Botulinum toxin injections soften lines by temporarily quieting the muscle underneath them (FDA label for Botox Cosmetic). The FDA labels for six products include cosmetic uses. They are Letybo, Daxxify, Jeuveau, Xeomin, Dysport and Botox Cosmetic. Platysma (neck) bands joined the Botox Cosmetic label in October 2024, which brought it to four cosmetic uses (FDA label for Botox Cosmetic). Before you book with a spa around Austin, it helps to know which product it uses, how it prices treatment and who Texas rules allow to inject. This page takes each in turn, using the labels and published studies.
Mechanism
What Botox does in the muscle
The active ingredient in Botox Cosmetic is a purified type A botulinum toxin, produced by Clostridium botulinum bacteria. Once injected, it cleaves a protein called SNAP-25. Acetylcholine, the signal that tells the muscle to contract, is then no longer released, so the muscle becomes less active (FDA label for Botox Cosmetic).
None of this is permanent. Per the label, the muscle may reinnervate, which slowly reverses the effect, and the effect on frown lines lasts about 3–4 months (FDA label for Botox Cosmetic). You need repeat treatments to keep the result.
Two things to keep in mind:
- Botox does not fill anything in. It cuts down the muscle movement that creates the line. The approved uses address lines linked to muscle activity (FDA label for Botox Cosmetic).
- Brands do not share units. A unit of Botox does not equal a unit of Dysport. The Botox Cosmetic, Dysport and Xeomin labels each say their own units cannot be compared with, or converted into, those of any other botulinum toxin product (FDA label for Botox Cosmetic) (FDA label for Dysport) (FDA label for Xeomin).
Products
Comparing the six FDA-approved cosmetic neurotoxins
All six are type A botulinum toxins. What separates them is the list of cosmetic uses on each label.
| Brand | Cosmetic uses on the FDA label | Company on the label | What else the label says |
|---|---|---|---|
| Botox Cosmetic | Frown lines, crow’s feet, forehead lines, platysma bands | AbbVie | Platysma bands arrived in October 2024 |
| Dysport | Frown lines | Ipsen (Galderma also distributes it) | Meant for adults under 65; includes a trace of cow’s milk protein |
| Xeomin | Crow’s feet, forehead lines, frown lines | Merz | No accessory proteins in the toxin |
| Jeuveau | Frown lines | Evolus | |
| Daxxify | Frown lines | Revance | No accessory proteins in the toxin |
| Letybo | Frown lines | Hugel |
Label sources by brand: Letybo, Daxxify, Jeuveau, Xeomin, Dysport, Botox Cosmetic.
Which areas are on the labels: Frown lines (the ”11s” between the brows) are on all six. Crow’s feet and forehead lines are also on the Botox Cosmetic and Xeomin labels, and only the Botox Cosmetic label includes platysma bands (FDA label for Botox Cosmetic) (FDA label for Xeomin). Treating an area a product’s label does not list is off-label use. Ask which product your provider plans to use and whether your area is on its label.
How long Daxxify lasts
In SAKURA 1 and 2, patients got one 40-unit Daxxify treatment. The median time with frown lines at none or mild was 24.0 weeks in one trial and 23.9 in the other (SAKURA trial report). Half of patients had a shorter result than the median. Follow-up lasted as long as 36 weeks (SAKURA trial report). The label sets a minimum gap of three months between Daxxify treatments (FDA label for Daxxify).
Does Dysport work faster?
You may hear that Dysport kicks in sooner than Botox. For frown lines, its label gives no onset time (FDA label for Dysport). The Botox Cosmetic label says muscle weakening usually starts one to two days after injection and builds through the first week (FDA label for Botox Cosmetic). Booking ahead of a wedding or trip? Ask your provider how many days to allow.
Evidence watch
Can “preventative Botox” stop lines from forming?
The approval for Botox Cosmetic covers a temporary improvement in how existing moderate to severe lines look. Preventing lines is not part of it (FDA label for Botox Cosmetic).
A 2006 report on a single pair of identical twins is the evidence cited most. Over 13 years, one twin had about 2 to 3 Botox sessions a year in the forehead and between the brows. The other twin had two. The regularly treated twin showed no resting lines on the forehead or between the brows, and the other twin did (Binder, 2006). With two people, there is no way to tell whether the finding holds for people generally.
Ask your provider whether the lines you have now are the reason to treat.
