Answering The Most Popular Questions About Botox

Hi, loves! Today is such a treat because my best friend and dermatologist is guest posting. After letting you all know I started botox this past year, it’s been the number one topic I receive questions about! So, today’s post is fully devoted to botox. I will be sharing a bit about my experience, and Dr. Austin will be answering your most frequently asked questions.

Before we go on though, let me introduce you to Dr. Austin!

Molly Burns Austin, MD received her medical degree from University of Texas Health Science Center at San Antonio and was inducted into the prestigious Alpha Omega Alpha honor society. She completed her internship in internal medicine at Baylor University Medical Center at Dallas and her residency in dermatology at University of Texas Southwestern in Dallas. Dr. Austin is in private practice in Dallas with a focus on skin cancer prevention, acne, and non invasive cosmetic procedures.

If you’re local to the Dallas area, you can schedule an appointment at (469) 523-1523. But, I encourage everyone to follow her on Instagram at @drmollyaustin.

Before we get to your questions, I wanted to explain to you all a bit about how I came to start botox. For the past two years I’ve really started to hone in on the best products and treatments for my skin. From sunscreen to night creams to micropen treatments, I have learned a lot about what is best for my skin. One of my biggest concerns has been the development of wrinkles at rest on my forehead, between my eyes, and my eyes.

Having a dermatologist as a best friend doesn’t hurt, when it comes to asking skin care questions. So, over the past year or so I’ve been asking Dr. Austin to let me know when she thought I was a good candidate for botox. Creams weren’t working well and I was eager to see some real results. I also didn’t want to jump the gun either. And to be honest, my husband wasn’t on board for a long time.

Then last fall Dr. Austin and I started to talk seriously about starting botox. As you’ll read below, botox is one of the best ways to prevent deep set wrinkles. It’s also a procedure that works best when preventing wrinkles as opposed to trying to correct them 30 years from now. As Travis and I processed botox, the cost, and the upkeep, we finally decided it was worth while. I think the number one thing that sold Travis was seeing the results after my first treatment. The second thing that sold Travis was knowing it didn’t have to be forever. Botox wears off after 3-6 months so if we decided it wasn’t for me, we could stop and my face would go back to how it was before.

The other thing that made me specifically feel comfortable about getting botox is that my security is not found in outward appearance or approval of man. My security lies with Jesus Christ and I know I am a treasured child of God. I know He loves and accepts me for exactly the way I am – botox or not.

So, last November I received my first round of botox and my second round was last week. A lot of you were curious if it hurt and to be honest, it really didn’t. I think everyone’s pain tolerance is difference, but to me it felt like a little pin prick. I think the thing that surprised me the most was that I still had so much movement in my face! I could and can still move my eyebrows just like before so to a random stranger, you would never know I had botox. Kinda cool, right? I think my parents’ generation has this preconceived notion that if you get botox your face will be frozen and your lips will be swollen. Not so, friends, and thank God for that. Haha.

Okay, let’s get down to business though! I’m going to let Dr. Austin take over from here and then scroll to the end to see my before and after pictures from my latest botox treatment!

Hi everyone! Today I am giving you some basic information on one of my all time favorite anti-aging secrets: BOTOX! Before we begin, let me clarify some terminology. I tell my patients Botox® is like “Kleenex®” in that it’s actually a specific brand of what we call “neuromodulators”, but most people refer to the general procedure as “botox”.  For the sake of simplicity, I will refer to the procedure as botox, but to be clear Dysport® and Xeomin® are also FDA approved products that treat wrinkles in certain areas of the face. Additionally, botox can be used to treat numerous areas of the face and neck, but the three most common areas are the forehead, glabella (muscles between eyebrows that create the vertical creases), and crows feet (radiating lines around our eyes). I will refer to these distinct areas as forehead, glabella, and crows feet in my discussion.

A lot of questions were sent to Anna! My hope is that after reading through these frequently asked questions you have a better basic understanding of this somewhat “taboo” and misunderstood topic.

1.) How does botox work?

Botox temporarily paralyzes the muscles in our face that make lines with movement. We call these “dynamic wrinkles”. Contrast these to the folds around your mouth (nasolabial folds) or say a crease you get from laying on your side when you sleep. These are static lines that are best corrected with fillers, not botox. Botox will only work on lines that worsen or appear when you contract a muscle in your face.

2.) How often do you have to get botox?

The textbook answer is that it lasts 4-6 months but the real life answer is closer to 3-4 months. I have learned that everyone is so different. Some of my patients are not back to their baseline for 5-6 months, but some are fast metabolizers that lose effect by 2 months. Again, I would say, average longevity is 3 months.

3.) How expensive is botox?

This answer is going to vary depending on who is doing your botox. Some offices charge by the unit (how much of the product you actually use) and some charge by the area. An average price per unit is $12-15. A typical forehead may use anywhere from 10-18 units ($120-$270), glabella 16-22 ($200-$330) and crows feet 16-24 units ($200-$375). Some injectors will charge set prices per area with the cost decreasing with more areas purchased. For example, $350 for first area, $250 for second, $150 for 3rd. Most places you go will likely work with you or give you some sort of discount the more you purchase.

4.) Once you start, do you have to “keep up with it”?

This is definitely one of the most common questions I get asked! I think there is a misconception that once you start you can’t stop. I tell patients that is not the case, it’s just most likely once you start you won’t WANT to stop:) The truth is people go longer than 3 months without botox all the time with no problem. If you regain full strength in those muscles, then yes, your wrinkles will return. However, if you don’t wait too long, we can just erase them again with more botox:) If you get botox and decide it’s not for you- no harm done!

5.) Does is hurt?

