Thinking About Botox? Here's What You Need to Know

Sure, we may be experts on faking a younger complexion with a good skin regimen and a couple sweeps of well-placed highlighter, but we aren't oblivious (or opposed) to more aggressive anti-aging measures—in this case, Botox. The frown-line treatment may get a bad rap (see: the frozen foreheads of some middle-aged reality TV stars), but don't let that mislead you. For anyone who has ever been curious about Botox, we spoke with dermatologist Dr. Karen Stolman and put together a handy guide that will answer all your questions. Keep scrolling to find out how it works, who should administer it, what it really feels like, and more. 

First things first—Botox is not a filler. Instead, an injection of it relaxes the muscle that's forming the wrinkle, rather than plumping it up (like fillers do). The word Botox is actually the brand name of a particular strain of the botulinum toxin—yes, toxin. But before you freak out, know this: Stolman says that all FDA-approved neurotoxins (like Botox, Dysport, and Xeomin) are very diluted, less potent version of the pure neurotoxins, which is how they can safely relax the muscle they’re injected into, without affecting surrounding muscles. “Even the muscle into which it is directly injected will not fully relax or be paralyzed,” Stolman explains. “Often, there is still some movement, permitting the treatment to look more natural and help you avoid the frozen look.” She explains that their temporary effect is the reason many physicians will refer to them as “neuromodulators” instead of toxins.

In addition to being used as an anti-aging treatment, Botox can be used to improve temporomandibular joint symptoms (TMJ), and to help curb excessive underarm sweating (otherwise known as axillary hyperhidrosis). Stolman also says that currently, Botox is being studied as an acne treatment—stay tuned.

These days, it seems like you can get Botox anywhere—from your medi-spas to your dentist's office. However, Stolman says that the Botox treatment is safest and will give you best results when it’s administered by a licensed, board-certified physician, preferably one that's a cosmetic specialist. “The Botox treatment should be modified to suit each person’s unique wrinkle pattern, muscle strength, and skin quality,” she says. 

We asked Stolman to walk us through the whole process from beginning to end, starting with the first initial appointment. “During my consultation, I will look at the patient’s face closely for any skin laxity and ask them to make some expression,” she says. “Then, I will advise them on whether Botox will achieve that they are hoping for, or if it is not recommended because, for example, some older patients may have a heavy, low, and lax brow, and would benefit more from a filler.”

According to Stolman, the first time you have your Botox treatment, the physician will usually recommend baseline photos, which are basically your “before” pics. This allows any baseline asymmetries in the treatment area to be documented in the medical chart. Then, the process starts. “The treatment area will be cleaned first, and some physicians will offer topical anesthetics (numbing cream) or ice,” Stolman says. “Treatment is a needle injection and will take anywhere from five to 15 minutes on average depending on how many areas are being treated.” 

Botox prices can vary, but most treatments are priced per vial, or by the area, and the average cost is between $300 and $500.

Stolman says that small discomfort is common during the injections from the needle, but most people do not have pain after treatment is complete. The discomfort is what she calls a “pinchy” feeling. You can request topical anesthesia, but it can take 45 minutes to an hour to kick in fully and, more often than not, the treatment is done without it. To prevent bruising, Stolman says she will sometimes hold pressure at the injection sites, along with giving her patients ice to apply to the area for ten minutes post-tretment. Another tip to minimize bruising? Avoid blood thinners, like aspirin, ibuprofen, fish oil supplements, and alcoholic drinks, before your treatment.

“Allergy to Botox is very rare, though possible and more likely to present itself while still at the doctor’s office in the form of hives and facial swelling,” Stolman says. “Dysport and Xeomin are other safe alternatives to the Botox brand that can achieve similar results.”

On average, a patient will regain full motion of the treated muscles about three to four months after the Botox treatment. However, Stolman notes that some people do develop a resistance to the effects of Botox over time. If that happens, she recommends switching to Dysport or Xeomin.

We had to ask—when is the ideal age to get started on Botox? For the most part, Stolman says that you can consider Botox whenever you have a “treatable wrinkle,” which can be verified by your physician. “The safety and efficacy of Botox in children under 18 is not established, and therefore a licensed physician should not be treating children with Botox unless it’s for exceptional medical reasons,” Stolman says.

What do you think—are you intrigued by Botox or will you leave it? Sound off below!

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