What happens at your first Botox appointment

Before the appointment

A first treatment with botulinum toxin type A starts long before the first injection. The most useful preparation is simple: think about which lines bother you and in which situations you notice them (when you frown, laugh, or concentrate), and write down any medication, supplements and previous treatments. Blood-thinning substances such as aspirin, ibuprofen, fish oil or vitamin E can make small bruises more likely. Never stop a prescribed medication on your own; discuss it with the physician first.

Botulinum toxin is a prescription medicine. It is not given during pregnancy or breastfeeding, with certain neuromuscular disorders such as myasthenia gravis, with a known allergy to the product, or when there is an infection at the injection site. These questions are part of the consultation, which is why it always comes first.

The consultation

The physician looks at your face at rest and in motion. You will be asked to frown, raise your eyebrows and smile, because the physician needs to see how the individual muscles work as well as where the lines are. Lines that only appear with movement (dynamic lines) respond differently from lines that are visible at rest (static lines). Our article on how Botox works explains the difference in detail.

This is also the moment to talk about expectations. A good result looks rested. The aim is to soften muscle activity while keeping your expression. If the physician advises against a treatment, or suggests a lower dose than you expected, that is part of careful medical practice. Whether a treatment is suitable for you is always decided in this conversation.

The treatment itself

The skin is cleansed, and the injection points are sometimes marked. The product is then placed with a very fine needle in a few small injections per zone. For the common upper face areas, frown lines, forehead lines and crow’s feet, the injections themselves take only a few minutes. Including the consultation, most first appointments take around 30 minutes.

How it feels

Most people describe each injection as a short pinch or sting. Cooling before the injections can make it more comfortable. Small raised spots (wheals) at the injection points are normal and usually settle within 15 to 30 minutes. Some people notice a slight headache on the first day, and a small bruise can appear, especially around the eyes where the skin is thin and well supplied with blood vessels.

Nothing changes immediately after the injections. Botulinum toxin blocks the release of acetylcholine at the junction between nerve and muscle, and this process takes time to develop. Most people notice the first softening after three to five days, and the full effect is reached at around two weeks.

Aftercare: the first 24 hours

• Do not massage or rub the treated areas, and avoid tight headbands or caps on the forehead.
• Stay upright for about four hours, and avoid lying face down.
• Skip intense exercise, sauna and steam rooms on the day of treatment.
• Make-up can usually be applied after a few hours on clean skin.
• Keep your skincare simple for a few days: gentle cleanser, moisturizer and sunscreen.

These precautions are meant to keep the product where it was placed. They are short, and normal daily life is possible straight away.

Side effects worth knowing

Most side effects are mild and short-lived: redness, small bruises, a slight headache. Less common is a temporary drooping of an eyelid or eyebrow, or a slightly uneven expression. These effects are temporary and fade as the effect wears off. If you notice difficulty swallowing, speaking or breathing, or vision changes, contact a physician immediately; such effects are very rare at aesthetic doses but are listed in the product information for good reason.

The follow-up after two weeks

Because the full effect takes around 14 days, this is the right moment to assess the result. A small asymmetry can be adjusted at this point. A first treatment is also a learning experience for both sides: the physician sees how your muscles respond to a given dose, which makes planning later treatments more precise. How long the effect lasts, and why it differs from person to person, is covered in How long does Botox last?

References

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2. Small R. Botulinum toxin injection for facial wrinkles. Am Fam Physician. 2014;90(3):168-175. PMID 25077722.
3. Dolly JO, Aoki KR. The structure and mode of action of different botulinum toxins. Eur J Neurol. 2006;13 Suppl 4:1-9. PMID 17112344.
4. Schlessinger J, Monheit G, Kane MA, et al. Time to onset of response of abobotulinumtoxina in the treatment of glabellar lines: a subset analysis of phase 3 clinical trials of a new botulinum toxin type A. Dermatol Surg. 2011;37(10):1434-1442. PMID 21745254.
5. Gostimir M, Liou V, Yoon MK. Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients. Ophthalmic Plast Reconstr Surg. 2023;39(1):13-25. PMID 35353777.
6. Carruthers JA, Lowe NJ, Menter MA, et al. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol. 2002;46(6):840-849. PMID 12063480.