Botulinum toxin injections temporarily reduce activity in the injected muscle, which softens the lines that muscle creates (Botox Cosmetic label). Six botulinum toxin products have FDA labels that include cosmetic uses: Botox Cosmetic, Dysport, Xeomin, Jeuveau, Daxxify and Letybo. In October 2024, platysma (neck) bands were added to the Botox Cosmetic label, giving it four cosmetic uses (Botox Cosmetic label). This guide covers what the labels and published studies say, where to find Houston prices, and how to check a provider under Texas rules.
Mechanism
How Botox works
Botox Cosmetic is a purified botulinum toxin type A produced by Clostridium botulinum bacteria. Injected into a muscle, it blocks the release of acetylcholine, the chemical signal that tells the muscle to contract, by cleaving a protein called SNAP-25. The result is a localized reduction in muscle activity (Botox Cosmetic label).
The effect is temporary. The label states that reinnervation of the muscle may occur, slowly reversing the effect, and that the effect on frown lines lasts approximately 3–4 months (Botox Cosmetic label). Repeat treatments are needed to keep the result.
Points to understand:
- Botox does not fill lines. It reduces the muscle movement that creates them. The FDA-approved uses are for lines associated with muscle activity (Botox Cosmetic label).
- Units are not interchangeable between brands. Each label states that its units cannot be compared to or converted into units of any other botulinum toxin product (Botox Cosmetic label) (Dysport label) (Xeomin label). A unit of Botox is not a unit of Dysport.
Products
The six FDA-approved cosmetic neurotoxins
All six are botulinum toxin type A products. Their FDA-approved cosmetic uses differ.
| Product | Company on label | FDA-approved cosmetic uses | Label notes |
|---|---|---|---|
| Botox Cosmetic | AbbVie | Frown lines, crow’s feet, forehead lines, platysma bands | Platysma bands added Oct 2024 |
| Dysport | Ipsen; also distributed by Galderma | Frown lines | Adults under 65; contains trace cow’s milk protein |
| Xeomin | Merz | Frown lines, forehead lines, crow’s feet | Toxin without accessory proteins |
| Jeuveau | Evolus | Frown lines | |
| Daxxify | Revance | Frown lines | Toxin without accessory proteins |
| Letybo | Hugel | Frown lines |
Sources: Botox Cosmetic label, Dysport label, Xeomin label, Jeuveau label, Daxxify label, Letybo label.
FDA-approved uses: All six labels include frown lines (the ”11s” between the brows). Botox Cosmetic and Xeomin are also approved for crow’s feet and forehead lines, and only Botox Cosmetic is approved for platysma bands (Botox Cosmetic label) (Xeomin label). Using a product for an area not on its label is off-label use. Ask your provider which product they plan to use and whether that area is on its label.
The Daxxify duration claim
In two phase 3 trials (SAKURA 1 and 2), frown lines stayed at none or mild severity for a median of 24.0 and 23.9 weeks after one 40-unit treatment (Carruthers et al., 2020). A median means half of patients had a shorter result. Subjects were followed for up to 36 weeks (Carruthers et al., 2020). The Daxxify label states it should not be given more often than every three months (Daxxify label).
The Dysport onset claim
Dysport is often described as starting to work faster than Botox. The Dysport label does not state an onset time for frown lines (Dysport label). For Botox Cosmetic, the label states that muscle weakening typically begins one to two days after injection and increases during the first week (Botox Cosmetic label). If timing matters, for example before an event, ask your provider how far ahead to book.
Evidence watch
”Preventative Botox”: what the evidence shows
Botox Cosmetic is FDA-approved to temporarily improve the appearance of existing moderate to severe lines, not to prevent lines (Botox Cosmetic label).
The most-cited evidence is a 2006 report on one pair of identical twins. One twin received Botox in the forehead and between the brows about 2 to 3 times a year for 13 years; the other received it twice. Lines at rest on the forehead and between the brows were not evident in the regularly treated twin and were evident in the other (Binder, 2006). A report on two people cannot show whether the result applies to people generally.
Discuss with your provider whether lines you have now are the reason for treatment.
What to expect
During and after treatment
The Botox Cosmetic label calls for a 30 to 33 gauge needle (Botox Cosmetic label). Ask your provider how long the appointment takes and whether they use numbing cream or ice.
