Have you ever contemplated, but perhaps shied away from, the idea of getting Botox? If you have, you’re not alone: Botox has a bad, undeserved rap. The word “Botox” usually invokes images of frozen-faced, expressionless celebrities, with “unobtrusive wrinkles” that go straight into the eerie perfection of the “uncanny valley.”
But Botox, when done right, can provide subtle, natural results — and you’ll still look like you. If you’re wary of ending up with the dreaded “frozen face,” know that it’s the most common fear, and it’s avoidable.
“The biggest misconception about Botox and other neurotoxins is that it changes the way you look,” says Dr. Estee Williams, board-certified dermatologist in practice on New York City’s Upper East Side.
It’s the top concern for new patients, agrees Dr. David Shafer of Shafer Plastic Surgery & Laser Center in New York City. But in the hands of a qualified and experienced injector, skillful Botox injections merely soften lines, rather than erasing them.
“The word ‘toxin’ is what typically elicits fear in people,” explains Dr. Deanne Mraz Robinson, assistant clinical professor of dermatology at Yale New Haven Hospital. In the era of clean beauty, we’re more concerned than ever about what we put on our bodies, and the idea of putting a “neurotoxin” into our bodies may sound a little terrifying.
That fear is unwarranted, according to Mraz Robinson. “[Botox] truly is very safe when injected by an experienced, board-certified dermatologists or plastic surgeons.” She points to its proven track record of “excellent safety data and efficacy” spanning three decades of use.
It’s a classic case of “the dose makes the poison.” (For example, you can die from caffeine overdose.) And as Shafer explains, the doses used in Botox injections are “extraordinarily small.” Bad or toxic Botox is often the case of an inexpert injector.
That’s why it’s still worth being cautious
Botox injections are not without risk of side effects, such as drooping eyelids, uneven eyebrows, or
Another common concern is the three to six month duration if you don’t like it. The chances are low, says Shafer, as “out of any cosmetic treatment, Botox has the highest satisfaction and lower complication rate.” If you’re more comfortable with a shorter time frame, you’re in luck: a new, more temporary form of Botox will be hitting the market soon.
Think “no-makeup makeup”: that’s the goal of a skilled injector. And we’ve seen those videos: It’s not necessarily about using less makeup. It’s about using the right kind in the right places. Botox is the same. Most professionals will use the most minimal amount, but to achieve the best results, finding the most effective locations also matters.
The forehead is involved in most of our expressions, has the highest risk of looking “off,” and of all the Botox injection sites, is “the most delicate and crucial area to get right,” explains Williams.
Have you ever seen someone with unnaturally arched brows and immediately knew they’ve had “work” done? It’s called the “Spock brow,” and it’s a telltale sign of too much Botox concentrated in the center of the forehead.
Be careful of injections around the mouth as well
The potential benefits make an attractive list, according to Shafer, including reducing a gummy smile and smoker’s lines in the upper lip, and more: “When done right, Botox in the depressor muscles under the lips can help turn a frown upside down — into a smile.”
But before you race to sign up for softened marionette lines, consider Mraz Robinson’s warning about the potential downsides: “One thing to be aware of in regard to the lip area is that you may have difficulty drinking from a straw or whistling.”
Prioritize skill, experience, and credentials over cost or convenience. Side effects and adverse reactions are possible with any medical treatment, so choose a provider with the credentials to keep you safe.
For Mraz Robinson, lack of credentials doesn’t mean lack of talent, but safety: “If you're placing [a substance that causes mild paralysis] into your skin, don't you want to be in hands of the most trained professional possible?”
Shafer and Williams also agree: Stick to credentialed, qualified injectors, such as board-certified dermatologists, plastic surgeons, ENT specialists, or registered nurses working under the supervision of a doctor.
Another red flag is cost. If a deal seems too good to be true, it probably is.
“It's not a time to bargain shop,” warns Shafer, who recommends you look for a high-volume practice to ensure your Botox is safe and effective. “If the office is only injecting a few patients per week, then it’s likely they aren’t giving you fresh Botox.”
If you see a heavy discount, Mraz Robinson suggests using that as a sign to ask yourself, “Why are they trying to move product so badly?” Chances are, it may be a sign of product sitting unused on their shelves, degrading its efficiency, and a provider who rarely performs the service.
No matter how skilled and qualified an injector is, they may not be able to give the result you’re looking for, and they should be upfront about it. They may even gently steer you away from Botox entirely, if it’s not a good fit.
Managing realistic expectations is part of the job. Williams cautions us to remember that Botox relaxes and smooths lines, it can’t erase them. It can prevent them from deepening, but she recommends resurfacing treatments, such as laser or microneedling, if lines are still noticeable when your face is at rest.
Less is more with Botox, especially if you’re looking for a natural result. If you start with minimal treatments, you can always add more if you want a more dramatic result, but too much Botox can’t be undone; you’ll need to wait months for it to dissipate.
Even if requested, Mraz Robinson refuses to over-inject her patients, and pregnant or nursing women are a no-go for Botox.
“Sometimes there is confusion by the patient of what Botox does and what Botox can achieve,” explains Shafer. “Sometimes a patient would be better treated with a dermal filler or even need a face-lift surgery.”
While our experts agree good lifestyle habits will help protect against visible aging, such as daily use of SPF 30+, not smoking, even staying hydrated with a balanced diet, sometimes there’s just no substitute for the real deal.
“Nothing on the market right now really compares to the impact that neuromodulators have,” says Mraz Robinson. But for her needle-shy, or more natural-minded patients, she uses lasers, light-based therapies, and skin care products instead.
“There is no alternative to neurotoxin (Botox, Dysport, Xeomin) in terms of effectiveness for dynamic wrinkle reduction,” agrees Shafer, but other treatments, he notes still provide excellent results.
Botox can’t treat everything, including loss of volume and skin texture issues. For that Shafer advises combining Botox with “laser, chemical peels, Ultherapy and a good daily skin care regimen. [This] can certainly help achieve above and beyond what the Botox treatments can do alone.”
Williams concurs: “There are no alternative or holistic remedies to prevent wrinkles like Botox does.”
So if you’re scowling in vain at your frown lines in the mirror, know that it’s not all or nothing with Botox. You don’t have to trade your expressiveness for the stone-faced perfection of Hollywood. If you’re just looking to soften those lines around the edges, or more practically ease the mental load of how you look off your mind, Botox can carry the weight for you.
Kate M. Watts is a science enthusiast and beauty writer who dreams of finishing her coffee before it cools. Her home is overrun with old books and demanding houseplants, and she’s accepted her best life comes with a fine patina of dog hair. You can find her on Twitter.