Botox for wrinkles: which lines it treats and which it does not

For Botox, the distinction that matters is between two types of line.

Dynamic wrinkles are the lines that appear when a muscle contracts — frowning or smiling.

Cleveland Clinic describes Botox as a treatment for these muscle-driven lines.

Static wrinkles are the lines still present when the face is at rest.

Botox Cosmetic's effect is a partial, localized reduction in muscle activity: injected into the muscle, it blocks acetylcholine release at nerve endings by cleaving the protein SNAP-25, and the label explains that reinnervation slowly reverses the effect.

Because the drug changes muscle activity rather than adding volume, Cleveland Clinic notes that patients whose wrinkles are present and deep at rest may benefit from adding a filler injection (in addition to Botox) to get the best and longest-lasting result.

For what a session involves, what it costs and how to vet a provider, start with the Botox guide.

The Botox Cosmetic label names four cosmetic areas in adults: moderate to severe glabellar lines (the frown lines between the brows), lateral canthal lines (crow's feet), forehead lines and platysma bands (the vertical bands in the neck).

No other cosmetic area is on the label.

The approvals arrived in stages: crow's feet on September 11, 2013, forehead lines on October 2, 2017, and the platysma indication on October 18, 2024 — the only US neurotoxin currently labeled for neck bands.

In the glabellar-line trials behind the label — 405 adults given a single 20-unit dose — investigators rated the lines none or mild at maximum frown for 74% at day 7, 80% at day 30, 70% at day 60, 48% at day 90 and 25% at day 120.

Those are trial averages for the group, not a prediction for any one person.

Responses also differed across the trial group.

Exploratory analyses found day-30 responder rates of 85% among 334 women versus 59% among 71 men, and responses appeared lower in adults 65 and older; these were exploratory looks at the data, not separate dosing rules.

Every cosmetic area outside those four is off-label.

Cleveland Clinic states that using botulinum toxin to elevate the eyebrows (a "chemical brow lift") and to treat lip lines and muscle laxity in the neck are off-label uses, and lists brow shaping, raising the corners of the mouth, lip creases and chin softening among the off-label uses it offers. (On the neck, the labeled use is only the vertical platysma bands approved above — broader neck laxity is not on the label.) Off-label, in this context, means the area is not on any current US label for the product.

Where the label does state doses for the four areas, they are set out in our Botox areas guide.

The label landscape also differs by brand: Xeomin's current aesthetic label covers the same three upper-face areas, and Dysport's US cosmetic indication is limited to glabellar lines in adults younger than 65.

The muscle drug and the filler do different jobs, so the question is what the line is made of.

Botox treats the dynamic component — the contraction that creases the skin.

When a line is present and deep at rest, Cleveland Clinic says patients may benefit from adding a filler injection (in addition to Botox) for the best and longest-lasting result.

Fillers are also regulated differently.

FDA regulates dermal fillers as medical device implants — not drugs — with approval for adults over 21 for specific uses such as moderate to severe facial wrinkles and folds and augmentation of the lips, cheeks, chin and back of the hand.

How long a filler lasts depends on the filler material and where it is injected, and absorbable fillers are temporary and may need repeat treatment.

Skin treatments are a different family again, and which one fits is a question about the line and the skin around it.

Our all wrinkle treatments guide starts from the wrinkle and routes to the treatments that address it, Botox included.

Onset: the 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.

Duration: the label gives 3 to 4 months for glabellar lines — the frown-line figure — and the effect fades gradually rather than switching off, which is what the trial ratings falling from day 30 to day 120 measure.

The American Academy of Dermatology likewise says "the improvements last about 3 to 4 months — and sometimes longer." The fade, the retreatment interval and what changes duration are the subject of our guide to how long Botox lasts.

What else shows up?

In the trials, the most common adverse reactions were area-specific: eyelid ptosis (a drooping eyelid) in 3% of the frown-line group versus 0% on placebo, eyelid swelling in 1% of the crow's-feet group, and headache in 9% versus 5% on placebo with brow ptosis in 2% in the forehead-line trials.

The label says adverse reactions generally occur within the first week and, while often transient, may last several months or longer.

The label also states that there have been no definitive serious adverse event reports of distant spread of toxin effect with dermatologic use at specific labeled doses — 20 units for frown lines, 24 units for crow's feet, 40 units for forehead plus frown lines, and 44 or 64 units combined.

That statement does not cover off-label areas or higher doses.

The CDC advises getting botulinum toxin injections only from a licensed, trained provider using product from an authorized source.

That advice is not abstract: in April 2024 the FDA warned that counterfeit Botox had been given to consumers for cosmetic purposes in multiple states, with adverse events including hospitalizations, and traced the incidents to injections by licensed and unlicensed individuals and/or in non-medical or unlicensed settings, with product apparently bought from unlicensed sources.

The label gives you two concrete checks.

Genuine Botox Cosmetic shows U.S. License number 1889 on the vial and carton, and the label says not to use it — and to contact AbbVie — if that number is missing or the tamper-evident features look broken.

Beyond that, the practical test of a provider is the consultation: whether they map which of your lines are dynamic, which are deep at rest, and where a treatment other than toxin would do the work.

For credentials, red flags and the questions to ask, our how to choose a med spa guide goes deep.