As a beauty editor, I’ve been writing about the latest and greatest in the skincare and aesthetics space for years. While buzzy ingredients, tricked out lotions and potions, and new-age technologies with miracle claims pop up on the regular, there are a few tried-and-true workhorses that transcend trends. Daily sunscreen and nightly retinol usage are two such stalwarts (I’ve mastered the former but, admittedly, still haven’t found my groove with the latter), as are neurotoxin injections.
Since Allergan’s Botox® was approved by the U.S. Food and Drug Administration (FDA) for the temporary improvement of moderate to severe glabellar lines (i.e. the frown lines between the eyebrows) in April 2002, it has become the go-to for anyone looking to reduce the appearance of fine lines and wrinkles caused by facial expressions (think: frowning, squinting, smiling, and the like). Competitors like Dysport®, Jeuveau®, and Xeomin® have followed suit (get up to speed on the ins and outs of neuromodulators) — employing small doses of botulinum toxin type A (BoNT-A) to temporarily paralyze muscles for cosmetic effect. The lack of muscle contraction prevents the face from forming and/or deepening lines and wrinkles. The result? Smoother skin until it wears off.
Personally, I always felt the question wasn’t so much if I would go under the needle but rather when I would choose to do so. Even so, I hadn’t actually tried anything more invasive than a skincare routine nearing double digits in length and an occasional facial or light chemical peel. But, as a soon-to-be 29 year old whose forehead lines were no longer disappearing like they once did, it felt like as good a time as any to give it a try.
For my first Botox® appointment, I chose double board certified facial plastic surgeon Lesley Rabach, MD, of LM Medical in Manhattan because I appreciate her less-is-more approach (when she started our conversation with the refrain “cosmetic procedures are a luxury not a necessity,” I knew I was in good hands) and trust her thoroughness (she answered all of my questions, plus ones I hadn’t thought of with the patience of a saint).
“As a soon-to-be 29 year old whose forehead lines were no longer disappearing like they once did, it felt like as good a time as any to give Botox a try.”
After a consultation, Dr. Rabach injected 20 units of Botox® into my glabellar lines, above my brow bone, and into my upper forehead lines. I lost count after the one injection between my brows and two above each brow, but it was no more than 10 or 12 pricks total that, despite making my sensitive eyes water, hardly felt like anything (more on the pain, or lack thereof, below!). Five days later, my results appeared; a few days after that, I went in for my follow up appointment (typical for first timers); and six weeks later, I am happy to report that I love the way it turned out.
Throughout the pre- and post-procedure process, I was most struck by how many friends said they couldn’t wait to hear about my experience because they had thought about getting Botox® — but just didn’t know where to start or what to expect. With their curiosity in mind, I’ve compiled a list of the nine things I believe are most useful to know before going under the needle for the first time:
1. There Is No Right or Wrong Time to Start
While it may seem like people are opting to get Botox® and the like at an earlier age, there is no right or wrong time to begin treatment. As Dr. Rabach told me during my first appointment, no one needs Botox® (or any cosmetic procedure for that matter). But, if you are interested and in a position to start early, neurotoxin injections can potentially have a preventative effect.
“We are so lucky to be in a world where we can prevent many aging processes that generations before us couldn’t. Botox is a wonderful tool to use in small amounts to prevent wrinkles from ever starting.”
Needless to say, patients in their twenties and thirties will need less product than someone in their forties or fifties, but everyone will see results. “Patients who already have lines require more units to decrease the movement and often need adjunct procedures like peels, fillers, and microneedling to remove the lines that are etched in,” Dr. Rabach says. “Someone in their twenties may use a fraction of the number of units to maintain ageless skin.”
2. A First-Time Consultation Is Important
As with any procedure, finding a provider that makes you feel comfortable and, in this case, matches your aesthetic is of the utmost importance. Booking a consultation with a board certified plastic surgeon or dermatologist will help you get a sense of their work and bedside manner — and ensure that whatever you wish to have done is actually right for you. “We see new patients first for a consultation, medical history, and physical exam, followed by treatment,” Dr. Rabach explains. “Occasionally, patients want to have a consultation and wait to do the treatment on a later day, but most do both the same day.”
During my consultation, Dr. Rabach asked me where I thought I wanted Botox® as she studied my face. I explained the increasingly omnipresent nature of my forehead lines, and she proceeded to have me raise my eyebrows (my go-to facial expression), furrow my brow, and squint. Doing so allowed her to better understand my facial structure. “I assess the function of the muscles and see how exactly the different muscle groups contract and pull the skin, so that I know where to place the Botox®,” she shares. “All of the muscles of the glabella (between the eyebrows), forehead, and around the eyes (crow’s feet) attach to the skin, which is why it causes wrinkling when they contract.” Neurotoxins disrupt this relationship. “Botox® reduces the muscle’s ability to contract fully, thereby reducing/removing the wrinkle,” she adds.
