21 Places To Use Botox From Head To Toe

From the calves to the brows and everywhere in between, there’s a multitude of places where neurotoxins work wonders.
Written by Elise Minton Tabin
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These days, ‘Botox’ is a household term. According to the American Society of Plastic Surgeons (ASPS), botulinum toxin type A injections (which includes Botox®, Dysport®, Jeuveau®, and Xeomin®) is the most popular minimally invasive procedure, namely for non-surgically treating everything from lines and wrinkles to lifting a saggy brow to diminishing the discomfort of tooth grinding. But do you know everywhere on the body the neurotoxin can be used? Spoiler alert: Some will no doubt surprise you.

Botox 101

The primary ingredient in Botox® (and its extended family of injectable neuromodulators) is botulinum toxin type A (BoNT-A), which is a naturally occurring toxin that paralyzes muscles by inhibiting a nerve signaling molecule called acetylcholine, explains Macrene Alexiades, MD, a board certified dermatologist and founder of Macrene Actives. “Not only does it reduce active wrinkles by stopping you from frowning or lifting through its muscle relaxing properties, but stopping the activity of acetylcholine has other effects that we can use to our advantage as well,” she shares.

Botox® and the like temporarily weaken the muscles that are responsible for contraction. “Botox® is used most frequently for the reduction of dynamic wrinkles (wrinkles of movement), which are associated with expression,” says Jonathan Cabin, MD, a double board certified facial plastic and reconstructive surgeon in Arlington, VA. As the muscle wanes (about three to seven days after treatment), the contractions diminish, making the skin noticeably smoother with fewer lines and wrinkles. “By reducing the strength of these muscles, the wrinkles improve or resolve,” he shares. “In addition, consistent use of Botox® can reverse and prevent the ‘etched in’ wrinkles that form in certain areas over time from repetitive folding and age-related skin thinning.”

Prejuvenation vs. Rejuvenation

Not everyone waits until a line, wrinkle, or furrow is evident to treat an area. Plenty of toxin users subscribe to the theory of preventative use. “My strategy, since inception, is to use Botox® to train the facial muscles to prevent and reverse unwanted creases,” Dr. Alexiades says. She likens lines and wrinkles to “scars on the skin” that are “due to repeated movements.” With proper technique, they can be prevented before they ever need to be corrected. “When I place Botox® as accurately as I do, I can reverse existing lines and prevent creases from forming if done before the wrinkles become etched into the skin,” she notes.

When using a toxin for prejuvenation purposes, it’s best to determine the type of wrinkle you are dealing with: dynamic or resting. “Dynamic wrinkles form when the muscle contracts but resolve when it is relaxed,” says Snehal Amin, MD, a board certified dermatologist in New York City. “As we get older, these dynamic wrinkles, along with sun damage, start to create permanent folds in the skin.” Age is not necessarily the prime factor here, but rather when the dynamic wrinkles start to show. Botox® and its competitors can prevent these lines and wrinkles from ever becoming engraved into the skin, especially in younger patients. “It is reasonable to inject a 30 year old with Botox® on the forehead to avoid permanently etched lines on the forehead and crow's feet area,” he states.

What Does ‘Off-Label’ Mean?

Neurotoxin injectables have an array of uses that are both aesthetic and therapeutic in nature. Botox®, for example, was first approved by the United States Food and Drug Administration (FDA) to treat eyelid spasms, Dr. Amin notes. Today, that approval extends to treating migraines and hyperhidrosis (read: excessive sweating), relaxing muscle contractions, and minimizing wrinkles.

However, it should be noted that not every place on the face and body where doctors inject neurotoxins is an FDA-approved use. Plenty of dermatologists and plastic surgeons safely and effectively use these products in an ‘off-label’ manner. As a quick refresh, off-label means using an FDA-approved product for either a treatment area or an indication that it has not received clearance for. Simply put, any non-FDA-approved use of a neurotoxin is considered off-label.

So, what does off-label use mean for you? “For many drugs, some of the off-label uses may be more important than their on-label use, although those off-label uses may not have been studied as well,” says Joshua Fox, MD, a board certified dermatologist in New York. Regardless of where you are seeking Botox® and the like, finding a qualified provider with the necessary experience is of the utmost importance. “Physicians who use products off-label know the risks, benefits, alternative treatments, and potential complications,” he says.

