We've come a very long way since Samantha Jones first uttered her now-iconic "mani, pedi, Botox," quip on "Sex and the City": Back in the early aughts, the wrinkle-thwarting injectable treatment was relatively new to dermatology offices, and while Hollywood jumped on board quickly, it took a little more time for the general public to get comfortable with it. Fast-forward to the social media age, and not only are injectables like Botox amazingly commonplace — according to The American Society for Aesthetic Plastic Surgery, injectable use has spiked by 40% over the past five years — people are also starting to experiment with them at younger ages.
This trend may be taking off because younger generations spend so much time assessing (and adjusting, editing and filtering) photos of themselves for social media. "Consumers, especially millennials, are showing much more interest in skin care as a part of their overall health and wellness," says Gabrielle Garritano, founder and CEO of Ject, a medical aesthetics boutique in New York City. (She is also a board-certified physician assistant who specializes in both injectables and non-invasive cosmetic procedures.)
But the uptick in patients in their 20s and 30s dabbling in Botox also owes to increasing awareness that when it comes to warding off wrinkles, prevention is key. Using the treatment to inhibit the development of lines — and to train facial muscles to behave differently — is, it turns out, incredibly effective. But confusion about the still somewhat taboo treatment persists. So let's clear a few things up, shall we?
WHAT BOTOX IS
What most people know as "Botox" is, in fact, the name of a brand (owned by parent company Allergan) for a product made from the toxin produced by the bacterium Clostridium botulinum. There are other brands that offer alternatives — Dysport and Xeomin, for example — but for the purposes of this story, consider Botox the generic umbrella term for the injectable treatment. "Botox is a neuromodulator that directly acts on motor neurons to reduce muscle activity," explains Garritano. Botox was approved by the FDA for cosmetic use in 2002, but it had been used in other non-cosmetic treatments since the late '80s.
HOW PREVENTATIVE BOTOX WORKS
The mechanism of the injectable is key to understanding how Botox can be used preventatively: "Botox works by blocking the signals from the nerves, telling the muscles to contract. The injected muscle doesn't contract, and this makes the wrinkles relax and soften," explains Dr. Hadley King, a board-certified dermatologist at Day Dermatology & Aesthetics in New York City. "This makes Botox ideal for wrinkles that come from the contraction of muscles — most commonly the '11s' between the brows, horizontal lines across the forehead and crow's feet."
By inhibiting the movement of these muscles — and training the face to avoid them, even as the product wears off — Botox can be a useful tool for preventing these wrinkles from forming in the future, starting from a young age. "Because wrinkles [result from] the repetitive movement of the skin, getting neuromodulator injections earlier can keep them from happening in the first place, rather than attempting to fix them after they've developed," says Garritano. "Slowing down the use of these muscles early will prevent the deep lines from developing. Think of it as a marathon: Small treatments and maintenance over time will result in much more natural long-term results."
WHEN TO START PREVENTATIVE BOTOX
Most experts are wary of pinpointing a specific age at which patients may want to start getting Botox injections for maximum efficacy, and that's because it can vary greatly from one person to the next. "We use our muscles of facial expression very differently: Some people use their forehead constantly and will have etched-in lines by the time they're in their low 20s. Others rarely use their forehead at all and may have virtually no forehead lines in their 40s," says Dr. King. Genetics and the overall health of skin come into play, too. "Quality of skin also makes a huge difference — sun damage and damage from smoking, for example, will make lines worse. If I had to give a number, I'd say that most of us could begin to benefit from Botox by our mid 30s."
Garritano echoes that there's no single age she'd recommend starting Botox, adding: "Whether you're 25 or 35, the best time to start treatment is before lines appear at rest."
WHAT TO EXPECT FROM YOUR FIRST TREATMENT
Understandably, most people aren't thrilled by the idea of procedures that involve needles on a voluntary basis, but Dr. King notes that Botox "is usually [less painful] than people imagine." (Editor's note: Having personally gotten both Botox and very minor lip injections — not to mention two ears full of piercings! — in my estimation, Botox is the least painful of the three, and the initial sting wears off quickly, since there's a slight numbing effect with the product itself.)
"Most of my patients say a flu shot or laser hair removal is much worse than Botox," says Garritano, who describes the sensation as "tiny pinches which go away right after the injection." If you are especially concerned about the pain, however, she suggests requesting a numbing cream, which can be applied beforehand.
The entire process is a quick one, perhaps surprisingly so for most people: Garritano suggests reserving about 30 minutes for the consultation, especially for an initial treatment with a practitioner, but notes that the actual injections should require only about five to 10 minutes.
It's normal to experience a bit of bruising at the injection site, which in most cases disappears within a few days of the treatment. Redness and bumps can also occur in the hours immediately following the procedure, but they are usually minimal and can be covered with makeup.
