Botox: Let’s take a trip to anti-wrinkle Land
You might not know that Botox is a brand name – just one of many products now used to paralyse muscles in order to lift brows or smooth out wrinkles. Lots of people get anti-wrinkle treatments and don’t even know what product they’ve had. You also might not know that there are many, many applications for Botox beyond fixing your frown lines.
For lots of people (me included) Botox is the first injectable treatment they receive. Breaking the skin barrier in this way opens up many considerations about your practitioner’s skill, experience, and knowledge of sterilisation practices. You owe it to yourself to know what product is being used and the credentials of your provider.
For SEO purposes (and being too lazy to type ‘anti-wrinkle product’ again and again) I’m going to use Botox as an umbrella term as I walk you through everything you need to know about the magical world of neurotoxins.
What Is Botox?
Like many cosmetic medical marvels, Botox was discovered completely by accident and was first used for non-aesthetic reasons.
So the story goes, in the late 1800s a group of Belgian musicians became very sick after eating some suspicious ham. The food poisoning was so severe that they sent the ham off for samples. Turns out this fun youth elixir is the same thing that might make you sick after eating a dodgy kebab.
It took a few years (and a couple of World Wars) before the Botulinum toxin was cleaned up and rediscovered in the ‘70s by ‘The Father of Botox’, Dr Alan Scott. He successfully used it as a non-surgical alternative to treat patients with squints and concluded:
“I could immediately tell the value of botulinum toxin type A and thought that it would be useful in blepharospasm and other conditions of skeletal muscle overactivity (although I didn’t foresee cosmetic use!).”
Building on Dr Scott’s initial discovery, Botox was regularly used to treat eye conditions, jaw-clenching, migraines, and so on. Surprisingly for everyone, the byproduct was fewer wrinkles in the treatment areas. So, shortly after FDA approval for medical use arrived in 1989, doctors finessed its use as an anti-wrinkle treatment and the world hasn’t looked back.
What Aesthetic Concerns Can Botox Be Used to Treat?
Botox can be used in pretty much any muscle that needs relaxing for whatever reason – from headache relief to urinary incontinence. Here’s a round up of some of the most common and/or interesting aesthetic reasons to seek Botox treatment.
1. Botox for Smoothing Facial WrinkleS
The three typical Botox injection areas in the upper face. Image courtesy of ResearchGate.Net
The most common cosmetic reason to get Botox. There are three main areas in the upper face that you can get treated:
The forehead, for the horizontal wrinkles you can see when raising your eyebrows
The glabellar, for frown lines
Lateral canthal sites, for crow’s feet
Most clinics offer some sort of reduced cost the more areas you get treated. Some people really like laughter lines around the eyes so might opt out of having that area treated. But usually it’s recommended to get the two forehead sites done together. I have seen one celebrity who I’m guessing got glabellar Botox but skipped the forehead — it gave them a very strange amount of expression right at the top of their head. Each to their own!
I’ve only ever had the classic three-area Botox treatment - here’s my before and after. I did have a hair cut in between, which doesn’t make this the most useful comparison, but hopefully you can see a general lifting/refreshment. As well as me needing to use my ear muscles now if I need to move my face around…
2. Botox for Lifting the Brows
I’ve never had this done as it feminises the face a bit. Game changer for some people though. A little bit of product applied well can create more lid space and give a more alert look. You definitely need a skilled practitioner if you want to avoid looking permanently surprised.
Example brow lift before/after. Courtesy of Mabrie Facial Institute.
3. Masseter Botox for Facial Slimming and Bruxism (Tooth Grinding)
Masseter Botox offers a double whammy: it can be used to alleviate the symptoms of bruxism, as well as offering a way to slim the jaw very naturally. Another procedure that can be used to feminise the face.
Example before/after. Also from Mabrie Facial Institute.
4. Botox Lip Flips
A great alternative to lip filler – Botox lip flips don’t add volume, but do create a ‘poutier’ appearance. This generally makes it much easier to get a natural end result. Also great for if you’re looking to correct asymmetry or a gummy smile.
Example before/after. This time from the Riverside Clinic.
What’s the Difference Between Botox, Azzalure and Bocouture?
These are the three main products available in the UK (though there are many more available). The differences between them honestly don’t really matter to you, the patient, as much as they do to the practitioner. If your clinic doesn’t use actual Botox that doesn’t necessarily mean they’re using a worse alternative. As long as they are procuring the products legitimately, any of them are equally able to treat the same cosmetic concerns.