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Immediately after
Pain, swelling, redness, tenderness or bruising may occur at the injection sites. Needle pain or anxiety can cause fainting or a drop in blood pressure (Botox Cosmetic label).
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First day
The label does not include aftercare rules such as staying upright or avoiding exercise. Follow your provider's instructions.
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Days 1–7
For frown lines, muscle weakening typically begins one to two days after injection and increases during the first week. Most side effects appear within the first week (Botox Cosmetic label).
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Follow-up
Ask whether the practice offers a follow-up visit to check the result, and whether touch-up units cost extra.
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Months 3–4
The effect on frown lines lasts approximately 3–4 months. The safety and effectiveness of Botox Cosmetic given more often than every 3 months have not been evaluated (Botox Cosmetic label).
Labeled Botox Cosmetic doses by area (Botox Cosmetic label):
- Frown lines (”11s”): 20 units (4 units into each of 5 sites)
- Crow’s feet: 24 units (12 units per side)
- Forehead lines: 20 units, treated together with 20 units for frown lines, 40 units total
- All three areas together: 64 units
- Platysma bands (neck): 26, 31 or 36 units, depending on the number of bands
- Bunny lines, lip flip, masseter (jaw), chin dimpling, brow lift: not on the label; off-label, with no labeled dose
- Underarm sweating: treated with BOTOX, the non-cosmetic product; the labeled dose is 100 units for severe primary axillary hyperhidrosis
Units for other brands differ and cannot be converted from Botox units.
In Houston
Houston heat and aftercare
Many Houston patients ask about heat, sweating and outdoor exercise after treatment. The Botox Cosmetic label does not address heat, sweating or exercise (Botox Cosmetic label). Ask your provider what they recommend for the first day, and plan outdoor activity around their instructions.
Pricing
Houston pricing: what to expect
Prices vary by spa and by how many units you need. Each neighborhood page on this site lists the regular prices that med spas there publish on their own websites, with a link to each.
Nationally, the American Society of Plastic Surgeons gives an average cost of $435 for botulinum toxin injections, per treatment (ASPS). That is a national figure from plastic surgeons, not a Houston med spa price, and ASPS does not give a year for it.
Some practices price by unit and some by area. Before treatment, ask:
- How many units will I need, and what is the price per unit?
- If the price is per area, how many units does it include, and what do extra units cost?
- Which product is being used? Units of different brands are not comparable.
Daxxify pricing
Daxxify units are not comparable to Botox units (Daxxify label), so compare the total price of a treatment, not the price per unit. Ask for the total cost and how often you would expect to come back.
Rewards programs and memberships
Ask whether the product’s manufacturer runs a patient rewards program and whether the spa participates. If the spa offers a membership, ask for the monthly fee, the discount per unit and the cancellation terms, and compare that with how often you plan to be treated.
Safety
Side effects and safety
The table lists the most common side effects reported in the Botox Cosmetic clinical trials, compared with placebo (Botox Cosmetic label).
| Side effect | Area treated in trial | Botox Cosmetic | Placebo |
|---|---|---|---|
| Eyelid drooping | Frown lines | 3% | 0% |
| Eyelid swelling | Crow’s feet | 1% | 0% |
| Headache | Forehead + frown lines | 9% | 5% |
| Eyelid drooping | Forehead + frown lines | 2% | 0% |
| Brow drooping | Forehead + frown lines | 2% | 0% |
| Facial pain | Frown lines | 1% | 0% |
The label states that side effects generally occur within the first week and, while many are transient, may last several months or longer (Botox Cosmetic label). In the Daxxify phase 3 trials, the most common treatment-related side effects were headache (7.0% and 5.9%) and injection-site pain (5.0% and 2.4%) (Carruthers et al., 2020).
Serious adverse events
All botulinum toxin products carry an FDA boxed warning that the toxin effect may spread from the injection site, causing symptoms such as muscle weakness, double vision, drooping eyelids, and trouble swallowing, speaking or breathing, hours to weeks after injection. Swallowing and breathing difficulties can be life-threatening, and deaths have been reported (Botox Cosmetic label). The label states the risk is probably greatest in children treated for spasticity, and that there have been no definitive serious reports of distant spread at the labeled cosmetic doses (Botox Cosmetic label).
