Botox

Botox is the brand name of one botulinum toxin type A product. Injected in small doses into a muscle, it stops the nerve signal that makes that muscle contract. Softer contraction means the skin over it creases less, which is why it is used on the lines that movement makes: the forehead, the frown lines between the brows, and the crow's feet at the eyes.

It is a temporary treatment. The effect builds over about a week and fades over three to four months as the nerve endings recover. Other botulinum toxin products (Dysport, Xeomin, Jeuveau, Daxxify) work the same way and are often grouped under the one name.

A first appointment starts with a conversation: what bothers you when you look in the mirror, what you want to keep moving, and your medical history. The provider watches your face move, marks the injection points, and cleans the skin.

The injections themselves take a few minutes. Most people describe a pinch. There is no downtime — you can go back to your day — though most providers ask you not to rub the area, lie flat or exercise hard for the rest of the day. Small bumps at the injection points settle within the hour.

You see the result over the following days, with the full effect at about two weeks. A follow-up at that point is where a good provider checks symmetry and adjusts.

• Who is holding the syringe? In the United States, the person injecting should be a licensed medical professional — a physician, physician assistant, nurse practitioner or registered nurse — working under a medical director. Ask for the name and the licence.
• Which product, and is it FDA-approved? The vial should be a named, approved product, bought from the manufacturer or an authorised distributor.
• How many units, and what does a unit cost? Pricing is by the unit or by the area. Either is fine; a price you cannot pin down is not.
• What happens if I do not like it? Botox cannot be reversed, but it does wear off. Ask how the provider handles a heavy brow or an uneven result at the two-week check.