I suppose one exception would be if you’ve had a problematic reaction or underwhelming result with one product, you could try a different brand and see if that works better for you. Otherwise the main differences just affect the volume of product needed and whether or not it needs to be stored in the fridge.
The Risks of Botox & How to Mitigate Them
Compared to something like fillers, Botox is relatively safe. The worst-case scenario is likely a droopy eye, which will resolve over time, or an infection that is pretty easy to treat. But you still don’t want either of those things.
The reason for ptosis (the fancy word for a droopy muscle) is due to the consistency of Botox. It is very liquid. That means that it can travel away from the treatment area and into a muscle you don’t want it to go into. The muscles responsible for your baked-in frown line are very close to the ones that keep your eyes upright; it’s very easy to have a mishap. A temporary droopy eye is just an aesthetic problem, but it can become more problematic. For example, scuba divers and singers are advised against Botox in the mouth: loose lips mess up singers and drown divers.
There are two ways to avoid this issue: one, pick a skilled provider (I’ll expand on this later), and two: follow the post-care advice carefully. A good practitioner will advise you to stay upright for about four hours after your Botox procedure. Going back to the liquidness of Botox: by not laying down and squishing your face, you increase the chances of keeping the product in the muscles it was meant to relax. My doctor tries to keep Botox appointments earlier in the evening, to increase the chances of patient cooperation and decrease the chance of a droopy eye.
The second main risk is infection. If this happens it is really down to the practitioner. An infection will either come from shoddy black-market product, or poor-quality sterilisation processes. To protect yourself from this, you need to find someone who has reliable access to the best and safest products. And who has in-depth knowledge of how to maintain a sanitised environment.
That’s why I would strongly recommend only getting injectable treatments from a doctor. Perhaps a dentist or prescribing nurse. Botox is a prescription medicine, so it needs someone with that level of medical authority to source it. Anyone else is reliant on somebody else to give it to them, which increases the chance of you receiving a poor quality product.
Well-meaning beauticians may have a wonderful eye for smoothing and lifting the face, but they are not henpecked belligerently at medical school to understand the severity of infections. Nor are they equipped to deal with them. To labour the point: do pick a regulated medical professional; don’t go for the cheapest option.
How to Find a Good Practitioner
Expanding on the above advice, your first port of call is checking your practitioner’s credentials. Doctors, dentists and nurses have public-facing résumés; and, usually, LinkedIn profiles.
Once you’ve identified they’ve got the right medical experience, it’s time to dig a little deeper. What exactly do they know how to do? A GP will have an encyclopaedic knowledge of illnesses, but that doesn’t mean they are experienced in the subtleties of lifting an eyebrow. There is no regulatory requirement for formal training to administer Botox. So even though doctors will be able to legally procure it, they might have never offered it to anyone before.
Best then to see if your doctor/nurse has specialised in cosmetic medicine. There are a variety of postgrad diplomas and certifications in aesthetics – the more time your practitioner has spent learning, the better the quality of your treatment. Again, LinkedIn is a great tool: no self-respecting doctor would risk embarrassment by lying about their credentials on a public platform.
That leads to the final way to source a good practitioner: reviews. Good old Google reviews are probably some of the most reliable. They cannot be altered, fake reviews are eventually detected and removed, and they cannot be bought. Websites like Real Self aren’t as reliable – like all review platforms there’s an element of ‘pay to play’, or at least being able to tidy away a particularly scathing comment.
Another top tip: look at how your clinic advertises Botox. As it’s a prescription medicine, it has to be advertised very carefully. Websites should refer to it as an “anti-wrinkle treatment”. Not “anti-wrinkle injectable”, and definitely not “Botox”. Anyone advertising it incorrectly should set off alarm bells – it either means they don’t know or don’t care to follow the regulatory rules, or they are not a regulated medic and therefore have nothing to lose. You’ll soon notice how prolific the mis-promotion of Botox is in the industry. Pick a provider that does things properly.
Wrapping it all up, then, the most important thing to find the right practitioner is doing your research. If you’re going to be investing the money in a procedure like this, you need to make sure they’re up for the job.
When do you ‘need’ to get botox?
The general guidance of when to get Botox (IF you decide you want it) is at the early signs of ageing. That means a few very faint static wrinkles around the forehead or eye area. There is quite a lot of truth to the adage, ‘prevention is better than cure’. However there is absolutely no reason for very young people to be getting it. I personally started in my late ‘20s and am quite happy with that. Do make sure you’ve at least got your skincare regime nailed down before going down the Botox route — it can lift and smooth wrinkles, but won’t do anything to help common skin complaints like acne, hyperpigmentation, or dryness. Here’s my guide on building a basic skincare routine if you haven’t already got that sorted.
