Everything you ever wanted to know about Botox, but were afraid to ask

It's 35 years old this year and it's been keeping me 35 for over a decade. Today - Botox! Let's dig in...

Disclaimer: this is not how Botox is administered. Also, do not give your dog Botox, you monster

WTF is Botox anyway?

I’ve got you…

WTF is... Botox anyway?

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Before I say anything else..

This post will assume that you’ve read The Rules and their deep-dives

The 6 Rules of Cosmetic Work (per me)

and the Research Phase Guide to getting cosmetic work

So You've Decided You Want Cosmetic Work? What To Do Next: Part One (Research Phase)

If you haven’t yet, well…

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‘Botox in a bottle’

Few things boil my piss more than clickbait articles and ad campaigns that claim a skincare product is ‘Botox in a bottle’.

The only Botox in a bottle is Botox¹.

The end.

As ever, I’m not here to advocate for or against Botox or any other cosmetic work, but if you are preoccupied with wrinkles, skincare can’t reverse or eliminate these. Botox can.

Save the money you would have spent on that purported miracle cream or serum. It is not going to replicate the effects of Botox.

Now, IF you have all of:

1. Fine lines

2. Dehydrated skin

3. No current skincare regime to speak of

your skin will almost certainly perk up if you start moisturising it² and it is likely that your fine lines will then appear less pronounced. This is especially the case if you start using a prescription retinoid.

This should not be confused with reducing the appearance of actual wrinkles on otherwise well-balanced skin.

No-one is non-surgically reducing the appearance of wrinkles without the use of injectables and Botox is more predictable than filler so is likely to be the injectable of choice.

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'But I’m not the kind of person who gets Botox, so I’d rather go down the skincare route’

You do you. It’s your money.

But there isn’t ‘a Botox type of person’ any longer.

There are:

• People who don’t want wrinkles and get Botox (these people don’t have wrinkles)

• People who don't want wrinkles and don’t get Botox (these people have wrinkles)

• People who don’t give a shit about wrinkles (these people have wrinkles)

As ever, I will remind you that there is no moral imperative to cosmetic work. There’s only: what you want (which can be nothing at all), can responsibly get and can afford.

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If you’re worried about what people will think, that’s a separate issue.

Try not to live life not doing things you want to do because you’re worried about what other people will think.

This may help:

How To Talk About Cosmetic Work - Part One: What To Do When People Say Unhelpful Things

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If you’ve judged other people for getting Botox/cosmetic work in the past and would now feel like a hypocrite:

1. This may help

   How To Talk About Cosmetic Work - Part Two: How Not To Say Unhelpful Things

2. Congrats on your personal growth at judging others less and don’t make yourself suffer needlessly for the sins of your past. It’s just some Botox. It’s fine to get it if you want it.

It’s equally fine not to get it if you don’t want it.

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Those perma-surprised faces from the mid-90s

Some people still legitimately think this is how all Botox looks. Also, RIP Divine, we shall never know your like again

Botox and filler get a bad rap because everyone remembers the bad examples.

There are millions³ of people getting Botox every year. Technique and dosage have been refined over time and - if you’re going to a doctor who is a specialist practitioner - it’s highly unlikely that you’re going to end up with your eyebrows in your hairline.

Stern reminder to do your research and only go to a doctor who is a reputable expert specifically in Botox injections.

Not your dentist, not your GP friend who does it on the side, not someone in a side room at your hairdresser’s.

This is your FACE. Don’t cut corners. And if you do, understand that you’re exponentially increasing your chances of Looking A Bit Weird afterwards…

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What does it involve?

So, your Ladybird guide to Botox is as follows:

Before the appointment

• You’ve researched and found your practitioner

• You have a good idea of what outcome you want, eg:

  • range of motion post-injection

  • whether you want any visible wrinkles (if you want to retain some, this is often referred to as ‘baby Botox’)⁴

  • what areas of the face you want injected: forehead, frown (aka glabellar), crows feet, jaw (masseter⁵), lip (flip), neck, eyebrows (for a deliberate lift, not perma-surprise), bunny lines (side of nose), chin, jowls, people are getting their earlobes done

    • Reminder - just because you CAN doesn’t mean you SHOULD.

  • do you mind having a post-botox shiny forehead? If you do, make sure you tell your practitioner - there is a tradeoff here, it’s quite hard to have ‘no wrinkles’ without ‘shine’, but they can try to get you the outcome that you want and you can refine your priorities once the Botox has taken effect.

• You’ve read this before attending your appointment:

How To Talk About Cosmetic Work - Part Three: Talking to surgeons, practitioners and other healthcare professionals

• You arrive at the appointment without foundation/blusher/contouring or eyebrow makeup (they’re going to sanitise your face before they inject)

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At the appointment

• You fill out a weirdly detailed form about your medical history

• You have a good chat with your practitioner about what you want. Don’t be upsold unnecessarily, but listen to their opinions and benefit from their expertise.

• They may take photos of you. Make sure these won’t be used for promotional purposes if that would bother you⁶

• They swab your face with alcohol/antibacterial. If your face is sensitive to alcohol, mention this upfront before they start cleaning you. Bring a medicated cleanser from home if you’re super, super sensitive.