This answer is very subjective. Generally, it just feels like teeny tiny little sting with each needle insertion. Most of the time it’s the “sound” the needle makes as it goes into your skin that freaks people out the most. Generally the glabella area is the most sensitive, in my opinion, with forehead and crows being the least. I find that the limiting factor is the general fear of needles and anxiety about the procedure and less than the actual pain of the procedure.

6.) Is botox better than wrinkle creams?

There is absolutely no comparison. You will see more of a result with Botox when compared to any cream. I advise all of my patients to be on a retinoid/retinol if they are able to tolerate it (more on that in a later post). Retinoids can help longterm with very fine lines and wrinkles, but a retinoid will not give you the results of botox.

7.) When should I start getting botox?

This is such a great question.  You will hear a lot about the preventative benefits of botox. I agree with this wholeheartedly. HOWEVER, I do not think you need to get botox until you are seeing LINES AT REST.  Everyone is so different with regards to when this starts happening. I started getting forehead lines at rest around age 24 (this is a genetic trait!), therefore I started that early. The issue is if you wait TOO long, the lines can become too deep that botox can only lessen the depth of the lines, not erase them completely. I always look at patients and determine where I see their most prominent lines at rest and that is usually where we start.

8.) How many areas should you treat at once?

You can do as many areas as you want at once!! You can do only 1 if that’s the only area that bothers you but most commonly I do a combination of 2-3 areas. I usually recommend doing the forehead and glabella together to prevent the forehead from feeling heavy.  If an older patient is using their forehead muscle to lift their eyes up to see (i.e. they have droopy eyelids or a heavy brow), if we only do their forehead the eyebrows and eyelids can drop lower than their baseline. Think of it as a tug of war— if we paralyze the only muscle that pulls up, all of the tension will pull our face downward.

9.) How quickly do you see results?

With Botox® you usually start to see the “freezing” start on day 3 and continue through day 7-10. Dysport® sets in sooner and sometimes the next day you can start seeing the results. By 2 weeks, the final effect will have been achieved, and this is when I like to see my new patients back to assess for touch ups.

10) Can you still move your face after botox?

Yes! You should still have natural movement in your eyebrows and face when you smile. If overdone, you can definitely get a “frozen” unnatural look. This is why it is always my policy to start conservative. We can ALWAYS add more but we cannot take it out. If too much is put in, it will loosen up over the next 3-4 weeks so it’s not the end of the world, but most injectors try very hard to avoid this. The best botox will give you a freshened natural look, without being frozen.

11.) Where should I get it done?

As popular as botox has become it sometimes feels like you can get it on every corner (at least in Dallas!) This is not a bad thing, necessarily. I am thrilled that this many people are loving the product. I am actually not of the mindset that only a board certified dermatologist can inject botox. I care much more about the experience, integrity, and conservative nature of the injector than the letters behind his/her name. You need to make sure whoever is injecting you, if not an M.D., is supervised by one. I have learned so much from experienced injectors that may or may not have an MD by their name. There are so many wonderful injectors out there who do excellent work. On the flip side, there are plenty of people who should not be doing botox- just make sure you do your homework. I will also add, if the price seems too good to be true, it probably is! Feel free to always ask to watch the assistant draw the product out of the vial to make sure it is an FDA approved product.  Counterfeit botox can be attained that is not FDA approved in the US. This article discusses how scary this can be!

12.) Is botox safe? What are some of the risks?

One of the reasons botox has become so popular is its low risk profile. There really are no “dangerous” long term side effects. Bruising (a risk with any injection and sometimes impossible to avoid) and a headache are probably the most common complaints. Like I discussed earlier, if someone has a heavy brow and uses their forehead muscles to see, they are at risk for dropping their brow or feeling heavy with any forehead botox. Additionally, there is always a risk that you will need a touch up or that you have an asymmetry that needs to be corrected. Lastly, you should not get botox if you are pregnant or have a rare nerve condition called Myasthenia Gravis.

13.) What are some of the other less common areas injected?

There are so many other areas we can use botox!

• “Bunny Lines”– the lines around your nose that scrunch up, they are usually thin and subtle but an area we can treat, nonetheless.
• “Brow Lift”– if someone doesn’t necessarily have wrinkles/doesn’t care to treat them but just wants their eyebrows elevated, we can strategically inject the muscles that pull down the eyebrows so that that “tug of war” results in a slight elevation.
• “Masseter muscles”– These muscles are the muscles that bulge out when we chew in our lower cheek. Injecting these muscles with botox will create a more oval, slim, and less squared off face shape which many women find more aesthetically pleasing. This also helps people not grind their teeth at night!
• “Gummy Smile”– if you don’t like how much of your gums show when you smile, a tiny amount of botox can bring the upper lip down a bit when you smile, revealing less gum.
• “Smokers Lines”– a tiny bit of botox injected into some of the lines around the lip can help soften these. Most of the time, these need additional filler or laser resurfacing to completely obliterate them- but botox can help!
• “Marionette Lines”– these muscles are around in the chin area that pull down the corners of our mouth. Injecting a small amount of botox into this area can help prevent the downturning of our mouth. This is a subtle improvement and is best used in combination with fillers.
• “Neck bands”– these are the vertical bands that we see in our neck that get more prominent as we get older. Injecting botox into this area can make these bands appear less prominent and take away from the downward pull of the lower half of the face.

MY BEFORE & AFTER PHOTOS:

NOTE: The after pictures are 8 days after my treatment. There is still potential to see the wrinkles smooth out even more.

GLABELLA (11 LINES/FROWN LINES)

FOREHEAD LINES

CROWS FEET/SMILE LINES