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While many celebrities are speaking out against plastic surgery, there are plenty that still go under the knife, or rather, needle. If you’ve considered targeting fine lines and wrinkles in a more permanent way, you’re not alone. It’s completely normal to find yourself wondering what Botox is, (a.k.a. Botulinum toxin type A). And though some are vocally opposed to the cosmetic procedure, plenty of people swear by it (Kelly Ripa says it’s like magic).

A recent survey of the American Society of Plastic Surgeons found that people are seeking to rebound from pandemic stress and are willing to spend more on cosmetic procedures than before the pandemic.

The top minimally invasive procedure this year? Botulinum toxin type A, also called Botox. There also are several other similar products on the market, including Daxxify, which was approved by the FDA in September and is reported to have longer-lasting results.

But like any elective procedure, you should do a little homework ahead of time to figure out if Botox is for you. Read on to learn about what Botox is, what it can (and can’t) do, and what you should know about this cosmetic procedure:

Botox uses

When we look at our faces, we have both static and dynamic wrinkles. “Static wrinkles are those that are present when we have no expression, such as around the mouth or between the eyebrows,” says Edward Lee, M.D., chief, division of plastic surgery at Rutgers New Jersey Medical School. “Dynamic wrinkles are those that appear when we move, such as the fine wrinkles around our eyes when we smile. Botox smooths out static wrinkles but doesn’t erase them; you’d need a filler for that. But it also helps prevent dynamic wrinkles from becoming static.”

The results after injections are not as intense as they used to be, that is, you’re not going to look like you can’t move your face. “When it first came out, Botox was used so that people seemed to have a plasticized face or no expression,” says Dr. Lee. “But now we sculpt the face more selectively for a natural look. We don’t want people to be non-expressive because our expressions are part of how we interact socially.”

A good provider will take the time to see how your face moves—and injects accordingly. “I’m observing the way you speak, laugh, frown—we go through all your emotions, so I know which muscles to inject and how much,” says Dendy Engelman, M.D., director of dermatologic surgery at Metropolitan Hospital in New York City. “And you should never feel pressured to get more than you’re comfortable with.”

You also don’t want to not look like yourself. “Over treatment and improper placement are the two biggest causes of ‘bad Botox,’” says Jerome Potozkin, M.D., board-certified dermatologist and author of Botox and Beyond.

How does Botox work?

Botox is made from a protein, botulinum toxin, which freezes your muscles. “In simple terms, Botox binds to the receptors on the muscles, so that they don’t receive the signal to contract,” Dr. Engelman says. And as Dr. Potozkin puts it, “Botox essentially acts as a mute button between the nerve and muscle.” That “mute button” means you won’t be able to make the movements associated with wrinkles between your eyebrows, crow’s feet, and forehead lines, which are the three FDA-approved areas for cosmetic treatment.

Botox benefits beyond targeting signs of aging

You’ve probably heard that Botox also can be used used to treat non-cosmetic issues; it’s FDA-approved to treat overactive bladder, eyelid spasms, and some types of muscle spasms. In addition, it is used to treat excessive sweating and to prevent chronic migraine headaches. Interestingly, the therapeutic use to prevent migraine headaches was an incidental discovery: When people who received Botox for wrinkles got injections, they had fewer migraine headaches, so researchers investigated its effectiveness specifically for migraine.

How much does Botox cost?

Prices vary based on your provider, but Dr. Engelman’s patients usually pay $150 to $400 per area treated, such as the forehead or around the eyes. Botox for purely cosmetic procedures is not covered by insurance.

How long does Botox last?

It’s also important to know that you won’t see results the second you step outside of your doctor’s office; it typically takes two to seven days for Botox to take effect, says Dr. Lee. Generally, the results lasts three to four months. After that time, you’ll start seeing wrinkles again in your forehead, for example, or it may start to feel somewhat odd when your forehead moves because it hasn’t in a while.

Is Botox safe?

The FDA notes that there is a chance that the toxin can move beyond the site of injection, causing muscle weakness, double vision, urinary incontinence, or difficulty breathing, or speaking—any of which require medical attention ASAP. In addition, swallowing and breathing difficulties can be life-threatening, according to the FDA.

Typically, severe side effects are not associated with cosmetic use, in which the doses are much lower than the doses given for therapeutic usage, says Dr. Lee. However, ideally, you should see an experienced provider such as a board-certified plastic surgeon or dermatologist trained in the use of the product.

“Botox is safe and efficacious as long as you’re in the hands of someone who’s licensed and trained,” Dr. Engelman says. (However, pregnant and breastfeeding women should steer clear.).

What are Botox’s risks and side effects?

As with any drug, there are possible side effects, albeit minor ones, such as bruising and minor swelling. But you can reduce swelling with a cold compress. “Side effects are uncommon but include a headache, bruising, and a drooping brow or eyelid,” Dr. Potozkin says. If you’re one of the few people stuck with one of the latter, Dr. Potozkin says your doc can prescribe eye drops to stimulate the eyelid muscle and raise the lid. “Or, if the brow is drooped, you can inject Botox into the muscles that pull the brow down to get some brow elevation.” This side effect is rare, but you can reduce your risk by seeing an experienced provider.

Does Botox hurt?

Everyone reacts differently, but yes, you will feel the pinch of injections because it is a small needle. To give you context, the needle used for Botox is smaller than that which is used for a blood draw, says Dr. Lee.

The number of injections varies by what you’re having done, but it may be just a few injections to up to 10 or 15, if you’re doing your full forehead, for example. Occasionally, some practitioners apply a cold roller to the area first to numb it, but it’s not commonly done, says Dr. Lee.

The bottom line

Botox is a popular treatment that comes with typically minor side effects when performed by an experienced provider. The treatment is minimally painful and lasts up to four months but is pricey and not covered by insurance for cosmetic purposes.

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