As you coast from your 20s to your 30s and beyond, you might start to notice some things. Your reflection might reveal a solid line carving between your brows or a collection of them fanning out around your eyes when you smile. Photos might demonstrate a forehead that isn’t quite as smooth without an Insta filter. Makeup might start to settle in the creases. Just as you’re starting to see these little changes, your friends might start to talk about their appointments, send you before and after photos, or just show up to brunch looking like they’d spent a weekend on a beach. Age is creeping in. None of us are immune to it, but we can at least get it to pump the brakes. I’m here for you. Let’s talk about Botox.
What is it?
When I mention Botox, I am talking about neuromodulators but using the most common household name for the class. Also known as Dysport, Xeomin, or most recently, Jeuveau, they are all wrinkle-relaxing injections of the botulinum toxin.
In its native form, botulinum toxin is a highly effective neurotoxin that inhibits signal conduction to the neuromuscular endplate. In not so scientific language, it creates a temporary muscle paralysis on the area it is injected by blocking communication between brain, nerve, and muscle. This only works on movement signals, so although the muscle won’t move, you will still be able to feel the sensation of touch.
Starting in the 1970s, botulinum injection was used for strabismus or lazy eye with incredible results. The use of toxin spread to treatment of facial paralysis, migraines, excessive sweating, certain types of neuromuscular disorders, and, of course, fine lines and wrinkles.
What does it treat?
Since 2002, Botox Cosmetic has been FDA approved to treat moderate to severe frown lines in adults. The most commonly treated areas are between the brows, around the eyes, and along the forehead. It can also treat a gummy smile that shows too much teeth, the little crinkles along the side of your nose, a dimpled chin, and multiple other uses best discussed with your injector.
What does it NOT treat?
One of the most common questions I get asked is the difference between neuromodulators and fillers. Neuromodulators will relax a muscle and can help to undo a wrinkle or two, but they will not add fullness. Chin, cheeks, or bigger lips? You’re going to need a filler.
Who should get it?
Botox is a personal choice. Nobody should do something they aren’t comfortable with, but if the fine lines and wrinkles creeping onto your face bother you, it is worth talking to an injector about your options. An important distinction to make is the difference between static or dynamic wrinkles.
Dynamic lines are the creases that form in response to your expression in relation to your muscle movements. These are easily relaxed with Botox and can result in a smoother appearance to the face. Static lines are caused by loss of skin elasticity and can be a little more difficult to treat. Over time, Botox can soften the look of these lines but a more aggressive treatment regimen may be needed before somebody is happy with their results. Starting treatment sooner, also known as “preventative” or “baby Botox,” can help the dynamic lines from carving deeper and becoming static or more permanent.
Who shouldn’t get it?
Botox and the like aren’t for everybody. Those with certain neuromuscular disorders, on some medications (including certain antibiotics), or with active skin infection at the site shouldn’t undergo treatment. For pregnant or nursing women, there is lack of adequate data to ensure safety, so sorry Mamas, you’ll have to wait.
What to expect at your consult?
A good injector should make you feel comfortable and take their time. You should have a review of your medical history, discussion about facial anatomy, and your concerns and expectations before a needle ever touches skin. There is nothing wrong with making an appointment just to talk before you commit to a treatment.
Where do I find a “good injector?”
A good injector is an experienced and licensed professional with solid knowledge of facial anatomy, preparation, and administration of Botox. Stay away from Groupon or any unverifiable site such as some medi-spas, salons, or home parties. With aesthetics, you get what you pay for and “bargain Botox” may end up costing you more in the long-run. Word of mouth is one of the best ways to find a solid specialist, so don’t hesitate to ask a fresh-faced friend.
How much does it cost?
Botox is most commonly charged “by the unit” and can run anywhere from $8 to $20 per unit. There is no way of knowing how many units your face will require without a consult from a professional.
Does it hurt?
The needle is tiny and injections are quick. From start to finish, the treatment is completed within minutes. Some locations will offer ice packs or topical numbing medication but not all. Personally, having only been injected sans anesthesia, I find the treatment no worse than a brow wax.
When will I see results?
You will begin to notice the treated area becomes tighter within a few days. I will always tell patients that it feels like you have a mud mask on your face. Peak effect is reached in two weeks and can last anywhere from three to six months depending on the person.
What can go wrong?
Botox is associated with few complications, most commonly bruising or bleeding at the injection site. Some patients will experience a dull headache. The least favorable results are when the toxin causes excessive weakening of the target muscle or affects a neighboring muscle. This can affect the appearance of the face with rest and expression.
With good technique and aftercare, the risks are small but remain possible. While small touchups can sometimes be made to adjust the result, more often the only treatment is time. The good news is that even “bad” Botox isn’t permanent, and as the effect of the toxin wears off, the treated area will return to its previous state.
Why should I listen to you?
As a certified Physician Assistant in plastic surgery, I have been treating cosmetic patients with Botox for nearly five years. On a personal level I have been getting treated since my late 20s with breaks for babies and breastfeeding. As far as cosmetic procedures are concerned, there is a lot of bang for your buck with neuromodulators, especially for those individuals with strong expression and facial musculature.
I am not alone in my love of a smooth face as according to the American Society for Aesthetic Plastic Surgery Botox is the single most popular non-surgical procedure performed. Treatment with Botox carries minimal risk, offers a quick procedure with barely any downtime, and delivers a fresh face that doesn’t scream “I’ve had work done,” especially if you find a competent and compatible provider.
