Botox 101

To some, Botox is as commonplace as Advil, but to others, the thought of freezing your face muscles is still scary. Does it hurt? How long does it last? What are the side effects? How do you know when you're ready to go under the needle for the first time? There are a few questions you can get out of the way even before a consultation, so we asked two leading cosmetic dermatologists--Dr. Mark Rubin of Beverly Hills and Dr. Karyn Grossman of Santa Monica and Manhattan--to give us Botox 101.

What is it?
Our first question: what exactly is Botox? It, along with Dysport and Xeomin, is a brand of botulinum toxin (a purified version of a nerve poison produced by the bacteria that causes botulism) that prohibits nerves from delivering their signal to muscles, typically in your face, and glands, usually under your arms. "It does this by blocking the ability of the nerve ending to secrete acetylcholine, which the muscle needs in order to contract," says Dr. Rubin. To put it plainly, it freezes your face in a relaxed position to stop scrunching. It's the most common cosmetic dermatological procedure.

How long has it been around?
Though the toxin was first purified in the late '20s, it wasn't used for therapeutic purposes until the early '80s. Over the next decade, doctors realized the drug could be used to control muscle spasms and inhibit sweating. In 1989, a plastic surgeon first noted its effects on wrinkles and in 2002, the FDA approved its use for cosmetic purposes. Two years ago, they approved its use to fight chronic migraines.

What does it do?
You need Botox (as much as one ever needs a cosmetic procedure) when wrinkles appear even when your face is at rest. The doctors disagree, however, on whether or not it's a healthy preventative measure. "If you start using it too early, you can build resistance to the product, making it less effective later on," Dr. Grossman says. Dr. Rubin, meanwhile, says that it can work as "preventative therapy." Botox essentially freezes the muscle, leaving you unable to make a wrinkle-causing expression, meaning lines will take longer to develop. He does, however, warn of one major problem with starting early: "Using [Botox] can be psychologically addictive, so you really don't want to start until you are ready to make a lifelong commitment. It's very rare for someone to try Botox and not want to continue."

Where do you get it?
Where you have wrinkles! Though Botox can be used many places, the most common spots are crow's feet around the eyes, frown lines between the eyebrows, and furrows on the forehead.

How long does it last?
Botox typically wears off in three to four months, though it might last a few months longer the first time around. (If you're using it under your arms, it can actually last up to nine months and "can reduce sweating anywhere from 60-90%" says Dr. Rubin. There are at least a dozen other alternative uses for Botox, which we'll cover in another feature!) When it does wear off, everything will revert back to normal. "One occasionally sees a cumulative effect in the 11s between the brows," Dr. Grossman says, referring to the common formation of two parallel wrinkles between the eyes, "especially when combined with fillers." But for the most part, you're back at square one.

What are the side effects?
Of course, there will be side effects. According to Dr. Grossman, the most common issues are headaches and bruises--"stick a needle in your face and this can happen"--but she names everything from "crossed eyes" to "inability to swallow" as potential problems, most of which can be avoided by going to a qualified dermatologist or plastic surgeon and all of which can be avoided by exploring needle-free alternatives. As for bruising, you can lessen any visible effects by avoiding anticoagulants like Advil and alcohol for a few days before the procedure.

Are there any alternatives?
Frownies, anti-aging patches that actually smooth wrinkles while you sleep, are like stickers, keeping the skin flat, relaxing muscle memory, and eliminating fine lines and reducing wrinkles after just a few nights. They really work--but nothing is as fast and lasts as long as Botox.

Still have questions? Good! Because the first thing you should do (after reading this) is talk to your dermatologist. And stay tuned for Botox 102! We'll break down the toxin's alternative uses.