The label also lists serious allergic reactions, including anaphylaxis, and cardiovascular adverse events, some fatal, and advises caution in people with existing heart disease (Botox Cosmetic label). Seek medical care right away if you have trouble swallowing, speaking or breathing after treatment.
Pregnancy and breastfeeding
Safety has not been established. The Botox Cosmetic label states there are no studies or adequate data on developmental risk in pregnant women, and that animal studies showed effects on fetal growth at doses associated with toxicity in the mother. It also states there are no data on whether Botox Cosmetic passes into breast milk or affects a breastfed child (Botox Cosmetic label).
Tell your provider if you are pregnant, may be pregnant or are breastfeeding. If you learn you were pregnant at the time of a treatment, tell your OB/GYN.
Contraindications and cautions
The Botox Cosmetic label lists two contraindications (Botox Cosmetic label):
- Known hypersensitivity to any botulinum toxin product or to any ingredient in the formulation
- Infection at the planned injection site
Dysport is also contraindicated in people allergic to cow’s milk protein (Dysport label).
The label calls for caution or close monitoring with (Botox Cosmetic label):
- Nerve or muscle diseases such as ALS, myasthenia gravis or Lambert-Eaton syndrome
- Aminoglycoside antibiotics, curare-like agents or muscle relaxants, which may increase the toxin effect
- Breathing or swallowing problems
- Another botulinum toxin product given within several months
Choosing a provider
How to choose a Botox provider in Houston
Under Texas Medical Board rules, injecting substances for cosmetic purposes is a nonsurgical medical cosmetic procedure, which the rules treat as the practice of medicine that can be delegated and supervised (22 TAC §169.25). These rules took effect January 9, 2025 (Texas Medical Board).
| Who | What the rules and TDLR say |
|---|---|
| Physician (MD/DO) | The procedure is the practice of medicine and can be delegated (22 TAC §169.25) |
| PA or APRN | May establish the practitioner-patient relationship when acting under a physician’s delegation; one of them or a physician must be onsite or immediately available (22 TAC §169.26) |
| Person performing a delegated injection | Needs appropriate training, a written order and a signed written protocol (22 TAC §169.26) (22 TAC §169.27) |
| Esthetician | License does not allow injecting botulinum toxin (TDLR) |
Key requirements for a delegated injection:
- Before the procedure, a physician, or a PA or APRN acting under the physician’s delegation, must establish a practitioner-patient relationship with you (22 TAC §169.26). The industry often calls this a good faith exam; the rule does not use that term.
- A physician, PA or APRN must be onsite or immediately available for emergencies (22 TAC §169.26).
- The procedure requires a written order (22 TAC §169.27). The person performing the procedure must also sign and date a written protocol (22 TAC §169.26).
- The delegating physician’s name and Texas license number must be posted in each public area and treatment room (22 TAC §169.28).
TDLR states that Botox and filler injections are medical treatments that must be provided under the order and delegation of a licensed physician (TDLR).
Verifying credentials: three steps
- Check the physician’s or PA’s Texas license on the Texas Medical Board’s Look Up a License page. Verifications include any Board action taken against the licensee (Texas Medical Board).
- Check board certification through the American Board of Medical Specialties’ patient lookup, Certification Matters, linked from the ABMS Verify Certification page.
- Check nurse licenses (RN or APRN) through the Texas Board of Nursing’s license verification.
Questions to ask at consultation
- What is your training in cosmetic neurotoxin injection, and how many treatments have you performed?
- Who is the delegating physician, and is their name and license number posted here?
- Who will establish the practitioner-patient relationship with me before treatment?
- Which product do you use, and is my treatment area on that product’s FDA label?
- How many units do you plan to use, and what is the total price?
- Is a follow-up visit included, and do touch-up units cost extra?
- What do you do if I develop eyelid drooping or another side effect?
Red flags
- No identifiable delegating physician
- No physician name and Texas license number posted in the public areas and treatment rooms (22 TAC §169.28)
- No practitioner-patient relationship established before treatment (22 TAC §169.26)
- An esthetician performing the injection (TDLR)
- No review of your medical history and medicines before treatment
- A price quoted without a unit count, or high-pressure “today only” pricing
Treatment Areas