By Marissa DeSantis
Whether you’ve already decided on getting Botox months ago or you’re just starting to think about if the minimally invasive procedure is for you, trying anything for the first time can be intimidating. In the case of Botox (or any injectable for that matter), which involves needles, having a few reservations is more than understandable — after all, we’ve all seen more than one viral horror story about botched procedures from inexperienced injectors thanks to social media.
To arm you with the most knowledge possible before your consultation and ease any anxiety you might be having regarding the safety (and pain level) of Botox injections, we spoke with Dr. Melissa K. Levin, board-certified dermatologist and founder of Manhattan-based Entière Dermatology. From choosing the right injector to how long you can expect results to last, here’s everything you need to know before getting Botox for the first time.
Botox, or botulinum toxin type A, is a type of neuromodulator (meaning that it changes nerve function). “It’s really blocking or diminishing nerve impulses to the injected muscle,” Dr. Levin explains. “By reducing muscle activity, that relaxes facial lines.” While Botox is technically a brand name, people tend to use the word ‘Botox’ when referring to any of the manufacturers of cosmetic neurotoxin injectables (kind of like how Kleenex has become synonymous with all tissues).
As Dr. Levin points out, Botox tends to get a bad rap because of the word ‘toxin’, but in addition to being used cosmetically, it’s also safely used for medical reasons. “I think it’s important for people to know that it’s really a purified protein that’s derived from a bacteria called clostridium botulinum, and how we’re using it is completely different from how we originally discovered it hundreds of years ago as a toxin to paralyze the respiratory muscles,” she says (which admittedly, sounds kind of scary).
“When we’re doing it for cosmetic purposes or even medical purposes, you’re using teeny, tiny micro amounts,” Dr. Levin explains.
Adding that years of clinical data and research have gone into making sure it’s safe. “Because it’s a toxin, I think people think it’s bad for you or it causes something negative for your health, which is not true,” she stresses. It’s also worth noting that Botox (including other manufacturers of botulinum toxin type A) is the most popular cosmetic procedure according to the American Society of Plastic Surgeons, with over 4 million procedures taking place in 2020.
No one actually needs Botox when used cosmetically (and any provider who tells you otherwise is probably not someone you want to trust with your injections, but more on that ahead). “I always say it’s a happiness treatment,” says Dr. Levin, who adds that there’s no specific age that someone should start getting Botox either. “Everyone’s skin is different in terms of sun exposure, genetics, skin type, what skin conditions they have,” she says.
“However, if you do start sooner, it does make a meaningful difference. It’s harder for me to treat a moderate to heavier line as opposed to treating a fine line or preventing that fine line,” she explains.
It’s also important to note that you cannot get treated with Botox if you are pregnant or breastfeeding. “You also can’t have certain neurological diseases like myasthenia gravis,” Dr. Levin shares.
As for where Botox is injected, Dr. Levin explains that there are three locations that are FDA-approved for Botox. “It’s used to treat those vertical lines between the brow called the glabellar complex, the frontalis muscle or those horizontal forehead lines, and then it’s used to treat crow’s feet by targeting something called the orbicularis oculi muscles.” Additionally, there are multiple off-label uses for Botox on the face, which Dr. Levin says include TMJ treatment, softening fine lines around the mouth, a lip flip (or creating a fuller lip), giving an eyebrow lift, treating bunny lines on the nose, and treating neck lines. “They all work the same way,” she says, “We’re targeting that nerve to block the nerve impulse so that we soften muscle activity.”
Of course, as with any minimally invasive procedure, there are risks involved when getting Botox, which is why it’s crucial to find a qualified and experienced provider. “It may look very simple on social media, but complications can happen, as people have seen,” Dr. Levin says of getting Botox. “These can include a dropped brow, heaviness on the lid, heaviness on the brow, asymmetry, or an odd appearance in terms of the pulling of the eyebrows that can lead to an over-surprised expression,” she elaborates. “It’s very, very rare, but it can weaken certain muscles that cause double vision, so it’s really important to go to someone that does these treatments a lot — they’re not just doing this once a week, but multiple times throughout the day.”