On the other side of things, leaving your wrinkles to become too entrenched on the face will make Botox less effective. Botox on its own is not sufficient for very heavy wrinkles. You’ll probably need additional filler and/or some additional skin tightening treatments to get the results you want. Or to skip straight past this and opt for the surgical route.
How Do You Know If You've Found the Right Person?
You’ve hopefully done the hard part by now, but you still need to validate your choice in person. A bad practitioner will hastily get you in a room, jab you, and move you on. A good practitioner will offer you a consultation, tell you whether the procedure is going to give the effects you want, patiently explain the risks and answer any questions you have. And you should be asking questions! Ask about what products they use, their process, how much experience they have. They should be willing to answer them and should not be rushing you into doing anything. Don’t just jump into bed with the first person you meet. There’s a time and place for that.
Then it’s just down to chemistry. If someone’s going to be holding a needle near your face, it’s a lot more enjoyable if you like them.
What Happens When You Get Botox?
The process is very simple. You’ll fill in some paperwork with the clinic, meet the practitioner, confirm the areas you’d like treated, and discuss whether it’s right for you. If you decide to go ahead, you’ll likely get some photos taken, get the area numbed (if you feel like you need it), and then sit down in one of those comfortable dentist chairs. Your practitioner will cleanse your face, prepare the needle, and get you to pull strange faces to see where your particular muscles are. Then it’s a couple of sharp scratches in a few places as the product gets distributed around the face. Your practitioner might go back and top up an area if they feel it could use a little more product.
That’s it! You might get some small lumps (which will soon disappear), or a tiny bruise that you can ice down or use arnica cream to get rid of fast. Your provider might also offer a no-fee check up in two weeks to assess whether you need a little more product.
How Long Does Botox Last?
Botox takes about two weeks to become active in the face then lasts about four months. It does depend on how much product you get, where you get it, and how strong the muscle is.
What Does Getting Botox Feel Like?
Botox is not painful at all. I opt out of numbing cream because it really just feels like a refreshing splash of water under the skin. I have had bruising once and I felt a dull sort of ache when the needle hit a blood vessel, but it’s very, very manageable. Even if you struggle with needles a bit, it’s over so quickly. So sit back, relax, and let it work its magic.
How Much Does Botox cost?
Obviously, you should compare prices to make sure you’re not getting ripped off. However, you must acknowledge that anyone seriously undercutting the rest of the market is making a compromise somewhere. Either it is with time – you’ll get pulled into a room, jabbed, and let go in the fastest time possible. Or it is with the product. Maybe they go for a cheaper, less-regulated formulation. Maybe they cut corners with hygiene, like using needles that have fallen on the floor, or saving half-a-used syringe of product for the next patient (hopefully you can see why that’s a bad idea).
I go to SE1 Medical Aesthetics and I pay £370 for three areas (forehead, glabellar, crow’s feet). Sadly male privilege doesn’t apply to Botox pricing: men’s facial muscles are typically stronger and need a lot more product, so many clinics charge a bit extra for men. I’m happy to pay it — better I get enough product so it lasts, rather than get a stingy amount and end up needing to come back in 8 weeks when it’s worn off.
Botox Aftercare
There isn’t really any downtime post-Botox – you can go about your day with no one the wiser that you’ve had a little cosmetic pick-me-up. However you do need to stay upright for about four hours after your treatment. As I mentioned previously, Botox is a watery liquid and can easily travel outside of the desired area if you’re not careful. Going straight to bed after a treatment is a sure-fire way to increase your risks of a droopy eye.
Otherwise the only guidance for the 24 hours post-procedure is to avoid anything else that could risk product migration or chances of bruising. Keep exercise light. Avoid massaging the area or getting a facial. Don’t get bladdered at the pub. You can do all that the following day.
Triple A Rating: AAA
I’m going to rate every procedure I get on a ranking from A (not worth it) to AAA (go get it now). Botox gets the highest rating because it is quick, simple and has really reliable results. The only downside to Botox is that it needs topping up every four or so months. This can make it an expensive habit to maintain if you like it. You should also take breaks: not only can you develop Botox tolerance over time, but you can also forget what your face looks like without it. For me personally I did a lot of skin tightening procedures a couple of years ago, and it was only when I let my Botox wear off that I could appreciate the full impact. I then took a couple of years’ break because I was happy with how my skin was looking – don’t be afraid to continuously assess whether or not you need something done. I used this blog as an excuse to get it again but I will continue to take breaks in the future.
