10 Things I Wish I Knew Before I Got Botox
I’ve been getting Botox injections regularly for the past 4 years. To my surprise, there’s been a lot more trial and error in finding the right doctor, paying the right prices and knowing what to look for and ask for.
My first experience was 4 years ago when I turned 40. I went to a widely known (and expensive) doctor who gave me just a touch between my brows on my forehead (the area known as the “11s”). Within a week I looked fantastic. My eyebrows were lifted ever so slightly and I looked natural, rested and a lot less bitchy.
5 months later, after my first injection began to wear off, I began to think more was better. A stylist I was working with recommended a plastic surgeon that reportedly did excellent Botox (along with Kate Hudson’s new nose). Armed with a false sense of security in the hands of celebrity plastic surgeon, I went one step further and had my crows’ feet and more of my forehead injected to get an even stronger brow lift.
Hmmm. The results were a little harsher than I wanted, but I still liked my glamorous lifted new look. Botox was creating a new normal for me.
6 months later, my first Botox party (more on that later). Despite the doctor’s excellent credentials, I had too much Pinot Grigio and didn’t tell him about my earlier Botox injections, so wound up with more than I needed. My eyebrows were now so high and arched it looked like they were going to fly off my forehead.
My hairdresser whispered the name of yet another famous doctor (also with a skin care line), but when I learned he treated Madonna, I cancelled my appointment.
So I went back my original doctor who must have had a bad day. I told him to repeat what he did the very first time. He suggested more, I said yes wanting to trust and believe. A week later, my eyebrows were unnaturally arched and disturbingly uneven.
I looked like the sinister love child of Dr. Spock and Dr. Evil.
Flash forward to a year of letting it wear off and finally finding a new doctor in Manhattan who I love. Now , I only get Botox twice a year in very small doses.
If you’re a a Botox virgin or just getting your feet wet, I thought sharing my story and lessons learned would help avoid some of the pitfalls I encountered in my quest for a wrinkle free face.
1. Understand what Botox can and can’t do. Botox is a neurotoxin that relaxes the muscles underneath the skin that cause the wrinkle in the first place. Botox is only FDA approved to treat the “11s” – those lines that form between your brows. Off label it can also be used to treat horizontal forehead lines, crows feet, tiny bunny lines on the side of the nose and can give a gentle lift to the brows. While most doctors prefer to keep Botox to the upper third of the face, some also use it to lessen the bands around the neck, reduce some lip lines and in some cases give a more youthful decollete.
2. Find the best doctor “injector” you can afford. There is a difference between knowing who CAN inject, and who SHOULD inject because the laws vary by state. I’m going start off with a blanket statement that in most states, you should only get injections by an actively board certified (ABMS, ASPS, ASAPS, AAD) dermatologist or plastic surgeon at a medical facility. Their logos look like this:
Where things get a little confusing, is that in the US, there are some states that allow a nurse practitioner or physicians assistant to prescribe and inject Botox (for example New York, Florida, Texas, California and Oklahoma). In most cases this means under the direct supervision of the doctor, but again in some states, such as New York the nurse practitioner can do this independently (you have to call your state’s medical board to find this out).
Second to being with the right health care provider, is making sure you’re seeing a cosmetic dermatologist or cosmetic plastic surgeon who has an active practice cosmetic practice beyond Botox (think lasers, chemical peels, upper/lower eyelid surgery, face-lift, etc). Once you’ve narrowed down from that criteria, make sure they’re a “high volume” injector meaning they’ve been injecting for over 5 years and come up close to the top in Allergan’s website doctor search engine (Allergan is the parent company of Botox). Also, don’t underestimate the innate talent of the injector; meaning a plastic surgeon isn’t necessarily better than a dermatologist at injecting, nor are either of them necessarily any better than a licensed nurse practitioner with many years of experience.
The important take away here is that just because your dermatologist saved you from that melanoma or you know a plastic surgeon that does brilliant reconstruction on accident victims, none of this is a guarantee that they’ll be any good at Botox. In fact, I have two dermatologists; one who does the serious mole check melanoma stuff, and another who specializes in all things cosmetic.
As you narrow your choice, resist the temptation to think that a widely recognized name guarantees great results. Publicity, advertising and having a skin care line does not mean the doctor is genius injector. Rather it means they have good marketing instincts, a crack publicist and social media guru with a good understanding of SEO. By all means don’t rule them out because of this, but you will likely pay a premium to see these guys (and believe me, I have).
Finally don’t be shy to ask ask ask ask ask. Ask your facialist. Ask your hairdresser. Ask your eyebrow plucker. Ask your OB/GYN. And ask your friends who you suspect have had it done. I’m fortunate to work in an industry where I have a lot of contact with actresses, stylists, photographers and agents, and I’m always asking.