What to expect
The appointment and the weeks after
According to the label, Botox Cosmetic goes in with a 30 to 33 gauge needle (FDA label for Botox Cosmetic). Ask how long the appointment lasts and whether numbing cream or ice is used.
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Right after
Expect possible pain, swelling, redness, tenderness or bruising at the injection sites. Needle pain or anxiety may cause fainting or lower blood pressure (FDA label for Botox Cosmetic).
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The first day
The label gives no instructions like staying upright or avoiding exercise. Do what your provider tells you.
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Days 1–7
With frown lines, muscles typically start weakening one to two days post-injection, and the weakening builds across the first week. Most side effects appear in that same week (FDA label for Botox Cosmetic).
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Follow-up
Ask if a follow-up visit to review the result is offered, and whether extra touch-up units are billed.
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Months 3–4
Expect the effect on frown lines to last about 3–4 months. For dosing sooner than every 3 months, the label notes safety and effectiveness are unevaluated (FDA label for Botox Cosmetic).
Botox Cosmetic dose per area, from the label (FDA label for Botox Cosmetic):
- Frown lines (”11s”): 20 units, given as 4 units at each of 5 sites
- Crow’s feet: 24 units, 12 per side
- Forehead lines: 20 units, added to the 20 units for frown lines for 40 units in all
- Frown lines, crow’s feet and forehead lines treated together: 64 units
- Platysma (neck) bands: 26, 31 or 36 units, depending on how many bands are treated
- Not on the label: bunny lines, lip flip, masseter (jaw), chin dimpling and brow lift. These are off-label uses with no labeled dose.
- Underarm sweating uses BOTOX, which is not the cosmetic product. The labeled dose for severe primary axillary hyperhidrosis is 100 units.
Other brands count in their own units, and Botox units cannot be converted into them.
Aftercare
Heat, sweat and exercise afterward
The Botox Cosmetic label says nothing about heat, sweating or exercise after treatment (FDA label for Botox Cosmetic). Ask your provider what they recommend for the first day about heat, sweating and exercise, and plan outdoor activity around their answer.
Pricing
What Botox costs in Austin
Spas set their own prices, and your total depends on the units you need. Ask each practice for its rate. The Austin area pages on this site list the same national average given below.
The American Society of Plastic Surgeons reports a national average of $435 per treatment for botulinum toxin injections (ASPS). Plastic surgeons supplied that figure, so it is not an Austin med spa price, and ASPS gives no year for it.
Some practices charge per unit and others per area. Questions to ask before you book:
- How many units does my treatment need, and what is the cost of one?
- If the price is per area, how many units come with it, and what do additional units cost?
- Which product is it? Different brands use units that cannot be compared.
Pricing for Daxxify
You cannot compare Daxxify units with Botox units (FDA label for Daxxify). Look at the total price of a treatment rather than the price per unit, and ask how soon you would expect to return.
Rewards programs and memberships
Check if the maker has a patient rewards program and if this spa participates. For memberships, compare the cost per month, the per-unit discount and how cancellation works against how often you expect treatments.
Safety
Risks and side effects
This table lists the most common side effects from the Botox Cosmetic clinical trials, next to placebo (FDA label for Botox Cosmetic).
| Trial area | Effect reported | Botox Cosmetic group | Placebo group |
|---|---|---|---|
| Frown lines | Eyelid drooping | 3% | 0% |
| Frown lines | Facial pain | 1% | 0% |
| Crow’s feet | Eyelid swelling | 1% | 0% |
| Forehead and frown lines together | Headache | 9% | 5% |
| Forehead and frown lines together | Eyelid drooping | 2% | 0% |
| Forehead and frown lines together | Brow drooping | 2% | 0% |
Per the label, most side effects arise within the first week. Many pass, though some last several months or longer (FDA label for Botox Cosmetic). In the Daxxify phase 3 trials, injection-site pain (5.0% and 2.4%) and headache (7.0% and 5.9%) were the treatment-related side effects reported most often (SAKURA trial report).
Serious adverse events
Every botulinum toxin product carries an FDA boxed warning about spread of the toxin effect from the injection site. Symptoms can arise hours to weeks after injection and include muscle weakness, double vision, drooping eyelids, and trouble swallowing, speaking or breathing. Swallowing and breathing difficulties can be life-threatening, and deaths have been reported (FDA label for Botox Cosmetic). Per the label, the risk is probably greatest in children treated for spasticity. For the labeled cosmetic doses, the label cites no definitive serious reports of distant spread (FDA label for Botox Cosmetic).
