Botox Precautions: Facial Wrinkles and Body Botox, Explained

This is an English adaptation of a clinical article Dr. SangYoul Yun — board-certified dermatologist and Medical Director of Delight Dermatology in Gangnam, Seoul — originally published in Korean. Read the Korean original on Naver. It has been restructured and translated for international readers.

Hello, this is Dr. SangYoul Yun, board-certified dermatologist. Botox is a very common treatment, yet many people avoid it out of a vague fear. It improves and prevents wrinkles of the forehead, glabella, crow's feet, nose (bunny lines), under-eye, perioral area, and neck. Knowing the answers to the usual questions should ease some of that fear — so here are the ones I'm asked most often.

Facial wrinkle botox

My eyebrows lifted after forehead botox (the "samurai" or Spock brow)

This can happen when the outer forehead isn't injected enough, or when only the glabella and central forehead are treated without the forehead muscle. It's understandably worrying, but in practice it's readily corrected with an additional botox touch-up.

My eyelids feel heavy after forehead botox

Most people open their eyes using the muscles around the eye, but some rely mainly on the forehead muscle to do so. In those people, paralyzing the forehead with botox can make it hard to open the eyes. The dose should be kept small, treating only the central-to-upper forehead wrinkles.

Can under-eye wrinkles be solved with botox alone?

Botox can address fine under-eye lines to some degree, but combining it with treatments that improve the peri-ocular environment — such as eye Thermage or eye Rejuran — is more effective.

My job involves a lot of facial expression — can I still get botox?

Actors, for example, sometimes find it hard to make expressions when the muscles around the eyes are over-relaxed. In such cases the dose and area can be adjusted to still allow treatment. If it remains persistently uncomfortable, though, it's better to avoid it.

Pregnancy and breastfeeding

Can I get botox while trying to conceive?

Botox has a large molecular weight and generally does not cross the placenta easily, but because its effects on the fetus are not fully established, caution is advised.

Is botox okay while breastfeeding?

I recommend avoiding botox while breastfeeding where possible.

Asymmetry and the masseter

Can botox correct asymmetry?

Jaw asymmetry can arise from sleeping and chewing habits. Exact symmetry is difficult to achieve, but a degree of asymmetry can be corrected by adjusting the dose. The chewing muscle (masseter) is distributed broadly from the center to the outer edge of the jaw, and asymmetry there can look pronounced.

Body botox (trapezius and calf)

Will trapezius botox weaken my arms?

People who use their arm and shoulder together to lift objects may feel as though their arm is weaker. In most cases, though, the body adapts over time. If you need to exercise intensively, treatment should be approached with caution. Because body botox of the trapezius, calf, and similar areas targets large muscles, the timing of the effect differs from the face (see below).

Aftercare

• It's best not to lie down for 4 hours after treatment — the agent can otherwise flow into other muscles.
• Swelling can occur, so be cautious with saunas and hot places for about 2 days.
• Be cautious with exercise on the day of treatment.
• After jaw (masseter) botox, be careful with gum and hard foods.

Onset, intervals, and tolerance

When does it take effect?

Facial wrinkle botox — forehead, glabella, crow's feet — takes effect within 1 week, while large muscles such as the jaw and body botox take effect at 2–3 weeks.

How often should I have it?

It varies by person and area, but on average treatment is repeated at 4–6 month intervals.

Doesn't frequent botox cause tolerance?

Getting botox frequently can lead to tolerance, where the effect gradually weakens. Patients who have it regularly are better off using low-tolerance products (for example, Xeomin).

No matter how careful we are, occasional side effects can occur — but many of them are relatively simple to correct. I recommend clearing up any questions thoroughly during your consultation before treatment.

Medical disclaimer. This article is general information and does not replace individual consultation. Whether botox suits you, and the appropriate dose and sites, depend on your muscle-use habits and health, and should be decided through an in-person consultation with a dermatologist. If you are trying to conceive, pregnant, or breastfeeding, please tell us before treatment.