Botox: what it is, cost, results, risks and where to get it near you

Botox Cosmetic is the brand name for onabotulinumtoxinA, a botulinum toxin type A made by Allergan, part of AbbVie.

It is given by injection, and the FDA label — not the med spa — defines what it can be used for.

The label approves Botox Cosmetic in adults for exactly four cosmetic uses: moderate to severe glabellar lines (the frown lines or "11s" between the brows), moderate to severe lateral canthal lines (crow's feet), moderate to severe forehead lines, and moderate to severe platysma bands (the vertical neck bands).

No other cosmetic area is on the label.

The approvals arrived one area at a time.

The toxin was first approved in the US in 1989; the frown-line approval came on April 12, 2002; crow's feet followed on September 11, 2013; forehead lines on October 2, 2017; and platysma bands on October 18, 2024, which makes Botox the only US toxin currently labeled for the neck bands.

Botox works by blocking the release of acetylcholine, the chemical nerve endings use to tell a muscle to contract — the toxin does it by cleaving a protein called SNAP-25.

The result is a partial, localized reduction in muscle activity, and the effect is temporary because the muscle slowly regrows its nerve connections.

That mechanism is why Botox targets what Cleveland Clinic calls dynamic wrinkles — the lines that appear when a muscle contracts, as in frowning or smiling.

The same source notes that patients whose lines stay deep even at rest may benefit from adding a filler, which works differently.

For which lines respond, see which wrinkles Botox can treat.

Two names, one drug: Botox and Botox Cosmetic contain the same active ingredient in the same formulation but carry different labels.

The approval for severe underarm sweating, granted July 19, 2004, sits on the therapeutic Botox label, not the Cosmetic one.

For a sense of scale, the American Society of Plastic Surgeons' 2025 statistics report says neuromodulator injections (Botox, Dysport, Letybo, Xeomin, Jeuveau, Daxxify) accounted for about half of all minimally invasive procedures performed in 2025, with hyaluronic acid fillers another 30%.

The four labeled areas come with labeled doses for Botox Cosmetic, and they are worth knowing because the dose drives both the result and the price.

• Frown lines (glabellar lines) — 20 units, given as 4 units into each of 5 injection sites.
• Crow's feet (lateral canthal lines) — 24 units in total, 12 units per side.
• Forehead lines — labeled only in combination with the frown lines: 20 units to the forehead plus 20 units to the glabella, 40 units in total, a pairing the label uses to minimize the risk of a dropped brow. There is no forehead-only dose on the label.
• Platysma (vertical neck) bands — 26, 31 or 36 units, depending on how many bands are treated.

Treating all three upper-face areas in one session adds up to 64 units on the label; frown lines plus crow's feet comes to 44 units.

These are label doses, not a promise of what you will receive — a licensed provider sets the dose for your anatomy and goals.

For dosing by area, see how many units of Botox you may need.

Every other area you will see advertised — the lip flip, jaw (masseter) slimming, a chemical brow lift, bunny lines, a gummy smile, chin softening, lifting the mouth corners — is off-label for Botox Cosmetic, because its label lists only the four areas above.

None of those uses is on any current US neurotoxin label, so no brand is FDA-approved for them.

Cleveland Clinic, for its part, describes brow shaping and elevation, treatment of lip lines and neck laxity, raising the corners of the mouth, lip lengthening for a gummy smile and chin softening as off-label uses — a list written before Botox's 2024 approval for the vertical neck bands, which remains the only on-label neck use.

The lip flip is off-label across the board: no US neurotoxin label includes the lips.

Because off-label areas carry no label dose, there is no label number to check a clinic's plan against — one more reason to ask a provider how they arrived at a dose.

Botox is priced per unit or per treatment area, and the two are linked: an area's price is roughly its unit count times the clinic's price per unit.

The label doses give a reference point for what an area takes — 20 units for frown lines, 24 for crow's feet, 40 for forehead lines treated together with the frown lines — so a quote should name both the per-unit price and the number of units.

What moves the total is mostly the dose, and the dose moves with the number of areas treated and with the person.

In a 2005 dose-ranging trial of 80 men, 40, 60 and 80 units to the frown area outperformed the 20-unit label dose on response rate and duration, with no increase in adverse events; the authors concluded that men benefit from starting doses of at least 40 units.

That is a study finding at doses above the label, not a license recommendation — but it shows why two people's "same treatment" can carry very different unit counts.

What does Botox cost in dollars?

We could not confirm a current national average price: the ASPS 2025 statistics report gives procedure shares but omits average fees for minimally invasive work, and we could not verify other national figures.

Prices are set clinic by clinic, so ask each office for its per-unit price and the planned units.

