Everything you need to know about the needle

Inevitably, every gal will have a moment like this: You’re working on a new eyeliner trick or you catch a glimpse of yourself in different lighting. You look closer.

Are those the faint lines of crow’s feet? Have the “11’s” officially taken up residence between your brows?

You might shrug it off. After all, wrinkles give us character. But if you’re bothered by a perma frown or anything else, it’s nice to know you’ve got options. Botox is one of them. And when done right, the results look glorious.

Join us on an information deep dive for everything you need to know to avoid uneven brows, dramatic unnatural results, and frozen faces.

If you’ve ever wondered how Botox wrangles wrinkles, here are the deets.

Botox is the brand name of botulinum toxin, and it’s produced by the bacterium Clostridium botulinum. C. botulinum is found in plants, soil, water, and animal intestines. This chemical blocks the neurotransmitter acetylcholine, causing muscle paralysis that lasts for several months.

Botox is a highly poisonous substance that affects the nervous system. But fear not! When used to minimize wrinkles, it’s administered in super small doses. And it’s even used to treat some medical conditions. The muscle paralysis effect is how a Botox shot reduces the crinkling and wrinkling that naturally happens when we make certain expressions (and simply, aging). In some cases, Botox may even prevent further creasing.

For the sake of beauty, is Botox actually safe?

That all sounds a little freaky, right? We’re talking about an injection with poisonous origins, and it’s being injected into faces all over the nation!

However, researchers consider Botox to be relatively safe when compared to other, more-invasive cosmetic procedures. Although risks do exist, a recent study found that when performed by a board-certified dermatologist, less than 1 percent of patients experience an issue.

1. How to choose the right clinic

Botox is currently the top nonsurgical cosmetic procedure in the United States. That means there are a lot of clinics out there. It’s up to you to choose the right one.

“Limit your search for a provider to board-certified dermatologists and plastic surgeons,” says Adrienne M. Haughton, MD, of Stony Brook Medicine in Commack, New York. “These physicians are experts in facial anatomy, and their training is not limited to a weekend course, as is the case for many other types of physicians or nonphysician injectors.”

Next, check social media and the doctor’s website to see if their work matches your desired aesthetic. Think of it in much the same way you would if getting a tattoo. You’d take a good look at the artist’s portfolio, right? Do the same with a Botox doc.

“Look at previous before and after results, or if possible, see a patient in person,” suggests Joshua D. Zuckerman, MD, of Zuckerman Plastic Surgery in New York City. “If the patient is totally ‘frozen,’ then you may not want to visit that physician.”

Although you likely aren’t going to become BFFs with your dermatologist, it’s also important that you like your provider in order to feel at ease. Read online reviews to get a take on a doctor’s bedside manner.

Once you’ve narrowed down your list, schedule a consultation to see if the doctor’s philosophy aligns with yours. “It’s your face, your budget, your decision,” stresses Keira L. Barr, MD, of Resilient Health Institute in Gig Harbor, Washington. “If you feel pressured by a provider, walk away — and fast. Finding a physician who listens to your concerns and desires is key. Your doctor should be your collaborator in helping you achieve your goals, not dictate your goals.”

Find the right Botox doc

  • Consider credentials and experience.
  • Research the doctor’s previous work.
  • Check online reviews.
  • Meet the doctor face to face for a consultation.
  • Does their philosophy align with your goals?
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2. Make a Botox plan with your doctor

When you’ve settled on a physician, make a Botox plan with them. Remember that your beautiful face is unique and attached to a unique individual — you! That means that your Botox plan will be different than your mom’s or even your bestie’s. And it should be.

“The most important part of creating any plan is understanding a patient’s goals and establishing realistic expectations for a patient,” Barr says. “To that end, a physician needs to educate about what Botox can and can’t do.”

And depending on your goals, you may need to visit the clinic up to six times a year for different treatments. Your dermatologist should outline all your options, including treatments not related to Botox.

Once you share your goals with your dermatologist, they should consider your age and look closely at the depth of your facial creases, says Caroline A. Chang, MD, of Dermatology Professionals in East Greenwich, Rhode Island. She prefers to use Botox to treat fine wrinkles. For deeper set lines, she looks to see how Botox could be used alongside additional procedures to achieve a person’s desired aesthetic.

Your doctor should also evaluate all your dynamic muscle movements. “I have the patient flex the muscles in the area of concern to see whether Botox is a good option and/or how much to inject,” Chang says.

