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What to Expect at your First Botox Appointment

By Crystal Wilson, CNP

If you have been thinking about getting Botox and feel ready to take the plunge, this post is for you! I will walk you through what you can expect during a Botox appointment to help you prepare. I will use the term Botox to categorize all neurotoxins throughout this post. There will be more on that later.

First, let us discuss what Botox is. In layman’s terms, it paralyzes muscles so they cannot move. We use Botox to treat numerous muscles of the face so they stop contracting. When these muscles contract, they form creases in the skin or wrinkles. When Botox stops these contractions, it allows the skin overlying the muscle to relax and smooth. Most patients require treatment every three months, or twelve weeks, to maintain smooth skin. Treatment usually kicks in within 2-10 days following the procedure, and peaks at two weeks or 14 days. I find Botox treatments look best between the 4-8 week mark. After that, the Botox will start to metabolize slowly, and movement will slowly come back to the face. By 12 weeks, the Botox should be completely metabolized out, and it is time for your next treatment. This time frame can differ between patients. Some patients can go longer, getting treated every 4-6 months. Some patients, with high metabolisms or who are very active, may feel like they need to be treated more often. I usually do not recommend this though. When you get treated inside the 12-week mark, it will be difficult for your injector to figure out your perfect dose because each treatment will wear off at different times. You will also increase your likelihood of resistance to the product, and no one wants that!

There are currently four kinds of neurotoxins that are widely used and FDA-approved in the United States. You will hear people refer to neurotoxin treatment as “Botox” even if they are not truly getting brand-name Botox injected. It is kind of like an umbrella term for all of the neurotoxins. They include Botox, Xeomin, Dysport, and Jeuveau. All are comparable in terms of onset, action, efficacy, and duration. Most importantly, they all get the job done. Some are reconstituted and dosed differently, but that is for your injector to know. I always like my patients to know exactly what product I am using on them so they can see the difference in outcome and find one that they feel works best for them. If patients do not have a set preference, I may switch up their product choice every once in a while to limit the chance of resistance to any one product. Some patients may choose which product they want to use based on that company’s specific rewards program.

When you first schedule a Botox appointment, you may feel a little nervous. Most injectors are very educated and welcoming people and should make you feel comfortable the entire time you are at their office. If you do not feel that way, maybe that injector is not for you. I love to get to know my patients and make sure they are educated about the choices they make for their faces. Nothing irks me more than when one of my patients comes to me after being elsewhere for injections, and they have no clue what was done or put into their faces. It is your face! Your injector should always be educating you and telling you exactly what he/she is doing. You should also feel comfortable enough to speak up and ask questions. Informed consent is a huge part of the first appointment, so your injector should be taking time during the appointment to sit down and go over all aspects of the consent and answer all of your questions before getting started. Every one of my patients answers a health history questionnaire, which lets me know if they are an appropriate candidate for the procedure they are wanting to be done. Then I go through the consent of said procedure and make sure they fully understand it and all of their questions are answered.

Patient photographs are a huge part of the aesthetic industry. It is necessary to have baseline photos of each and every patient, and photos should really be taken at every single appointment. Sometimes, you may be asked to sign a model release so your photos can be shared on social media. If you do not feel comfortable signing a model release, you will still probably have photos taken. These are used strictly by your injector to monitor your progress and show you as well!

After the patient feels comfortable, I am certain they are an appropriate candidate for Botox, and the patient has signed a consent, I will begin talking about their goals for this treatment, dosing, and what product I am going to use. Most first-timers like to start with a lower dose just to see if they like it first. Some other patients want to be frozen. It is all patient preference while keeping your doses safe and appropriate for the specific muscle you are treating. Once we agree on a treatment plan, I will get everything ready. I make sure the patient is not wearing any makeup and I clean their face with either alcohol or Hibiclens. Once they are cleaned, I will mark up all of the areas on their face where they are getting treated. I pull up all of the Botox I need and go to work!

Most patients are able to sit through the treatment with no issues. It is a small pinch from the needle, and some areas are more sensitive than others, but most patients do well. I like to utilize distractor tools for my patients, like a stress ball for example. This way they have something to squeeze and focus on instead of the needle going into their face. The procedure itself is also very quick. Even a full face treatment will take maybe 5 minutes if the injector is experienced. The consent, treatment plan, and drawing everything up are what take the longest.

After the procedure, you may have little raised red areas over your face where you were injected. These typically go away after about 30 minutes. It is very important to not touch your face or raise your body temperature for the next 4 hours. A 2-week follow-up appointment should be scheduled, and it is essential that you attend that appointment. Your injector will have the opportunity to evaluate your results and give you any enhancements, if necessary. It is also awesome to take after photos and see the difference between today and the picture that was taken 2 weeks prior!

Hopefully, after reading this, you feel more informed about what goes into a Botox appointment and what you can expect. Cheers to smooth, wrinkle-free skin!


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