Fear of Botox!


Fear of Botox!

Many women and men have considered whether they should have Botox (by which I mean, Botox Cosmetic, Xeomin, or Dysport) to improve lines and furrows or harsh facial expressions. Some are fearful about having that first treatment. Recently I have even seen articles in the press wherein celebrities have been quoted as saying they have never and would never have Botox, or, if they have had Botox, they would not do it again. This has perplexed the dermatologists who know which of those celebrities have in fact had the procedure and were delighted with the results.

Some patients, including celebrities, do fib about having Botox. In part this is because we all wish to be thought to be naturally beautiful. People fear that they will be judged as vain. They fear that others will not understand that in our culture our job may depend upon a perception of self-confidence, effortless competency, health and vitality, or that others will not understand the real distress of projecting a different emotion than one is actually feeling (for example, appearing to scowl when in fact one is happy and calm). For celebrities, there may be fear that directors or producers will be dubious of an actor's ability to express a full range of emotions.  They may worry that paparazzi or directors may see a change in facial expression over the course of filming a movie or television series, or that pictures may show a difference from one month to the next.

However, when Botox is performed skillfully, the ability to express a full range of emotion remains intact. The brows can lift with conversation and retain a normal arch without being depressed or angled abnormally. Also, facial expressions do not need to change dramatically over time.  Treatments can be planned on a schedule that allows for subtle changes that are maintained until the next treatment.

These subtleties in treatment require an advanced injector with years of experience with an intimate knowledge of facial anatomy and function,  who understands that the dosing and pattern of injection varies from patient to patient and evaluates each patient's anatomy and muscular function carefuly prior to deciding upon the treatment plan for that patient both for that day and into the future.

Fear of Botox has developed because when Botox is performed without skill and knowledge, the results can be very bad. These unfortunate patients stand out, but we don't see the far more numerous patients who have had a great result, because results are invisible when designed and performed well.  Even worse is the outcome when Botox falls into the hands of unscrupulous individuals who have injected counterfeit substances, with which the results have ranged from lack of an effect to dangerous side effects.

Botox has been used for many medical issues with great safety and success. Botox Cosmetic has been proven to help depression. Botox has been successfully employed to prevent migraines and excessive sweating, and to treat muscle spasms, essential tremor, multiple sclerosis, urinary incontinence, strabismus, torticollis, Bell's palsy, overactive sphincters, tennis elbow, and more. Treatment if these medical indications sometimes requires many multiples of the doses needed for aesthetic purposes, and occasional side effects are reported.  But when used for aesthetic purposes, Botox Cosmetic has an outstanding safety profile.  It also improves self-confidence and makes one feel more in control and eases the distress of having one's emotions misinterpreted. In addition, Botox Cosmetic has been proven via a centrally-mediated effect on the neural circuitry of the brain to ease depression.

I will suggest to you exactly what I would tell a family member or close friend: choose a board-certified dermatologist or plastic surgeon who has had years of experience and extensive and advanced injector training, who has a detailed knowledge of static and functional facial anatomy, who performs the procedure many times each week, and who can explain to you why she or he is recommending a particular pattern of injection. Here is a radical proposition for your consideration: because of the ongoing training, knowledge, and experience required to provide great results, this is not a procedure that should be performed by a dentist, gynecologist, family practitioner, ear nose and throat specialist (ENT), internist, nurse practictioner (NP), or physician's assistant (PA), nor with a discount or in a spa or 'Botox party.' If you feel that you are being rushed through the procedure or the doctor is in a hurry, it may not be the right place for you. If you have found someone who is qualified, and there are many who are, it shouldn't be necessary for you to be vigilant about checking for counterfeit substances, but if you want to know how to do so, please see the video called 5 Questions to Ask Before Choosing Your Botox Injector on Sheryl Clark MDs Channel on YouTube, which shows real bottles of Botox, Dysport, and Xeomin, and tells you how to spot a counterfeit bottle.

If patients become more educated and sophisticated in choosing the right provider, perhaps a day will come when they won't feel they have to lie about having had Botox.

Sheryl Clark MD
Assistant Clinical Professor and Attending in Dermatology, Weill-Cornell School of Medicine and The New York Presbyterian Hospital
Article by
New York Dermatologist