In regard to forehead lines, for example, Chang examines how a patient looks with eyebrows raised, at rest, and with eyes closed.

“There are some people who have genetically heavy eyelids who compensate by keeping their eyebrows raised all the time,” she explains. “Botox of the forehead can weaken these muscles and prevent the compensatory raise.” As a result, the person would feel like their lids are even heavier. Not a good situation.

How to create your Botox plan

  • What are your goals?
  • Can your goals be achieved with Botox?
  • Consider your age.
  • Discuss supplementary treatments if necessary.
  • Consider your budget.
  • Discuss lifestyle factors.
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3. Let your bank account — not you — guide your decision

What’s in your wallet also plays a role in your Botox plan of action. Botox is temporary, lasting about four to six months. If you like the results, you may decide to continue with several treatments a year.

“Respecting a patient’s budget is important, and devising a plan that accommodates both benefit and budget for a treatment is vital,” Barr says. Botox fees can range from $100 to $400 to treat a single area. Be honest with yourself if the commitment and fees are worth it to you.

Think about your lifestyle, too, and talk to your doctor about how it impacts your skin. Aging occurs because of both intrinsic and extrinsic factors, explains Barr. Our genes, ethnicity, and even certain medical conditions are intrinsic, and we don’t have control over them. We have more control over extrinsic factors, like air pollution, stress, or smoking.

“Educating the patient about the different types of aging and having a candid discussion about their particular habits, environmental exposures, as well as their diet and lifestyle choices will help guide the plan, maximize the benefits, and optimize the results,” Barr says.

Cost of Botox

  • Treatments can range from $100 to $400 to treat a single area.
  • Botox is more than one injection. Depending on your facial muscles, you may need to treat different areas of your face.
  • Botox upkeep may require anywhere from two to six sessions per year.
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Although the time frame will be different for everyone, Barr recommends Botox when those fine lines appear and start to bother you.

“In our 30s, our skin cell turnover and our collagen production begins to slow down, and it is the time when many of us begin to see the signs of aging,” Barr says. Some people might choose to get Botox before then, and many providers will oblige, but Barr says they’re better off focusing on first lines of defense.

“Individuals in their teens and 20s should save their pennies and focus more on their diet, lifestyle, and environmental exposures, to help maintain that youthful glow,” she suggests.

Non-cosmetic uses for Botox

With its muscle paralyzing or weakening action, Botox has benefits beyond tinkering with appearance. Botox is a medical treatment for migraines, excessive sweating, pelvic pain, overactive bladder, facial twitching, TMJ, and even depression.

As a treatment for looking younger, Botox is still a spring chicken itself. The U.S. Food and Drug Administration (FDA) approved Botox for certain cosmetic uses in 2002. Although clinicians have deemed Botox relatively safe, studies are still in play regarding long-term effects and other factors.

For example, researchers in 2016 found that higher doses of Botox can spread along nerve cells beyond the intended injection site. The FDA has issued a warning regarding Botox, but it’s still approved in smaller doses for the temporary reduction of the appearance of wrinkles on the forehead and around the eyes and mouth.

Additional risks of Botox include a botched job if too much of the neurotoxin is used or injected in the wrong spot. Bad Botox might include a “frozen” or expressionless face, asymmetrical issues, or drooping. Thankfully, since Botox is temporary, any of these mishaps will eventually wear off. Same goes for any light bruising that may occur after receiving injections, which should disappear after a few days.

Contact your doctor if you have

  • swollen or drooping eyes
  • headache
  • neck pain
  • double vision
  • dry eyes
  • allergic reaction or difficulty breathing
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If you’re considering Botox for cosmetic reasons, be honest with yourself as to why you want it. Are all your friends hopping on the Botox bandwagon? Are you using Botox to blunt your feelings? (Yes, that’s a thing.)

There’s nothing wrong with doing something for yourself if it makes you feel more self-assured. But never be pressured into changing your looks by someone else or for perceived societal standards. Whatever you decide, make the decision to Botox — or not to Botox — only for yourself.

Remember, aging is a natural and beautiful thing. Those lines hold the tales of every time you’ve smiled, laughed, furrowed your brow, or frowned. They’re the topographical map of your history. And that’s something worth owning.

Jennifer Chesak is a Nashville-based freelance book editor and writing instructor. She’s also an adventure travel, fitness, and health writer for several national publications. She earned her Master of Science in journalism from Northwestern’s Medill and is working on her first fiction novel, set in her native state of North Dakota.