If you haven’t tried Botox yet, but are curious, this guide is for you. It might feel a little scary to think about, but once you try it for the first time you’ll see why your friends love it so much. I’m here to demystify Botox for you and answer all your questions.
Botox is a trade name for an injectable that is derived from the Botulinum toxin (yes– the one that causes botulism!) This toxin causes temporary muscle paralysis, and when it is placed into certain muscles in the face, relaxes them and decreases wrinkles. There are actually 5 toxins that are FDA approved in the US, Botox being the most famous. But Dysport, Xeomin, Jeuveau and Daxxify are all similar products that have slightly different features. There are also many different toxins that are available in foreign countries, but those are not legal in the US.
The most common wrinkles that are well-treated with Botox are the 11’s between the eyebrows, forehead lines and crow’s feet. Toxin can also be used to treat bunny lines, lip lines, chin dimples, vertical neck bands, and downturned corners of the mouth (RBF).
Many times, people are confused about what Botox is compared to a filler. Some people think Botox is a filler. These are very different products. The thing they have in common is that they both are injected with a needle and can be used to improve the facial appearance. But that is where the similarity stops.
As explained above, Botox is a neurotoxin used to relax muscles and minimize the appearance of fine lines and wrinkles. Dermal filler is an injectable gel made out of hyaluronic acid, a natural substance that is found in your skin and joints. This gel can be used to replace volume that has been lost with age. It can be used to fill hollows in the cheeks, for example. It can also be used to fill wrinkles in the skin. When used conservatively, replacing volume that used to be there but has been lost, it can be quite beautiful. Sometimes, people end up getting too much filler, or have it placed in areas where they never had volume there before. This can lead to what I call an “overstuffed” look. I would call this a very bad result. Used properly, it can be a great adjunct to other injectables, like Botox.
Botox has to be injected into the muscles using a needle. The needle we use is very very small, and pain is minimal. Many people do not feel much at all. The crow’s feet area tends to be a little more sensitive than the 11’s or forehead.
Botox can hurt a tiny bit, but pain is generally very minimal and most people tolerate the injections without discomfort. The needles we use are very tiny and sometimes it is hard to even feel them. This is particularly true in the glabella or the 11’s between the eyebrows. There aren’t very many nerve endings there, and often you won’t feel that at all. Sometimes the skin around the eyes is a little more sensitive, but most people say having Botox is an easy experience.
Since Botox can be used to treat so many things besides fine lines and wrinkles– sweating, teeth grinding, migraines– most people have at least one reason to find out more about it! As long as you are a healthy person, there is no reason you could not have Botox. It is not recommended for people with neurologic problems, like MS. If you are pregnant or breastfeeding, you’ll have to wait until you are done. If you are wondering whether you are a good candidate for Botox, ask during your consultation.
It is really important to go to someone who is an expert in botox and can legally inject it. In just about every state in the US, this means you would have to see a Doctor or a Physician's Assistant or Nurse Practitioner (who works under a doctor). Although Registered nurses can legally perform the injections, they cannot perform an initial exam or prescribe or design the treatment. So, you would have to see the doctor first. If you are going to a new appointment, ask about what the credentials are of the person you’re seeing. If it is not at least an MD, PA or NP, find somewhere else.
Botox is quick and easy, and there is not much you need to do to prepare. It is best if you show up with a clean face; although, your injector will be cleaning your skin with alcohol regardless. It is best to avoid blood thinners before your appointment as well. Aspirin should be stopped at least 4 days ahead, and ibuprofen 1 day ahead. If you are on any prescription blood thinners, like coumadin, check with your doctor to see whether you can stop them temporarily. If not, you will simply risk a higher chance of having a bruise.
Don’t massage your face for 24 hours after your treatment– no face-down massage or upside down yoga. Take it easy– no major athletic events for 24 hours.
The main risk of having Botox injections is bruising. This can happen any time you cross the skin with a needle. However, the risks are low, and even lower if you find a place that uses a vein finder– like Accuvein– which allows us to avoid bruising most of the time.
The big thing that can happen (rarely, in good hands) is a droopy eyebrow or eyelid. You’ll see lots of photos on the internet if you look for it. This can happen with too much being placed in the forehead too far over to the side. A droopy lid can happen from an injection that was too deep. Luckily, these effects can usually be treat, and are also short-lived. But this is one big reason to pick someone who is an expert! It can happen to anyone, but the chances are much lower if you go to someone who has done it a zillion times.
Typically it takes 1-2 weeks for the results to set in and Botox lasts around 3 months. Dysport botox acts a little faster, setting in in about 3-5 days and lasts a little longer, usually 4 months. Those the the two toxins we use at Glow Medispa. In our experience, Xeomin and Jeuveau do not last as long as Botox, so we don’t use them. The newest one, Daxxify, is much more expensive and purports to last longer (5-6 months) but we have not seen this in practice.
The cost of Botox can depend on the location and experience of the injector. The range can be $12-20/unit. It tends to cost more in larger cities and suburbs. Beware of any place that seems to have super cheap Botox. There are plenty of people importing grey-market and black-market toxins in the US. Anyone offering a super low price is cutting corners somewhere. Treatment is usually between 20 and 50 Units, depending on how many areas are being treated. So the total cost is typically around $300-700.
There are two ways to find a great Botox injector. First, ask a trusted friend who they go to. Referral is by far the best way to find an expert. If you’re new in town and you don’t have someone to ask, the best thing is to read the profiles of the injectors on the website, make sure they have the proper credentials, and then read reviews on Google. When you make your first appointment, ask the following questions:
The biggest piece of advice is to find someone you can truly trust. Don’t use a Groupon. Groupon deals often require service providers to discount their offerings significantly, which can incentivize cutting corners in ways that could impact the quality and safety of the service. This is especially concerning when it comes to medical procedures like Botox injections. You want to ensure that the person providing your treatment is an experienced, certified professional who uses FDA-approved products.
Once you find the right place to go, you will be so glad you went. It is much easier than anyone thinks, and you’ll look and feel refreshed.
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