While we’ve all seen local medspas offering Botox and other injectables (and Dr. Levin doesn’t rule them out entirely), your best option in terms of safety and achieving your desired outcome is seeking out a dermatologist who is board-certified. “As a dermatologist, we tend to recommend not just someone with experience and who does this treatment a lot, but a board-certified dermatologist or board-certified plastic surgeon who has been trained and continually gets trained or teaches other providers on how to do this treatment,” she says.
A consultation prior to injectables is also a must, not only so the professional can evaluate how your face moves, but so that you can be certain you’ve found the right provider to give you your desired outcome.
“Whether it’s Botox, or cosmetics, or injectables, I think it’s really important to find someone who shares the same aesthetic as you,” she says.
“For example, I do a lot of lip filler, and I tell people, ‘Listen, if you’re looking for a big, voluminous lip, I’m probably not the right provider for you. Those huge, Kylie Jenner lips — it’s not something that I do, but if it’s something that you want, I’m happy to refer you.'” In some cases, you might be able to use social media to get a better idea of your provider’s aesthetic by looking at their work ahead of your consultation. But Dr. Levin says the provider’s appearance is generally a good indicator of where they stand, too. And, of course, you can always ask them directly what their aesthetic is and how often they do the treatment you’re looking to have done.
Before your appointment, you can follow your normal skincare routine. However, you’ll want to try to avoid taking any oral medications that thin the blood in the days leading up to your appointment if possible. “Really, anything that thins the blood can cause bruising more easily,” Dr. Levin explains, citing culprits like Aspirin, Motrin, any non-steroidal anti-inflammatory drug, vitamin E, and Omega 3.
Dr. Levin also points out that blood thinners like Plavix and Coumadin increase the risk of bruising, but because most people that are on these medications are prescribed them for their heart, they should continue to take them. “If you take any of these for a medical indication, that’s obviously more important than getting a bruise,” she says. “Alcohol is another big one that increases your risk of bruising,” she adds. “Try not to drink, or try not to drink heavily, seven days before your appointment.”
When it comes to the actual injections, it’s quick and virtually painless depending on where the injections are administered because the needles used for Botox are much finer than the needles used for something like having your blood drawn. You can also expect to be sporting little bumps that resemble mosquito bites at the injection sites for an hour or so after your appointment.
“When we inject Botox in certain areas, there is a little bit of migration that can happen,” Dr. Levin says, noting that it’s important to avoid activities that could cause the Botox to move for about four hours post-injections (think working out, and anything that involves touching the face like facials, massages, and acupuncture).
As for common side effects, Dr. Levin says bruising, redness, and a little bit of swelling (which will all go away) can happen. “Asymmetry is probably the most common side effect, so that’s why it’s really important to come back for a follow-up appointment,” she says.
Botox is pretty magical stuff, but it won’t instantly erase fine lines and wrinkles. Dr. Levin says that it typically takes two to five days to settle, with full results achieved two weeks post-procedure. “The Botox needs to attach to the nerve receptor and then immobilize the nerve conduction to that muscle,” she explains of why results aren’t instantaneous. Because of this, Dr. Levin also requires her patients to come back for a follow-up appointment two weeks after their injections for any touch-ups that might be necessary.
The longevity of Botox is typically three to four months, though Dr. Levin notes that a higher dosing can extend results for as long as six months. “But usually, those results are achieved only if you completely give a frozen appearance, which most people don’t want anymore,” she cautions.
The cost of Botox, including how the price is determined, differs depending on where you go. But in general, Dr. Levin says it can range anywhere between a few hundred dollars to $1,000 or even $2,000.
“Some places price Botox by the unit, and other places price it by the area,” she explains of one reason the cost varies. “
Manhattan tends to be more expensive in general just because we’re a more expensive market,” she adds, noting that her office determines pricing by the area (something that is discussed prior to receiving injections, during the patient’s consultation).
When used cosmetically, Botox is almost never covered by health insurance, but you can find companies that offer loyalty programs like Allergan Aesthetics’ (the makers of Botox) Allē. The rewards program works by allowing you to accrue points on products and treatments, that can then be applied to future purchases. Anyone considering Botox for the first time might also find Allē helpful when it comes to finding a provider for your consultation, as the program is able to connect you with licensed providers in your area.