Where to Use Botox

While neurotoxins act like a magic eraser of sorts for lines and wrinkles, there are plenty more uses for them. New and innovative discoveries are constantly developing to help treat aesthetic and medical concerns, but below are the top 20 places to use neurotoxins from head to toe:

1. THE AREA: The Armpits

  • FDA-Approved: Yes
  • Works For: Overly sweaty under arms
  • Lasts For: 3 to 5 months

There are few things more annoying than visible pit stains, however, the reason for hyperhidrosis (read: excessive sweating) varies from genetics to stress to exercise. “Botox® blocks the release of a neurotransmitter, acetylcholine, which mediates sympathetic neurotransmission in the sweat glands,” Dr. Fox explains. “By blocking this transmission in the sweat glands, it stops the release of excess sweat.” Although needle-free solutions, like MiraDry, are available, most doctors treat the armpits with Botox® because the toxin forces the tiny muscles in the area to stop sweat from squeezing out. “For those with this debilitating problem, Botox® has been revolutionary,” Dr. Amin says.

2. THE AREA: The palms of the hands & soles of the feet

  • FDA-Approved: No
  • Works For: Wet, sweaty hands & feet
  • Lasts For: Up to 6 months

Just as Botox® works to counteract super sweaty armpits, it works wonders for clammy hands that over-perspire and feet that transform from dry to slippery and sweaty in a matter of minutes. Treatment for both of these areas is pretty straightforward. First, numbing cream is applied to the hands or feet, and then a tiny amount of a neurotoxin is injected into the site, which signals the sweat glands to ‘turn off’ and stop production.

3. THE AREA: The scalp

  • FDA-Approved: No
  • Works For: Sweaty and/or oily scalps
  • Lasts For: 3 months

If you want to preserve the life of your blowouts, consider Botox® injections — yes, seriously. Working out, bouts of nervousness, not shampooing enough, or even just a lack of restful sleep can all signal the scalp to produce excess amounts of sweat and oil. “Any area of the body that has excessive sweating — including the scalp — responds nicely to Botox®,” Dr. Cabin says. “A good response is generally a 50 percent or more reduction in sweating.” Similarly, the injections temporary limit oil production for less greasiness.

4. THE AREA: The neck

  • FDA-Approved: No
  • Works For: Dynamic neck bands
  • Lasts For: 4 to 6 months

Known as the ‘Nefertiti neck lift,’ neurotoxins are often injected into the platysmal bands (i.e. muscles that become more prominent with age and display as vertical lines and bands on the neck) to soften signs of aging and tighten the skin. “When we inject these bands with Botox®, it relaxes them and makes them look less prominent and more even with the rest of the face,” Dr. Fox says. “This creates a smoother, younger look in the neck.” Relaxing the muscles in the neck not only makes them less visible, it also has a relaxing effect on the jawline, too.

5. THE AREA: The forehead

  • FDA-Approved: Yes
  • Works For: Horizontal lines & wrinkles
  • Lasts For: 3 to 4 months

Injecting the forehead with Botox® is one of the most common areas of use. In some people, the forehead muscles are strong, and scowling, raising the eyebrows, and making everyday facial movements leaves the forehead laden with deep wrinkles. A heavily wrinkled forehead can depict an angry, worried, or mad appearance, which many patients do not like. “Botox® relaxes the muscles in the area, which lessens the wrinkles,” Dr. Fox says. “You can expect good results and a fresher, smoother, and more radiant-looking face.”

6. THE AREA: Crow’s Feet

  • FDA-Approved: Yes
  • Works For: Fine lines around the eyes
  • Lasts For: 2 to 3 months

Botox® and other neuromodulators can improve the crepiness and tiny lines that form at the outer corners of the eyes. “The lower eyelid skin often bunches up when people smile,” Dr. Amin says. But it’s not just smiling that leads to these fine lines — squinting and laughing are equally responsible and sun exposure only makes them worse. Periorbital Botox® not only smooths out any evidence of lines and wrinkles but also prevents makeup from settling into them. The results are usually subtle, yet they create a more alert and wide-eyed appearance, especially when smiling and laughing.

7. THE AREA: The sides of the nose

  • FDA-Approved: No
  • Works For: Bunny lines
  • Lasts For: 3 months

Bunny lines around the nose can be cute, but, for those that dislike the tiny wrinkles that form when smiling or laughing (they tend to not be as pronounced when at rest), your doctor can eliminate them by injecting Botox®. Dr. Cabin likes to use small amounts of Botox® to treat the diagonal lines that can form from overactive nasalis muscles on either side of the nose. “By injecting the nasalis muscle on each side of the upper part of the nose, helps the lines to dissipate,” he notes.