On insurance, the American Academy of Dermatology says insurance does not cover botulinum toxin for signs of aging, while treatment of excessive sweating may be covered, at least partly, depending on the plan.

Manufacturer rewards programs attach to these products — Allē (Allergan Aesthetics), ASPIRE (Galderma) and Evolus Rewards — but we could not verify their current terms, so treat any point value or discount as something to confirm with the office running the program.

Onset is quick.

The label says muscle relaxation in the frown-line area typically begins 1 to 2 days after injection and builds through the first week, and the American Academy of Dermatology tells patients most people see results within 3 to 7 days.

For more on onset, see how long Botox takes to work.

Duration has one labeled figure: 3 to 4 months, and it is for frown lines only.

The label states no duration for the other areas, so treat any month count you see for the forehead or crow's feet as an estimate.

The AAD gives the same 3 to 4 months and adds that improvements sometimes last longer; Cleveland Clinic likewise says effects typically last around three to four months.

The label's own trial data show the fade as gradual.

Among 405 adults given a single 20-unit frown-line dose, investigators rated lines none or mild at maximum frown in 74% at day 7, 80% at day 30, 70% at day 60, 48% at day 90 and 25% at day 120.

For what results look like, see Botox before and after.

Results vary with the person.

In exploratory analyses of the frown-line trials, 85% of 334 women responded at day 30 against 59% of 71 men, and responses appeared lower in people 65 and older.

A 2010 review of duration studies put return to baseline at 3 to 5 months in women and 4 to 6 months in men, with most patients relapsing by 6 months.

On re-treatment, the label says the safety and effectiveness of dosing more often than every 3 months have not been clinically evaluated.

For the fade curve, the antibody data and what the studies say changes duration, see how long Botox lasts.

Many of the reactions the label lists are short-lived, though not all are.

The injection itself can cause localized pain, swelling, redness, tenderness and bruising; adverse reactions generally occur within the first week and, while often transient, may last several months or longer.

The label also notes that needle anxiety can cause fainting.

The trial rates, by area: eyelid ptosis (a drooping eyelid) occurred in 3% of people treated for frown lines, against 0% on placebo; eyelid swelling (edema) in 1% treated for crow's feet; and for forehead lines, headache in 9% (against 5% on placebo) and brow ptosis in 2%.

Those numbers are worth holding onto when you see Botox described as painless or free of downtime — the labels list pain, bruising, swelling, headache and ptosis among the reactions.

The American Academy of Dermatology does note that patients can return to most everyday activities immediately after treatment, but that and "no side effects" are not the same claim.

For what to do and avoid afterward, see Botox aftercare.

Who should not get it: the label contraindicates Botox Cosmetic in people with known hypersensitivity to any botulinum toxin product or any ingredient in the formulation, and when there is an infection at the planned injection site.

For the wider safety question, see is Botox bad for you.

Other conditions are warnings rather than bans.

The label warns that people with neuromuscular disorders — myasthenia gravis, Lambert-Eaton syndrome and ALS are its examples — may be at increased risk of clinically significant effects, and it advises caution in people with pre-existing cardiovascular disease or swallowing or breathing problems.

Pregnancy and breastfeeding: there are no adequate human data on Botox Cosmetic in pregnancy and no data on whether it passes into breast milk, so safety in both cases is not established.

Pregnancy is not one of the label's listed contraindications — the gap is a lack of data, not a listed ban.

The label addresses its training requirement to physicians: physicians administering Botox Cosmetic must understand the relevant neuromuscular and structural anatomy of the area involved, including any alterations to the anatomy from prior surgery or disease.

Who may hold the syringe is decided somewhere else.

AmSpa, the med spa trade association, says injecting botulinum toxin is the practice of medicine, because a prescription drug is used to affect living tissue, so it must be done by a physician, an independent-practice NP or another licensed professional acting within their scope — under rules that vary by state, so no single answer covers the country.

The CDC's advice to consumers is to get botulinum toxin injections only from a licensed, trained provider, and to ask whether the provider has a valid healthcare license and is trained to give the injections.

FDA, in its 2024 counterfeit warning, gave the same instruction: "Ask your health care professional if they are licensed and trained to administer the product."

So ask the med spa directly who will perform the injection, what license that person holds and which physician, if any, supervises the treatment.

"Near you" is the right way to shop for Botox, because the two things that matter most — who injects and where the product comes from — can both be checked before you book.

The CDC advises injections only from a licensed, trained provider using product from an authorized source, and notes that even FDA-approved botulinum toxin given correctly is "not risk-free."

A word on price shopping: because clinics can plan different unit counts for the same area, the cheapest per-unit price is not automatically the cheapest treatment, and a quote far below every other one is a reason to ask where the product comes from.