An immobile forehead. Eyebrows arched in a perpetual state of surprise. A total lack of expression. If the very mention of Botox causes these images to be top of your mind, we get it. This muscle-numbing cosmetic procedure has definitely gotten a bad rep over the years.
Are the frozen face fears warranted? This is a valid question — and likely one that has prevented you from taking the next step. But what do you truly need to know before you commit to the needle? If you’re on the fence about Botox injections and aren’t sure what to ask, board-certified plastic surgeon Dr. Leonard Hochstein and certified physician’s assistant Jenya Titova (aka the “Botox Master”) at Hochstein MedSpa in Miami suggest you start with these questions to help you decide whether Botox is the face smoother for you.
Isn’t Botox a toxin?
You should probably know what you’re about to inject into your body. Derived from the bacterium Clostridium botulinum, botulinum (Botox) is a neurotoxin that’s extremely poisonous; scientists estimate that 1 gram could kill as many as 1 million people. It’s this fact that fuels a large part of the fear that surrounds Botox. Why would we shoot ourselves with a toxin that’s so lethal? And yet, when Botox is injected in extremely small concentrations, it works effectively to block signals from the nerve cells to the muscles, weakening or paralyzing these muscles.
Those wrinkles you formed from furrowing your brow over and over? With a shot of Botox, the wrinkles lessen as the muscle contractions in this area are dulled. Despite the fear factor associated with Botox, it’s a well-tolerated injectable with very few side effects, making it the most popular minimally invasive procedure in the United States, with more than 6.7 million Botox procedures carried out in 2015 alone, according to the American Society of Plastic Surgeons.
Will Botox hurt?
Botox requires a needle, after all — so does it hurt? The actual injection feels like a small prick. It’s not deep like an injection (think: for treating iron-deficiency anemia) at the doctor, and the needles used for Botox are smaller, assures Titova. Beyond inquiring about pain felt from the needle, Dr. Hochstein stresses that you need to ask about the actual procedure and its immediate aftermath, as no two patients are alike.
For instance: Should you expect swelling and blotchiness, and for how long? “Everyone reacts differently given skin color, texture, and the injection site. It’s important you get a realistic expectation from your doctor,” Dr. Hochstein says. Your cosmetic procedure professional should assess these factors and walk you through exactly how your body could react, including swelling or bruising, as well as how to address reactions in the event that they occur.
What will my results be and how long will they last?
As a cosmetic procedure, Botox takes commitment — both financially and for upkeep. The length of time results last varies wildly from case to case. Botox’s smoothing effects (which take around seven days to kick in after injection) last four months on average, but they can range from as little as two to as many as six months, making this a treatment that requires regular appointments to maintain a consistent, desired outcome.
Dr. Hochstein says that the person administering your Botox should be able to gauge anticipated results depending on the area(s) of the face you’re addressing. This allows you to set expectations and map out whether the money and time commitment fall within a reasonable amount for you. Certain areas of the face will always require more maintenance and, in turn, more money, says Titova.
“When patients address deeper wrinkles, like frown lines and crow’s feet, with Botox, they often return within four months because these areas experience repeated expressions” that cause the smoothing effects to wear off more quickly, she explains. The good news: If you commit to receiving injections on a regular basis, you may be able to stretch out the time between touch-up treatments.
What is the best way to achieve a natural, smooth appearance with Botox?
How do you ensure you don’t accidentally go overboard with Botox? The answer: Be clear with your cosmetic professional about what you want. Dr. Hochstein suggests saying something to the effect of, “I want to reduce my wrinkles or lift my brows without compromising my ability to express myself.” Make sure you understand that certain target areas (like crow’s feet) can disrupt the movement of other parts of the face (like the cheeks). “It’s very important to understand how the muscles in the face all connect and work together so you achieve the balance between smoothing wrinkles without compromising facial expression,” says Dr. Hochstein.
Additionally, “frozen” faces often correlate to how much Botox is administered; too much in any one spot, and you can numb your face into an expressionless void. Your best bet: Go slow. “When you’re starting out with any cosmetic procedure, it’s important to take a gradual approach and keep things as natural as possible,” Dr. Hochstein explains. You can always build up later on if you feel it’s necessary.
What areas of the face can be treated with Botox?
“Traditionally, Botox is used in the upper face to treat forehead wrinkles, frown wrinkles, and smile lines around the eyes. However, we can also use it to correct some lower face and neck concerns,” explains Titova. These concerns include a dimpled chin, jowls, and neck lines.
What does Botox cost?
Nobody likes sticker shock, and asking your doctor or dermatologist how the money breaks down for Botox treatments ahead of your scheduled procedure will prevent any unhappy surprises. Don’t feel awkward about asking for an estimated cost; it’s standard practice.
Dr. Hochstein points out that professionals charge for Botox in two ways: by the facial region treated (flat cost per site) or by amount used (per-unit rates). Prices vary between $300 and $900 per site or $10 to $15 per unit, but the location of the practice (major cities versus more suburban areas) and the background of the professional (how many years in practice, whether he/she works on celebrities, etc.) will factor into the established rates.
At the end of the day, “when it comes to any procedure, you get what you pay for, so it’s important to do your research,” advises Dr. Hochstein.
Photo: Courtney K.