8. THE AREA: The jaw

  • FDA-Approved: No
  • Works For: Teeth clenching & tightness from TMJ; a bulky jawline
  • Lasts For: 3 months

If you’re one who incessantly grids the teeth at night and wakes up in the morning to pain and soreness in the jaw, then neurotoxins can help. “I have cured tooth grinding and TMJ (temporomandibular joint) through my application of Botox® to this area,” Dr. Alexiades says. But reducing discomfort isn’t the only benefit. The masseter muscle gets large in some people due to either their natural anatomy or constant grinding. “Just a small amount of Botox® will relax a part of the muscle,” Dr. Amin says. “If the muscle is not active, it will shrink.” Injecting the jawline creates a slimmer, more heart-shaped face as the muscles relax.

9. THE AREA: The eyebrows

  • FDA-Approved: No
  • Works For: Slightly saggy & asymmetrical brows
  • Lasts For: 3 to 4 months

A so-called Botox brow lift involves injecting the lateral (side) portion of the eyebrows to give a lifted, more awake appearance while negating the look of droopy brows. Often, small amounts of Botox® are injected into the forehead and between the brows to create a more harmonious look and smoothness. While the technique works for those with minimal sagging, it’s important to note that excessive sagging and hooding of the upper lids may not see dramatic results compared to surgical intervention, like a traditional brow lift.

10. THE AREA: The gums

  • FDA-Approved: No
  • Works For: A gummy smile
  • Lasts For: 4 months

If you show too much tooth or gum when you smile because the upper lip rests too high on the gums, a little bit of Botox® can make a big difference. “By injecting a couple of units of Botox® in the correct area, we can prevent this problem,” Dr. Fox shares. Good technique is essential: If injecting too much product occurs or if the injections are not precisely in the right area, the smile can take a turn for the worse and look uneven.

11. THE AREA: The chin

  • FDA-Approved: No
  • Works For: A pebbled, bumpy chin
  • Lasts For: About 3 months

Unbeknownst to many, the chin falls victim to aging in the form of dimples and uneven texture. “Many people notice wrinkling and asymmetry in the chin when they smile or frown,” Dr. Amin notes. One of the easiest and quickest ways to correct a dimpled chin so that the skin is even is with neurotoxins. “Botox® helps to relax the muscles that insert into the skin of the chin so that it is smooth and remains that way for about three months,” he says.

12. THE AREA: The pores

  • FDA-Approved: No
  • Works For: Overly oily facial skin
  • Lasts For: 2 to 3 months

If your skin pumps out more oil than a Texas rig, listen up! Microinjections of Botox® directly into the pores can drastically decrease the amount of sebum the skin produces. “The same way that Botox® reduces sweating, we can also use it to reduce sweat gland activity,” says Dr. Amin, who points out that the effects are not as dramatic but still noticeable. It’s a temporary treatment, but, for those with very oily skin, this treatment can be a godsend. According to Dr. Cabin, studies are underway on using very superficial Botox® injections to treat intradermal issues (meaning issues with the skin itself). he says. “This is tricky because we need to minimize the spreading of Botox® to the underlying motor muscles so as not to affect them,” he shares. “Some devices and advances will likely be coming to market soon that will allow this to be more reliable.”

13. THE AREA: Scars

  • FDA-Approved: No
  • Works For: Keloids and hypertrophic (thick, raised) scars
  • Lasts For: Up to 1 year

Lasers may be the gold standard for scar treatment, but Botox® comes in as a close second. “One reason why poorer scarring occurs is due to excessive movement around an incision or injury as its healing,” explains Dr. Cabin, who always pre-treats with Botox® to reduce movement for the duration of the acute healing period. “In traumatic lacerations, the only option is to do this at the time of repair,” he notes. “But, for scheduled procedures, I will pretreat the area two weeks in advance to ensure that the Botox® is maximally effective upon surgery.” Dr. Cabin adds that Botox® can also help treat pain associated with a scar or surgical incision.

“As a skin cancer surgeon, I often tell my patients to relax or immobilize the surgical site for a week or two after the surgery,” Dr. Amin advises. “Less tugging on the sutures is good for healing.” For some areas of the face, doctors prefer to inject Botox® to help paralyze the surrounding muscle and relax and soften the scar tissue. “This way, healing can proceed without the contact pulling of facial expression muscles,” he adds.