The label also lists anaphylaxis and other serious allergic reactions, as well as cardiovascular adverse events, some of them fatal. It recommends care if you already have heart disease (FDA label for Botox Cosmetic). After treatment, trouble swallowing, speaking or breathing needs medical care immediately.
Pregnancy and breastfeeding
Safety has not been established. According to the Botox Cosmetic label, there are no studies or adequate data on developmental risk in pregnant women, and fetal growth was affected in animal studies at doses toxic to the mother. It also reports no data on whether Botox Cosmetic enters breast milk or affects a breastfed child (FDA label for Botox Cosmetic).
Let your provider know if you are or might be pregnant, or if you are breastfeeding. If you later learn you were pregnant at the time of a treatment, tell your OB/GYN.
Contraindications and cautions
The Botox Cosmetic label gives two contraindications (FDA label for Botox Cosmetic):
- Hypersensitivity to any botulinum toxin product, or to any ingredient in the formulation
- An infection at the planned injection site
For Dysport, an allergy to cow’s milk protein is a further contraindication (FDA label for Dysport).
These situations call for caution or close monitoring, per the label (FDA label for Botox Cosmetic):
- Breathing or swallowing problems
- Another botulinum toxin product received in the past several months
- Aminoglycoside antibiotics, curare-like agents and muscle relaxants, which can increase the toxin effect
- Nerve or muscle diseases (ALS, myasthenia gravis, Lambert-Eaton syndrome)
Choosing a provider
Choosing a Botox provider in Austin
The Texas Medical Board classes cosmetic injection of substances as a nonsurgical medical cosmetic procedure. Its rules treat that as the practice of medicine, which can be delegated and supervised (Tex. Admin. Code §169.25). The rules took effect January 9, 2025 (Texas Medical Board).
| Role | What the rules and TDLR say |
|---|---|
| Physician (MD/DO) | The procedure counts as medicine, and a physician may delegate it (Tex. Admin. Code §169.25) |
| PA or APRN | Acting under a physician’s delegation, can establish the practitioner-patient relationship; a physician or one of them must be onsite or immediately available (Tex. Admin. Code §169.26) |
| Whoever performs a delegated injection | Needs appropriate training, a written order and a signed written protocol (Tex. Admin. Code §169.26) (Tex. Admin. Code §169.27) |
| Esthetician | Not permitted by license to inject botulinum toxin (TDLR) |
What a delegated injection requires:
- First, a practitioner-patient relationship with you. A physician, or a PA or APRN acting under the physician’s delegation, must establish it before the procedure (Tex. Admin. Code §169.26). Providers often call it a good faith exam, but that phrase does not appear in the rule.
- Someone qualified must be on hand for emergencies: a physician, PA or APRN, onsite or immediately available (Tex. Admin. Code §169.26).
- A written order (Tex. Admin. Code §169.27), plus a written protocol that the person performing the procedure signs and dates (Tex. Admin. Code §169.26).
- The delegating physician’s name and Texas license number, posted in each public area and treatment room (Tex. Admin. Code §169.28).
TDLR says Botox and filler injections are medical treatments, provided under the order and delegation of a licensed physician (TDLR).
Three ways to verify credentials
- Physician or PA: use the Texas Medical Board’s Look Up a License page to find the Texas license. Any Board action against the licensee shows up in the verification (Texas Medical Board).
- Board certification: the American Board of Medical Specialties offers a patient lookup called Certification Matters, reached from its Verify Certification page.
- RN or APRN: use license verification at the Texas Board of Nursing.
Questions for the consultation
- What training do you have in cosmetic neurotoxin injection, and how many treatments have you performed?
- Who is the delegating physician, and are that physician’s name and license number posted here?
- Who will establish my practitioner-patient relationship before treatment?
- Which product will you use, and does its FDA label list my treatment area?
- How many units do you plan to use, and what is the total price?
- Is a follow-up visit part of the price, and do touch-up units cost extra?
- If I get eyelid drooping or another side effect, what is your plan?
Red flags
- You cannot identify a delegating physician
- The public areas and treatment rooms do not post a physician name and Texas license number (Tex. Admin. Code §169.28)
- Treatment starts with no practitioner-patient relationship in place (Tex. Admin. Code §169.26)
- An esthetician is the one injecting (TDLR)
- Nobody reviews your medical history and medicines first
- The quote comes without a unit count, or with high-pressure “today only” pricing
Treatment Areas