Certain individuals should not get Botox due to potential health risks and contraindications. This includes those who are pregnant or breastfeeding, have certain neuromuscular disorders, or have known allergies to any ingredients in Botox.
Botox injections are relatively safe. Still, you shouldn't get this treatment if you're pregnant, breastfeeding or have: Neuromuscular disease. Drooping eyelids (ptosis).
Possible side effects and unwanted results include: Pain, swelling or bruising at the injection site. Headache or flu-like symptoms. Droopy eyelids or crooked eyebrows.
If you are in poor general health, your skin is very thick or you have existing muscle weakness in the proposed injection site, you may not be a good candidate for Botox. Patients with sensitive skin may experience an allergic reaction at the injection site.
In rare cases, Botox can cause botulism-like symptoms, spreading beyond the injection site and affecting the muscles causing difficulty swallowing, trouble breathing, and slurred speech. This is more likely to occur when Botox is administered in higher doses or in sensitive areas such as the neck.
Gen Z is saying "no" to Botox (or "notox") due to a desire for authenticity, a fear of the unnatural "Instagram Face," concerns about long-term risks, high costs, and a shift towards preventative, natural skincare and wellness, influenced by social media showing both the hype and potential negative outcomes of injectables. They prefer embracing individuality and investing in skin health through peptides, diet, and energy-based treatments, rather than relying on neurotoxins for "prejuvenation".
The "Botox Rule of 3" isn't one single rule but refers to key guidelines: 3 areas (forehead, frown lines, crow's feet are common), waiting at least 3 months between treatments to prevent resistance and maintain results, and a 3-to-5 day period for results to fully appear after the 3-to-4 month duration of the treatment. Key post-injection rules include avoiding bending/lying down for 4 hours and other treatments for 14 days.
Avoid Having Treatment the Day of a Big Event
It takes a few days for the results to become visible, and you might have minor bruising. If it is your first time having Botox, give yourself a buffer of about a week. If you have it regularly, give yourself three to four days.
You can also consider treatments such as retinoids, chemical peels, microneedling, and more. Dermal fillers are another alternative. This injectable treatment typically works immediately and lasts longer than Botox. But it's still a temporary solution.
There is no age limit for Botox treatments, and you can receive additional treatments whenever the results of the last one start to wear off.
The riskiest areas for Botox involve locations with crucial blood vessels and delicate muscles, primarily the glabella (between eyebrows) due to arteries that can cause blindness if blocked, the forehead/brow area risking eyelid droop (ptosis) or unnatural brow shapes, and the perioral region (mouth area), where poor placement can affect speech, smiles, or cause puckering. The masseter muscle (jaw) and neck (platysmal bands) are also sensitive, potentially causing chewing difficulty or swallowing issues with improper technique, requiring expertise to avoid complications like necrosis or paralysis.
Subtle Shifts in Results: After years of Botox use, some patients may notice changes in how their results appear. Over time, subtle shifts in facial structure, along with age-related changes to skin and muscles, can influence Botox outcomes.
Heart problems
Botox can affect your heart, but this is rare. It has the potential to cause heart rhythm problems (arrhythmia) or even heart attacks. This can be more likely if you already have heart problems. Be sure to talk about any heart problems with your healthcare professional before receiving Botox.
Potential Risks and Side Effects of Botox for Older Adults
Some rare but potential risks for patients over the age of 65 include: Reactions At the Injection Site—Bruising, pain, and swelling around the injection site are the most common side effects of a Botox treatment.
Alicia Silverstone. While speaking to Byrdie in August 2025, Alicia Silverstone confirmed that she's never had Botox, and instead wants to age naturally. “I have lines,” she said.
How to Reduce Fine Lines and Wrinkles — Without Botox
Daxxify is newer than Botox, with the FDA approving it in 2022. Botox has been approved since 2002. Daxxify and Botox both contain the same active ingredient: a neurotoxin called botulinum toxin type A. They are part of a drug class called neuromodulators, which means they act on nerve signals to the muscle.
On the other hand, the long-lasting cosmetic use of botulinum toxin can trigger permanent changes in facial expression, and an expressionless, mask-like face. Lack of facial animation or permanent changes in facial expression may be undesirable in some cases.
1) Forehead
When too much Botox is used in the forehead, it can overly relax the muscles, leading to a lack of natural movement and expression. In severe cases, excessive Botox in the forehead can increase the heaviness of the upper eyelids, causing them to become hooded.
The "Botox 4-hour rule" means you should stay upright and avoid pressure or lying down for at least four hours after injections to prevent the neurotoxin from migrating from the treated muscles to unintended areas, which can cause side effects like drooping or uneven results. This helps the Botox settle precisely where it's needed for optimal wrinkle-smoothing effects, so avoid bending, rubbing, or strenuous activity during this critical period.
The "Botox Rule of 3" isn't one single rule but refers to key guidelines: 3 areas (forehead, frown lines, crow's feet are common), waiting at least 3 months between treatments to prevent resistance and maintain results, and a 3-to-5 day period for results to fully appear after the 3-to-4 month duration of the treatment. Key post-injection rules include avoiding bending/lying down for 4 hours and other treatments for 14 days.
From 2025, following a landmark decision by the Nursing and Midwifery Council (NMC), new regulations for aesthetic injectables will ban nurses from prescribing botulinum toxin remotely face-to-face consultations will be mandatory before treatment.
You may need repeat treatments every 3-4 months to maintain your best results. We don't recommend treatments spaced more frequently than three months, or you could develop a resistance to the Botox's effects.