Why We Love Botox

Botox is the brand name of the most popular injectable neurotoxin on the market. It was the first and only injection to relax wrinkles for several years, so “Botox” is sometimes used to describe any of the injectable neurotoxins. Sort of like how “Jell-O” is what we call all flavored gelatin. Dysport and Xeomin are also brands of neurotoxin. They were approved for use in the U.S. within the last ten years.  More than 7 million Botox treatments were performed in 2017.

Despite its popularity, Botox has been known to inspire a bit of anxiety for some. It’s made from a purified form of the neurotoxin responsible for Botulism. But Botox has proven to be an effective treatment for countless medical conditions. As Paracelsus famously said, “only the dose makes a remedy poisonous.” It would be far from advisable to take any drug at 100-500 times the prescribed amount, but that’s approximately how much Botox would be required to cause any of the symptoms of Botulism. Not only would you need a much more potent dose, but that dose would then have to make it into your bloodstream. Tiny therapeutic doses of Botox are injected into specific muscles, and that is where they stay put; remaining active for three to four months.

neuromuscular junction when neurotoxin is not present

Botox works by blocking signals from a nerve ending to an overactive muscle. The neurotransmitter Acetylcholine attaches to the receptors on muscle cells and causes them to contract. Once injected, Botox prevents the release of acetylcholine. This ability to limit the contractions of muscles gives Botox a multitude of applications across medicine; from eye twitches to teeth grinding to leaky bladders.

How does this translate to wrinkles? Certain exaggerated facial movements are responsible for something called dynamic wrinkles. Temporarily relaxing key muscles in the face allows the skin to remain smooth. This lets the skin heal and thicken, which softens and even eliminates lines and wrinkles. Botox also has a preventative effect. Started early, it can prevent these wrinkles from ever showing up.

Photo credit: Drchugay.com

A study published in JAMA Facial Plastic Surgery in 2015 showed that Botox improves the elasticity and flexibility of skin after treatment. “The effects of botulinum toxin A on the skin are similar to those reported when using radio-frequency skin tightening,” according to the experiment.  These improvements in the skin lasted for the same amount of time as the Botox’s effects. Researchers were unclear as to exactly why this occurs.

Click here to read about the history of Botox.

It has been nearly forty years since Botox was first used on a human being. Despite all the research and FDA approved applications, there are still many misconceptions, myths, and misgivings about the drug.

Frequently Asked Questions:

Will Botox make my face look frozen, or fake?                                                                                                  

Botox simply relaxes the muscles responsible for wrinkles. Good Botox injections won’t make you look anything but well rested and refreshed.

When Botox was first introduced, a handful of celebrities could be seen walking around with immobile foreheads, or stiff, forced-looking smiles. It quickly gained a reputation for causing “frozen face.” Today, doctors have had more experience with Botox and know just how much and where to inject it for the most natural-looking results. Most doctors agree it’s better to keep a bit of natural movement.

Glabellar lines

Is Botox a filler?

Fillers are used to plump up areas of the face that have lost volume over time and provide some lift to lax skin. They can also be used to fill in lines that are a result of volume loss, like lines that go from the corners of the mouth to the nose. Botox, on the other hand, is for treating dynamic wrinkles: these are formed as a result of movement (frowning, squinting, raising your eyebrows in surprise, etc.). Over time the temporary lines that develop from these expressions become etched in our skin so that even at rest they are visible.  Botox doesn’t add volume the way a filler does.

Does it hurt?

Botox is injected through a very tiny, thin needle. Most people describe it as nothing more than a prick. If you’re very concerned, your injector should provide you with ice or anesthetic cream to help dull the sensation. I always tell myself that the results are worth any minor pain from an injection, and they are!

Forehead lines

What if I get addicted?

There is nothing chemically addictive in Botox. The only thing you could develop a habit of is having smooth, line-free skin. But, should you try Botox once and decide never to do it again, your skin will go back to the way it was previously and will be no worse for wear. Technically it would be better to do a little Botox over a lifetime than none. Every treatment gives the underlying muscles a short “vacation,” allowing your skin a few months to relaxing and recoup.

So, no, your wrinkles won’t come back “worse” after one Botox treatment. Truthfully, they will be a tiny bit worse if you spend the next three to four months without Botox.

What’s nice is the more often you get Botox injections, the longer the effect tends to last. After several treatments the relaxed muscle has weakened somewhat, requiring more time to become as active as it once was.

Canthal lines

When should I start getting Botox?

 Botox works amazingly well as a preventative measure. By relaxing the muscles responsible for forming wrinkles, it stops them from even appearing. If you already see lines, Botox can still help. For very deeply etched lines, it may take a couple of treatments for the skin to repair and smooth itself out. This is why it’s always better to start getting injected before (or as soon as) you see lines that bother you. People are getting Botox in their twenties these days, and while it may seem quite young, it’s the perfect time to start a preemptive strike!

Where is Botox injected?

Botox is approved for use between the eyebrows, the forehead, and for crow’s feet. There are also some off-label cosmetic uses for Botox, depending on the experience and discretion of the injector. Botox has been known to treat “bunny lines” (lines on the sides of the nose), down-turned corners of the mouth, a gummy smile (too much gum line showing when you smile), slim a wide or square jawline, smooth a dimpled chin, and more. Let your injector know what bothers you and see what they suggest. Neurotoxins can work wonders but done incorrectly or by someone inexperienced they can cause you to look odd or distorted.

How is Botox priced?

Usually, you’ll see prices for Botox listed either by the unit or by the area. A price listed somewhere in the range of ten to fifteen dollars is a “per unit” price. (The amount will vary based on where you live and where you chose to go for injections.) It’s impossible to know precisely how many units of neurotoxin you’ll need without the physician first examining you. This is because he/she needs an idea of how strong and how thick the muscles are that they’ll be injecting. You could require anywhere from about 5 to 30 units in any given area.

I much prefer going somewhere that charges by the unit. Everyone’s anatomy is different, so the number of units that works for someone else may not be right for me. Plus, usually, less is more with neurotoxin injections. It just makes more sense to me to pay for what I use; not more or less. If a business charges by the area, you’ll pay a flat fee for each “section” of your face addressed.

There is also a rewards program called Brilliant Distinctions which you should join. Sign up on their website. For all Allergan products purchased you receive points, and when your points accumulate you earn coupons to use on future Allergan purchases. In addition to Botox, Allergen makes a few different facial fillers, Latisse, Kybella, and the SkinMedica skincare line.

Don’t forget to prepare for your injections. Check back here for pre and post-injection suggestions to make the most of your treatment.


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