The question of how often one should get BOTOX does not have a simple single answer. It depends upon why it is being given and the goals of the patient. Let us briefly review the history of BOTOX usage. The FDA first approved the use of BOTOX in 1989 to treat strabismus (crossed eyes). It was then further utilized for multiple clinical indications where muscle relaxation would be beneficial to a patient. Some of these conditions included torticollis (neck spasms), facial spasms, headaches, migraines, excessive sweating, and bladder spasms. When it was used to treat facial spasms, clinicians and patients noted the wrinkles in the facial areas that were treated for spasms were significantly reduced or disappeared. That led to the development of cosmetic BOTOX in 2002.Initial clinical indications for cosmetic use were restricted to treating the vertical frown lines between the eyebrows. Since then, numerous other cosmetic indications have been very successfully corrected with BOTOX or the other neurotoxins on the market. Some very common sites of usage include the horizontal lines of the forehead and the crow's feet around the corners of the eyes. Less common areas of treatment are the bunny lines at the top of the nose, upper lip lines, neck bands, and prominent jaw muscles.BOTOX is a commercial product manufactured from Botulism toxin type A. While BOTOX was first to market, there are now four Botulism toxin type A products on the market. They are BOTOX, DYSPORT, XEOMIN, and JEUVEAU. They are similar and are all very effective, but there are differences between each product. The decision on which is best for you should be made in consultation with your physician.There is not a standard answer to the question "How often should I get BOTOX?". The answer depends upon three main factors- 1, the patient's physiology, 2, the patient's desired results, and 3, the patient's finances.Let us examine the physiology of how BOTOX and the other neurotoxins work. Without getting overly scientific, let's review how a muscle contract. An electrical signal is sent down the axon of a nerve and ends up at the motor endplate of the nerve. It signals for the release of a chemical called acetylcholine. The acetylcholine crosses from the nerve to the muscle and initiates a contraction. BOTOX and the other neurotoxins block the release of acetylcholine, thereby preventing the muscle from contracting. Typically, over the course of several months, the blockage wears off, and the muscle can then contract. This happens at a different rate from patient to patient, dependent upon their individual physiology. Due to the variability in how fast this process happens, it does influence the answer to the question of how often you should get BOTOX.Different patients have different goals with respect to their specific treatments. Some patients want absolutely no motion in the treated sites with no visible wrinkles, so they want more frequent treatments, usually every 2 1/2 to 3 months apart. Others enjoy the times when they have no wrinkles at rest, but a slight movement with expressions. Those patients may get treated once every 4 months. Patients with migraines usually require treatments once every 10 weeks. Athletes may require more frequent treatments than non-athletes. I usually advise my patients that the results last on average about three months and schedule their follow-up visits accordingly.The last part of the answer to the question of how often you should get BOTOX may depend upon the individual patient's finances. My advice would be to do what you can afford and go to a skilled injector who can customize your treatment to your individual needs, and will touch up any areas of concern after treatment free of charge. If done properly, the injections are virtually painless, and an experienced practitioner can avoid bruising at the injection sites and obtain a very natural result.