don't go over the recommended total dose that's safe to use at once.
                Is Botox for migraines the same as Botox Cosmetic (onabotulinumtoxinA)?
                No, those two products aren't the same. Botox Cosmetic (onabotulinumtoxinA) is only FDA-approved to temporarily improve frown lines, crow's feet, and forehead lines in adults. There is another version that's simply called Botox (onabotulinumtoxinA), sometimes known as Botox Therapeutics, that's FDA-approved to prevent migraines.
                Is Botox Cosmetic (onabotulinumtoxinA) safe to use during pregnancy?
                There isn't enough information available to know if Botox Cosmetic (onabotulinumtoxinA) is safe to take during pregnancy. In animal studies, Botox Cosmetic (onabotulinumtoxinA) caused harm to pregnant mothers and their unborn babies. If you're currently pregnant, discuss the risks and benefits of this medication with your provider.
                What's the difference between Botox Cosmetic (onabotulinumtoxinA) and cosmetic fillers?
                Both Botox Cosmetic (onabotulinumtoxinA) and injectable dermal fillers can reduce the signs of aging, but there are some differences between the two treatment options. Botox Cosmetic (onabotulinumtoxinA) is injected into certain muscles in your face to relax them, which can help flatten wrinkles. Dermal fillers are injected under the skin (not into the muscles) to smooth lines and to also add fullness. For example, they can be used to plump cheeks and lips. In general, dermal fillers tend to last longer than Botox Cosmetic (onabotulinumtoxinA) injections. The two treatments have different side effects, too. Your provider can help guide you to the best treatment option for your cosmetic goals.
                Can I use Botox Cosmetic (onabotulinumtoxinA) at home?
                No. Botox Cosmetic (onabotulinumtoxinA) should only be injected into your muscles by a healthcare provider at their clinic. Make sure you only go to a provider who is trained and licensed to give these injections. Misuse or incorrect use of Botox Cosmetic (onabotulinumtoxinA) by people who aren't properly trained can lead to serious side effects, such as botulism.
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                What are the risks and warnings for Botox Cosmetic (onabotulinumtoxinA)?

                Botox Cosmetic (onabotulinumtoxinA) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                risk-warning

                Spread of toxin effects

                • Risk factors: History of muscle, eye, or lung conditions

                  Although no serious reports have been made with the use of Botox Cosmetic (onabotulinumtoxinA) at the recommended sites and doses, it has the potential to spread to other body areas outside of the injection sites. This occurring hours to weeks after receiving the injection. The spread of Botox Cosmetic (onabotulinumtoxinA) beyond the injection sites can lead to serious side effects, such as unexplained muscle weakness, drooping eyelids, blurred or double vision, breathing or swallowing difficulty, slurred speech or trouble speaking. If you notice any of these side effects, seek medical help right away.

                  risk-warning

                  Difficulty swallowing or breathing

                  • Risk factors: History of swallowing or breathing problems | Using Botox Cosmetic (onabotulinumtoxinA) in certain muscles | Myasthenia gravis | Lambert-Eaton syndrome | Current muscle-nerve conditions

                    Though rare, Botox Cosmetic (onabotulinumtoxinA) can cause life-threatening problems with swallowing or breathing. In the rare case that Botox Cosmetic (onabotulinumtoxinA) spreads beyond the injection sites, there's a possibility it can by weaken muscles involved breathing and swallowing. This can occur anytime from hours to weeks after receiving Botox Cosmetic (onabotulinumtoxinA). These effects can last for many months. Your risk is higher if you have certain conditions affecting your muscles or nerves. If you notice any of these problems, seek medical help right away. If you have a history of swallowing or breathing problems, let your provider know before receiving Botox Cosmetic (onabotulinumtoxinA).

                    risk-warning

                    Worsening of certain conditions

                    • Risk factors: History of certain muscle-nerve conditions | History of heart problems | Inflammation (swelling) at the injection site

