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.

This is where Botox can get injected

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:

The board certifications your cosmetic plastic surgeon (middle two) or dermatologist should have (far right)

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