• They make you pull faces (“big smile! big frown! scrunch your face up!” It’s like Drama class when you were 7)

• They might draw on your face - some doctors do, some don’t. They clean you up before you leave if they do 😊

• You typically lie down. If you’re seeing someone who only has a chair, they are probably a part-timer and I would be sceptical of them.

• The injections happen. As Olivia Colman recently said (and I said in the WTF) “it’s needles in the face” and it feels like needles in the face. These are shallow and less invasive than filler feels, but you will definitely feel it.

  

  @bbcradio2Vernon Kay and Olivia Colman found out they were the same age when recording #TenToTheTop 😂 Listen to the podcast on BBC Sounds 🎧 #vernonkay #oliviacolman #jessiebuckley

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• They clean your face - possibly applying pressure if you’ve bled⁷

• You pay and leave

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After the appointment

• On the day, don’t do anything that causes sweating after your appointment. It can displace the ‘Tox.

• YOU WAIT FOR TWO WEEKS

  • By then you’ll have a good idea of the Botox’s efficacy although it will keep taking effect for another week or so

  • Bear this in mind if you are getting Botox for a specific event

• If you think you have been under-toxed or that it’s not given you the effect you were hoping for, any reputable practitioner will let you go back for a free top-up.

  • Some will automatically schedule a follow-up 2 weeks after your appointment, especially if it’s your first time being injected by them

  • Otherwise just call and say you want an appointment for a top-up. Don’t be shy of doing this. It’s baked into the cost of your original appointment

  • Again, bear this in mind from a timing perspective - it’s far better to see a practitioner who is conservative and tops-up as needed rather than one who takes a more cavalier approach, but it may be that you are a month away from your desired end result, all-in.

• If you want to repeat the injections, reschedule in 3-6 months. I try to go every 3 months as I really, really want no motion at all, but you need to figure out your own preferences and the rate at which your body processes your Botox out.

  • Mine has usually completely disappeared within 6 months and I’ve been getting it regularly for nearly 14 years - the effects are not cumulative.

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What makes a good Botox practitioner?

I’ve written about researching practitioners extensively in the past, but I recently had to find a new Botox doctor in Rio⁸ and these were the factors that made me comfortable that this was a woman worthy of jabbing my face all over.

Research phase

1. I started with Google because:

   1. this is a new city for me, so recommendations were thin on the ground

   2. I have enough experience of Botox that I don’t need to be hand-held through an appointment by my practioner

   3. It’s a comparatively low-risk procedure for me

2. Her reviews were plentiful, great and obviously genuine.

3. She’s a dermatologist with broad experience of a range of non-surgical procedures, all of which were well-reviewed.

   
   This was obviously a woman that KNOWS FACES.

4. Her Instagram wasn’t flashy⁹, she centres herself in the content (i.e. it’s mostly educational, not endless patient ‘before and afters’), she looks FUCKING GREAT¹⁰ without looking ‘done’ and she isn’t using egregious filters.

At the appointment

1. In an unexpected surprise, she spoke really good English which meant that…

2. We could have an excellent chat about Botox but also a raft of other procedures and we were broadly aligned on what we consider to be good/bad/ugly in the non-surgical space¹¹¹²

3. She offered a couple of things and anything that I didn’t want (eg neck Botox) she moved on from immediately - no hard sell

4. She was a really skilled injector (very few ouchies) and had really listened to what outcome I wanted.

5. Booked in a 2-week follow-up automatically

6. Sent email and WhatsApp guides to ‘what to expect’ guides for ‘day of’, ‘1 week after’ and ‘2 weeks after’ with encouragement to contact her/the office if I had any questions or concerns. It was slick.

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Much like finding a therapist, finding a practitioner that you like is a very personal experience, but all of the above worked for me 💯.

My regular Botox doctor in London shares the above qualities and is also very good at saying NO to me when I go in with some of my wilder ideas.

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Do I think you should get Botox?

As ever, my answer is: If you can’t decide this for yourself, you’re not ready for any cosmetic work.

But, in 2024 it’s low risk (SUBJECT TO BEING PERFORMED BY AN EXPERT), relatively affordable, will wear off within 6 months if you hate it and will remove your wrinkles if you want your wrinkles removed.

Whatever THIS is, is my next procedure

Until the next time x

1. For the purposes of this post, Botox and Azzalure are used interchangeably because Botox is the better-known brand. Daxxify will have a WTF post of its own imminently (it’s not good news 😬).

2. If you don’t know where to start, there is a comprehensive beginners’ guide to skincare here

3. Source here

4. I think this expression is repellant, but it’s common parlance

5. Also - non-cosmetically - for treatment of bruxism/teeth grinding

6. It would bother me

7. These are injections, you may bleed

8. Admittedly, a city stuffed full of aesthetic opportunities, both surgical and non-surgical

9. There will be a scorching hot take post soon on the perils of Insta/TikTok when researching practitioners/surgeons

10. She’s 44 - I would have put her at 38 at the oldest

11. This is the equivalent of finding a new BBF on the basis that you hate all the same people

12. I was in there for 90 minutes 😂😂😂. I’m not saying this is the optimal appointment time for you, but I had an absolute blast with her. 90 minutes of: chat about procedures, water, chocolates and as many SPF samples as I could carry. That’s my ideal first date, right there.