                      In people with certain medical conditions, Botox Cosmetic (onabotulinumtoxinA) can make symptoms worse and cause serious side effects. Botox Cosmetic (onabotulinumtoxinA) has caused heart problems including arrhythmias (racing heart) and heart attack after receiving Botox Cosmetic (onabotulinumtoxinA). Your risk is higher if you have a history of heart problems. People with certain muscle-nerve conditions might have a higher risk of serious side effects from Botox Cosmetic (onabotulinumtoxinA), including muscle weakness anywhere in the body, blurry vision, drooping eyelids, and trouble speaking, eating, drinking, or breathing. If you experience any of these side effects, seek medical help right away. Make sure to discuss your full medical history with your provider before using Botox Cosmetic (onabotulinumtoxinA). You should also let your provider know if you have any redness or swelling at the areas on your body where you'll be getting the injections, or if you're currently experiencing drooping eyelids or muscle weakness.

                      risk-warning

                      Reduced blinking, dry eye, and vision changes

                      • Risk factors: Previous eye surgery | Certain nerve problems

                        Injecting Botox Cosmetic (onabotulinumtoxinA) in or near the eyelid muscle leads to reduced blinking, which can lead to eye problems like ulcers in your eye. You're at a higher risk if you have a history of eye surgery or certain nerve problems. Your provider will make sure your eyes are okay and might prescribe an ointment or special contact lenses to protect your eyes if there are any problems. Botox Cosmetic (onabotulinumtoxinA) can also cause dry eyes as a side effect. If you experience eye irritation, sensitivity to light, or visual changes that don't go away, contact your provider.

                        dosage

                        Botox Cosmetic (onabotulinumtoxinA) dosage forms

                        Typical dosing for Botox Cosmetic (onabotulinumtoxinA)

                        Botox Cosmetic (onabotulinumtoxinA) is only available as an intramuscular (IM) injection that's administered by a healthcare provider.

                        • The dose can differ depending on which area of the face is being treated. Typically, you can receive an injection into a particular area at most once every 3 months. The maximum total dose is 400 units in a 3-month period.

                        drug-cost

                        How much does Botox Cosmetic (onabotulinumtoxinA) cost?

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                        Botox Cosmetic (brand)
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                        contraindications-icon

                        Botox Cosmetic (onabotulinumtoxinA) contraindications

                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Botox Cosmetic (onabotulinumtoxinA) will not be safe for you to take.

                        • Infection at injection site

                        alternatives

                        What are alternatives to Botox Cosmetic (onabotulinumtoxinA)?

                        There are a number of medications that your doctor can prescribe in place of Botox Cosmetic (onabotulinumtoxinA). Compare a few possible alternatives below.
                        Botox Cosmetic (onabotulinumtoxinA)
                        Used for:

                        • Temporarily improves the appearance of frown lines, forehead lines, and crow's feet lines in adults

                        $367.81 Lowest GoodRx priceView Prices
                        Xeomin (incobotulinumtoxinA)
                        Used for:

                        • Long-term excessive drooling (sialorrhea) in people 2 years and older

                        • Arm spasms in people 2 years and older

                        • Uncontrollable neck spasms (cervical dystonia) in adults

                        • Uncontrollable eye twitching (blepharospasm) in adults

                        • Frown lines in adults

                        View Prices
                        Dysport (abobotulinumtoxinA)
                        Used for:

                        • Neck spasms (cervical dystonia) in adults

                        • Frown lines in adults under 65 years old

                        • Muscle spasms in upper and lower limbs in adults and children age 2 years and older

                        $540.24 Lowest GoodRx priceView Prices

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                        References

                        Best studies we found

                        Allergan, Inc. (n.d.). Frequently asked questions.

                        Allergan, Inc. (n.d.). How Botox® cosmetic works.

                        Allergan, Inc. (2023). Botox cosmetic- onabotulinumtoxina injection, powder, lyophilized, for solution [package insert].

                        View All References (4)

                        American Board of Cosmetic Surgery. (n.d.). Injectable fillers guide.

                        Chertow, D. S., et al. (2006). Botulism in 4 adults following cosmetic injections with an unlicensed, highly concentrated botulinum preparation. Journal of the American Medical Association.

                        King, M. (2016). Management of ptosis. The Journal of Clinical and Aesthetic Dermatology.

                        Lagueny, A., et al. (1996). Mécanisme d'action, indication et résultats des traitements par la toxine botulinique [Mechanism of action, clinical indication and results of treatment of botulinum toxin]. Neurophysiologie Clinique.

                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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