Botox before and after: real results by area

The Botox Cosmetic label says muscle relaxation in the frown-line area typically begins 1 to 2 days after injection and increases in intensity during the first week.

The American Academy of Dermatology (AAD) says most people see results within 3 to 7 days.

Two weeks sits between the frown-line trials’ published checkpoints.

In those trials, 405 adults received a single 20-unit dose, and investigators rated frown lines none or mild at maximum frown in 74% at day 7 and 80% at day 30.

The trial’s primary endpoint was day 30, and the label’s results table reports days 7, 30, 60, 90 and 120 — no day-14 figure among them.

What the mirror shows in the first week can also include the injection itself: the label lists localized pain, swelling, redness, tenderness and bruising, and says adverse reactions generally occur within the first week.

Realistic also means individual.

Exploratory analyses of the glabellar trials found 85% of 334 women rated as responders at day 30 on the investigator assessment, against 59% of 71 men, and responses appeared lower in people 65 and older.

Botox Cosmetic is FDA-approved in adults for the temporary improvement in the appearance of four areas: moderate to severe frown lines (the glabellar lines between the brows), crow's feet, forehead lines and platysma bands (vertical neck bands).

No other cosmetic area is on the label.

Forehead lines carry a label detail that photo galleries leave out: on the label, forehead lines are treated together with frown lines — 20 units to the forehead plus 20 units to the glabella, 40 units in total, to minimize the risk of a dropped brow — and there is no forehead-only dose.

A label-dose forehead treatment is therefore a forehead-plus-frown-line result.

The change is movement, not skin texture.

Cleveland Clinic describes Botox as treating dynamic wrinkles — lines that appear when a muscle contracts, such as when you frown — and says patients whose wrinkles are deep even at rest may benefit from adding a filler.

Crow's feet are the eye area the label covers.

In the crow's-feet trials, the most common reaction above placebo was eyelid swelling, in 1% of treated subjects (0% with placebo), and the label also notes reports of dry eye with injection near the orbicularis oculi, the muscle that circles the eye.

For the labeled dose and injection points area by area, see the Botox areas guide; the Botox guide covers the treatment end to end.

A brow lift, under-eye treatment and chin softening are not among Botox Cosmetic's approved areas, so all three are off-label: they are not on any current US label for the product.

Cleveland Clinic names a “chemical brow lift” as an off-label use, and lists brow shaping, raising the corners of the mouth, lip creases, gummy-smile lip lengthening and chin softening (the “peach-pit chin”) among the off-label uses it offers.

For the under-eye area, the label's relevant note is a caution: it reports dry eye with injection near the orbicularis oculi, the muscle around the eye.

There are no trial figures on this page for these areas because we could not confirm any: we found no label, consensus paper or high-quality source giving unit ranges for a brow lift, under-eye or chin treatment, so doses for them are set by the injector's judgment.

That also means no label trial covers a brow lift, an under-eye treatment or chin softening.

Ask a licensed provider what evidence supports the before-and-after result you are shown.

The reactions behind a “bad result” in the trials are area-specific.

Eyelid ptosis (a drooping eyelid) occurred in 3% of frown-line subjects, brow ptosis (a heavy or dropped brow) in 2% of the forehead trials, and facial paresis and muscular weakness in 1% each of the frown-line trials.

The label tells injectors how to lower the ptosis risk: avoid the area near the levator palpebrae superioris muscle, place lateral corrugator injections at least 1 cm above the bony supraorbital ridge, and do not inject closer than 1 cm above the central eyebrow.

If the toxin seems not to work at all, the labels explain that only in general terms: dose selection, injection technique and, rarely, neutralizing antibodies, with trial response rates lower in men and in people 65 and older.

We found no label or study source on what causes an uneven result.

Resolution is built into the mechanism: the effect is temporary, and the label says reinnervation — the muscle regaining its nerve signal — may occur and slowly reverse it.

Adverse reactions are described as often transient, but they may last several months or longer.

The Medication Guide adds one practical rule: avoid driving or other dangerous activities if loss of strength, vision problems or drooping eyelids occur after injection.

This page publishes no photo gallery, and that is deliberate.

FTC guidance treats before-and-after photos as implying typical results, yet Botox results differ between people: in the label's frown-line trials, day-30 responder rates were higher for women than for men.

A photo documents one other person's result, not a preview of yours.

The AAD's list of questions to ask before a cosmetic procedure covers how to use a gallery well: ask what results you can realistically expect, and ask for before-and-after photos of patients with skin tones similar to yours.

A med spa's photo gallery near you is a starting point for that conversation, not an answer: bring the photo you liked, ask how many times the provider has done that exact treatment, and ask what changed between the two photos.

And whoever you book with, CDC advises getting botulinum toxin injections only from a licensed, trained provider using product from an authorized source — noting that even FDA-approved product, given correctly, is not without risk.