But whatever you do, no med spa without a doctor on premises, no aestheticians and certainty not your dentist who up until now just checked your teeth. I have a firm stance on this because it’s incredibly easy to become trained and licensed to inject Botox in little over a weekend. There’s a lot of financial incentive for doctors to hang their Botox shingle out and because it’s so easy to get licensed, it’s equally easy to find yourself in the wrong hands.
3. It’s your job to brief your doctor on the outcome you want. It’s your doctor’s job to figure out how to get there, and Botox may not be the only solution, so keep an open mind. That said, a lot gets lost in translation because one woman’s frozen forehead nightmare may be another’s definition of awesome. Often doctors will ask you questions like “what is bothering you about the way you look” and do a quick assessment based on your age, your style and lifestyle. If you say I’m just a busy working mom who wants to look refreshed and natural, they’ll err on the conservative side. On the flip side, if you say “I’m recently divorced, jumping into the dating pool and want to look a little sexier” that may signal you want more than you really do. My fail-safe method is to use pictures. Bring them a few pictures of women you don’t want to end up looking like (for instance, Jennifer Aniston versus Nicole Kidman).
4. Schedule your Botox appointment 6 weeks prior to any big event. It takes about 5 days for the Botox to take full effect, but should there be any issues, you want enough time for any swelling or bruising to go down, and have the doctor do any touch ups.
5. Stop taking all fish oils and ibuprofen 2 weeks prior to your appointment. I’m stunned at how many doctors’ offices don’t say this when making an appointment. This will limit the potential for bruising and swelling. Some women take extra measures by taking Arnica and or eating pineapple, which contains bromelian, a natural anti-inflammatory agent.
6. Understand the cost and make sure you’re getting what you’re paying for. Doctors charge for Botox one of two ways:
Per unit. This is my preferred way to pay for Botox because it’s very clear what you’re getting. Allergan sells Botox in units of 50, 100 and 200 vial bottles. The average cost can be anywhere from $9 to $20 per unit, depending on where you live. To give some perspective, the average person needs about 20 units to treat horizontal forehead lines, 2 to 10 units to treat crows feet around the eyes and 25 units to treat the glabella (men need more). So if I wanted all three of these regions treated (assuming I’m paying Manhattan prices), my total cost would be somewhere around $960. Lastly, always make sure the vial is opened in front of you so you can be sure it’s fresh.
Per area. What this means is that a doctor might charge anywhere from $250 to $500 (again, depending on where you live) for each area they inject. However, places like the forehead can have multiple areas. For example, if I wanted my “11s”, horizontal forehead lines and crows feet treated and my doctor charged $500 per area (again Manhattan prices), I would walk out with a bill of $1500. Ouch. Just because a doctor approaches his pricing this way doesn’t mean he/she is a bad injector, but I’ve always found I pay for more than I need. Further, there is the possibility of cross contamination because you didn’t just “buy” a vial of Botox, of your very own so there is a small risk of cross contamination.
7. More is more, not better! Nor is it more cost efficient (one of the main reasons women get too much). Remember, Botox is a strong neurotoxin that has the potential to dramatically alter the planes of your face. And smoother doesn’t always equal prettier.
8. Make sure you stay upright for at least 2-4 hours post Botox. This helps ensure the Botox doesn’t migrate to someplace it shouldn’t and means don’t go to sleep or hit the yoga mat.
9. Botox builds up over time. I was cheating on all my Botox doctors, meaning I switched doctors, didn’t share my injection history and had less than 6 months between each one, I was getting more Botox than I needed. So while you may have needed 5 units of Botox in your crows feet initially, over time you may need only 2 units.]
10. Mistakes happen, even with the best doctors. The most common worry is the droopy eyelid, which can happen if the doctor goes to deep or hits a nerve. Fortunately, this doesn’t happen that often and it does wear off in a few months. Your doctor will want to know about it though and in many cases, can inject additional Botox elsewhere to counteract the issue.
Have you been Botoxed? If so, what was your experience?
Sources, related articles and resources
- RealSelf.com
- Skin Tour.com/Dr. Brandith Irwin
- Beauty Junkies: Getting Under the Skin of the Cosmetic Surgery Industry by Alex Kuczynzki
- BOTOX Cosmetic
- Woman Accused of Giving Botox Injections Without License (WPBF.com)
- Can Botox Make You Look Older? (bellasugar.com)
I’ve been having mine done for nearly 10 years and I’d add ‘interview your injector as if they were going to take a scalpel to your face on you.’ Because I move countries a lot I’ve had to choose three different docs – and each time I interviewed and googled three or four before I chose them. One didn’t even touch my face (and he charged me $100 for the consultation), one got vetoed when I saw pics of him with a celeb I really didn’t want to look like! Touch wood, I’ve not had a bad experience yet.