14 THE AREA: The base of the nose

  • FDA-Approved: No
  • Works For: A droopy nose tip
  • Lasts For: 3 to 4 months

As cartilage and support diminish from the tip of the nose, it tends to drop forward, which becomes more evident when smiling. “A little bit of Botox® to certain parts of the nose can lift the tip of the nose nicely,” Dr. Amin says. However, Botox® won't correct those issues if the nose is bulbous or widening due to age. In those cases, surgical rhinoplasty may be necessary to fix the changes permanently.

15. THE AREA: The lips

  • FDA-Approved: No
  • Works For: The corners of the lips & the positioning of the upper lip
  • Lasts For: 3 months

Lip fillers are great for adding volume, symmetry, and shape, but they won't turnaround a mouth that looks like a permanent frown. As the mouth turns down and lines form in the surrounding areas, the mouth, as a whole, can give way to an upset or angry appearance. In that case, a bit of Botox® (often in combination with filler to address a lack of volume and symmetry) can roll the upper lip up and out.

16 THE AREA: The glabellar region

  • FDA-Approved: Yes
  • Works For: Mild to deep set lines between the brows
  • Lasts For: 3 to 4 months

Deep lines and furrows like to call the area between the brows home. Also known as 11 lines or frown lines, these etchings can ensue as early as the twenties, and smoothing out the area with a neurotoxin lends a more youthful, fresher appearance. If a frozen look is something you’d rather avoid, talk to your dermatologist or plastic surgeon about microinjections, which use smaller amounts of neurotoxin to erase the lines while maintaining some movement. Keep in mind that as elasticity and collagen diminishes from the skin, the glabellar lines become more pronounced.

17. THE AREA: The calves

  • FDA-Approved: No
  • Works For: Bulky calves
  • Lasts For: 6 months

What originated as a trend in Asia to create longer-looking legs has caught on stateside. Botox® can be used to treat the calf muscle, and administering it where the muscle is most pronounced relaxes and shrinks it. The more often the treatment happens, the more noticeable the results, although most patients notice a change after one treatment. Avid exercisers may require more frequent treatment.

18. THE AREA: The head

  • FDA-Approved: Yes
  • Works For: Migraines
  • Lasts For: 3 months

Anyone who has ever experienced a migraine knows that they can be debilitating. When they become a regular occurrence (read: 15 or more migraine days per month), Botox® injections can dramatically help. “One of the FDA-approved uses of Botox® is to treat chronic migraine headaches,” Dr. Cabin says. Each treatment involves about 30 injections to targeted areas of the head and neck.

19. THE AREA: Around the eye

  • FDA-Approved: Yes
  • Works For: Eye spasms
  • Lasts For: 3 months

No matter if incessant twitching (known as blepharospasm) affects the upper, middle, or lower portion of the eyelid, Botox® can help. Considering the drug's medical use, Botox® halts the twitching by relaxing the muscle and limiting spasms. Most patients that seek Botox® treatment report a dramatic reduction and improvement.

20. THE AREA: The vagina

  • FDA-Approved: No
  • Works For: Vaginismus
  • Lasts For: 3 to 5 months

Vaginismus is a medical condition that causes involuntary vaginal muscle spasms. It can make inserting tampons and penetrative sex painful — and, in some cases, impossible. Until recently, treatment often involved a combination of talking therapy sessions and vaginal dilators, but now providers are starting to use Botox® to paralyze the muscles that contract as a result of the condition. More often than not, just one session is needed. This long-term relief occurs despite the fact that the Botox® only lasts three to five months — the initial treatment breaks the pain cycle associated with vaginismus. It is possible, however, to have multiple treatments if results wear off over time.

21. THE AREA: The décolletage

  • FDA-Approved: No
  • Works For: Chest wrinkles
  • Lasts For: 3 months

Like the hands and the neck, the chest is a dead giveaway of your age. Years of sun damage cause the skin on the décolleté to become wrinkled and crepey, yet, as Dr. Amin says, one of the less common areas that doctors inject with Botox® is the upper chest. By relaxing the muscles in the chest, the skin becomes smoother, firmer, and more youthful. “It improves the décolletage,” he notes.

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ELISE MINTON TABINis a contributing writer for AEDIT.

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