Don't expect to see full, muscle-freezing results immediately: "It does take time for the Botox to get absorbed and to relax the muscle, so you won't see results right away. You'll start noticing a difference within a few days and results will peak by about 10 to 14 days," says Dr. King. The body slowly metabolizes the product, meaning its effects gradually wear off over the course of three to four months. This is both good and bad news: If you like the effects, they unfortunately won't last very long. On the other hand, if you aren't thrilled with them, they aren't permanent; in some cases, they'll disappear in half the time it would take to grow out a bad haircut.
In order to maintain the results of the treatment and see the most benefit in terms of wrinkle prevention, Garritano recommends an injection regimen of three times a year, or roughly every four months.
It's also important to keep in mind that it can't help with all types of wrinkles. "Lines from sun damage and gravity won't improve with Botox," says Dr. King. The upper third of the face – the forehead, in between brows and near crow's feet — can benefit most from preventative Botox, according to Garritano, while other areas are a bit trickier. "Botox can be used around the mouth, to slim the jawline and to raise angles of the mouth, but these areas have more risks involved, so it's important you go to an experienced injector for these areas."
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WHAT TO KNOW BEFORE YOU GET INJECTED
While Botox and injectables in general have become more commonplace and accessible over the last few years, it's still a medical procedure that should be handled as such. In other words, do your research first (and make sure it goes further than Instagram). Find a trusted professional, read online reviews and don't be afraid to ask questions. "Look for a board-certified dermatologist or plastic surgeon who has credentials you respect and who does a lot of Botox with results you like. Word of mouth is terrific if you have a trusted friend who has Botox results you admire," says Dr. King. She also recommends finding out about the office policy regarding pricing and follow up appointments, in particular. "In my office, for example, we charge by area and include a two-week touch up if necessary at no extra charge; this ensures that everyone gets an optimal result at a transparent price."
"Nowadays, most people are finding their injectors through media and social influencers," acknowledges Garritano. "Check out the provider's bio on their website before you make an appointment to make sure they have experience in medical aesthetics. Check that they are a board-certified medical provider in your state. Usually the best way to know if [you] can trust a particular provider is to go for the consultation and see how you feel when you meet with them. Make sure the practitioner spends time reviewing your specific facial features and educates you on what areas you are a candidate for. At the end of day, you want to build a long-term relationship with this person and you should feel comfortable with them."
Communication is key to managing expectations and ending up with the desired results. "Discuss what you're noticing when you look in the mirror that bothers you so that you are sure to be on the same page [as your practitioner]," advises Dr. King. "Discuss the outcome you want and ask them how they will address your concerns and desires. If you've had Botox before and experienced any results you did not like, be sure to discuss this as well — this is important information that can guide exactly how the doctor injects."
HOW TO HANDLE PRE- AND POST- TREATMENT CARE
Despite the fact that bruising can occur no matter how skilled a Botox practitioner is, there are a few ways patients can minimize these effects. "Avoid anything that could increase your risk of bruising for a week before your appointment — that includes blood thinners like aspirin, ibuprofen, vitamin E, St. John's Wart, fish oil or omega-3s, ginseng and gingko biloba," notes Dr. King. "If you need to take a pain medication, Tylenol is okay." She also suggests that patients avoid drinking alcohol in the few days leading up to treatment.
For post-treatment care, experts suggest avoiding strenuous exercise, hot showers and saunas — anything that may cause circulation to spike. Taking Arnica supplements in the days leading up to the injections can help to minimize bruising and irritation, while Dr. King also suggests trying a topical vitamin K. If bruising is particularly bad, "a pulsed-dye laser can help it resolve faster," she says, so that is also an option to bring up with your dermatologist.
WHAT IT COSTS
"There is a significant range when it comes to pricing. Some offices charge by unit while others charge by area [of the face being injected," explains Dr. King. "Who is doing the injecting — their training and their experience — will make a difference, as will where you are geographically." On average, Botox treatments can cost between $150 to $500 an area — that's a significant difference, so don't be shy about asking your practitioner about pricing during the consultation.
OTHER THINGS TO KEEP IN MIND
Botox and cosmetic treatments are becoming destigmatized, but that doesn't mean they are without risk. As injectables become more widely available, it's all the more important to seek out the pros with substantial training, says Garritano. "Go to a provider who is experienced in injectables and understands the anatomy to decrease risk of complication. For example, if Botox is being used to correct crow's feet and is injected too low onto the cheek, it can affect the patients smile, leaving them unable to smile," she says.
She also cautions against blindly diving into bargain Botox treatments, like Groupons. "When I see Botox being [offered at] extremely inexpensive prices, I question if they are diluting the product with saline — this can cause diffusion when it's injected and possible complications, like droopy brows or an uneven smile." And even with a skilled practitioner and quality, undiluted product, there's always some risk of droopiness and asymmetry.