Great build on interviewing your doctor. So many assume you’ll get injected right then and there. Thanks for taking a read!
Becca
I never had any but I really like this post as it is informative and honest! And yes … I might consider some now -:)!
Kind Regards,
Daniela
I’m lucky to have an excellent doctor who is an expert at injections. I wish I had found him 10 years earlier!
It’s great to find a good doctor. I’ve found it’s a lot of trial and error!
Sorry to burst your bubble. I’ve been a nurse practitioner for 39 years and have been injecting Botox for over 10. I’m the best injector I know. I have had numerous patients come to me over the years (many of them from doctor’s offices) having had negative experiences. They prefer my injection techniques hands down. Moral of the story, there are good and bad injectors in all classifications of professionals. But I don’t think being a doctor is the only criteria to use when looking for someone to help impove your appearance.
I knew when I wrote this post, it would irritate some of the nurses and PAs who are licensed to inject Botox under the supervision of a doctor, and to your point, in those circumstances it’s all about the talent of the injector. However, in this day and age of women getting irreversible damage due to illegal injectors, I stand firm in my view that injections should be done only a cosmetic dermatologist or cosmetic plastic surgeon, especially because there is too much inconsistency between states a licensing and the qualifications.
All that said, to your point Gigi (and for those reading this), I want to clarify that in the US, each state governs who can and who can’t inject Botox and there are a handful that allow a NP or PA to inject Botox (for instance New York, Florida, Texas, California and Oklahoma among others). However, this is only under the direct supervision of a doctor. Meaning the doctor is there in person, not in theory. Tying this back to my point in the post, for the best results possible, this doctor should be a cosmetic plastic surgeon or cosmetic dermatologist – not your dentist, not your OBGYN, not your internet, not your vet:)
California State Law:
“Is a nurse practitioner practicing illegally when the physician supervisor is more than 50 miles away?
The mileage between the nurse practitioner and the supervising physician is not specifically addressed in the NPA. However, the physician should be within a geographical distance, which enables her/him to effectively supervise the nurse practitioner in the performance of the standardized procedure functions.”
In NY state NPs are independent practitioners. That means they are not working under direct supervision of MD, they work in collaboration with physician which is a huge difference. So please, before you post anything on the internet make sure you familiarize yourself with the subject (otherwise your statements are missleading to others). Also, maybe if you didn’t lie to those who injected Botox for you (before you found your perfect physician), your results would be much better. So instead of saying someone was incompetent, maybe you should say: “I lied and this is the reason why my results were not what I expected.” Just think about this: who in their career do you think gives more injections: a docot or a nurse? MDs, NPs, PAs, RNs all have to take Anatomy and Physiology classes, but who injects the most? During my certification I saw many MDs whos hands were shaking while holding the syringe (one client even said:”I don’t want him to touch my face”), nurses had no problem…
Hi Maria, thanks for responding and I stand corrected. I called the New York State Medical Licensing board and they confirmed that a NP can write inject themselves in New York. None of this was available online though (about the NP not needing direct supervision of the MD in NY); I called the NY state medical licensing board, and after being passed around to about 5 people, finally reached someone who could help. But even then, there was pause and reflection before confirming their answer because the way it’s written isn’t straightforward (and the woman answering my question was in fact a nurse).
I think the bigger issue is the lack of clarity and guidelines available for the patient, which is the spirit of this post. It is horrifying to me that it’s this difficult for patients to understand the difference between who CAN and who SHOULD inject Botox. It’s compounded by the variability on licensing state to state. Even worse that a health care provider can take a weekend course and then offer Botox.
Thanks again for the clarification and I made appropriate revisions to the post above.
Becca
Gigi, it’s a shame that some nurses are cheating patients out of the true Botox. TOO much saline and no results.
I have a physician assist do my injections and she does a fine job
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I know somebody who is using botox to get rid of migraine headaches. They put it in her scalp. It’s the only thing that’s worked, so it has many other practical uses!
That’s true, it does. It also helps underarm sweating.
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Great and informative article on botox. As a nuse of 30 plus years, I can tell you doctors also us Botox for various other reasons, most popular for muscle relaxers in severe arthritic conditions. and extreme cases of headache…its good to do research in every med usage and you have. Thanks for the follow at ‘liking’ my post and follow. As Arnold says “I’ll be back” here as well
Ha ha “Ahnold”…thanks Clara.
Becca
Your honesty shall serve as a road map for others…
I hope so, its a more confusing path that it seems on the surface
Becca
Great info and great timing- I’m about to lose my Botox virginity very soon!!
Glad it helped! Let us know how it goes. Good luck (and it doesn’t hurt that much at all)
Becca
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