3. You Really Can Get It Done During Your Lunch Break
Kelly, the patient coordinator at LM Medical, told me that the most common question she hears from patients other than ‘does it hurt?’ is ‘can I get Botox® during my lunch break?’ The short answer is yes.
My first appointment (which included both a consultation and injections) lasted about an hour, but the majority of the time was spent filling out new-patient paperwork, having ‘before’ photos taken, and consulting with Dr. Rabach. The injections themselves took less than 10 minutes. Post-procedure, I iced my forehead for five minutes to help with any swelling or bruising and then headed back to work. Had I not told my colleagues where I was going, no one would have suspected a thing.
Prior to injecting, Dr. Rabach wiped my forehead down with an alcohol pad, which removed my makeup. She told me I could reapply beauty products (makeup and skincare) immediately, so feel free to bring along a touchup kit.
4. Be Mindful of Supplements and Allergies
Dr. Rabach says Botox® is “very well tolerated” by a large majority of the population for both cosmetic and therapeutic use, but it should be noted that diseases including Lambert-Eaton Syndrome, Myasthenia Gravis, ALS (Lou Gehrig’s Disease), and a few others are contraindicated. Additionally, allergies and meds should be considered.
While your daily supplement regimen won’t preclude you from getting injected, it may play a role in your recovery. “There are some supplements that potentially thin the blood, thereby making the chance of bruising — it is not very common but can occasionally occur — more likely,” she explains. “For this reason, we specifically ask about supplements. We ask about medications, of course, but have found that patients typically don’t think of supplements as medications. We like to be fully informed of our patient’s individual histories, so that we can set expectations.”
There are no medication contraindications to receiving Botox®, but aspirin and supplements like fish oil, ginseng, garlic, and ginkgo biloba (to name a few) can increase a patient’s chance of bleeding and, therefore, bruising. For the most seamless experience, lay off them before heading in for your appointment.
5. Workout Before Your Appointment
You may or may not be aware that Botox® arrives at your provider’s office in powder form and is mixed with saline and refrigerated prior to injecting. Because of the liquid nature of the combined formula, there is a theoretical risk that the solution could spread or move from the intended location.
After my 2 p.m. treatment, Dr. Rabach told me not to exercise for the rest of the day and to try to stay upright (read: not lay down or bend over) for three hours — but the directive was provided out of an abundance of caution. “When Botox® is mixed to the company’s recommendations, as is done in my practice, [movement] is a very rare occurrence. However, we are seeing more and more facilities that dilute the Botox® too much,” she says. “This can make it more risky for the patient to lay down or workout. At LM Medical, we recommend not to lay down or workout because we are extra careful, but it really stays where we want it.”
6. A Vibrator Might Be Involved
Yes, that kind of vibrator. During my appointment, Dr. Rabach hilariously told me that one of her early mentors gave her the tip to buy them in bulk from Amazon for the best deal... and results. Obviously, Cosmo has thoroughly covered the practice, but, in all seriousness, the vibrator serves a very useful purpose. “We have a lattice of very superficial sensory nerves and anything that touches the skin, they feel,” Dr. Rabach explains. “Using vibration during injection tricks the sensory nerves in the surrounding area to not ‘know’ exactly where the needle is coming and, therefore, makes the discomfort significantly less. Sometimes you can’t feel it at all!”
Dr. Rabach held the vibrator on the side of my forehead, asked me to make facial expressions, and injected into the lines that formed. I didn’t feel a thing, which may be a result of the vibrator or may have something to do with the fact that they quite literally use the tiniest needles on the market for the procedure. While I’ve been told I have a high pain tolerance, I don’t think anyone would tell you the injections feel like anything more than a pinprick.
Because my eyes are naturally watery, they teared up slightly, and there was a bit of blood left over that she quickly wiped away. Immediately following the treatment, there were small, bug bite-like bumps at each injection site. She handed me an ice pack to put on my forehead for five minutes and said the swelling would be gone entirely in 15 to 20 minutes. As promised, by the time I got back to my desk, there was no evidence I had anything done.
For the rest of the day, I felt like I had a very dull headache. My forehead felt a little tender to the touch (similar to how your arm feels after a vaccination) for the first 48 hours or so, but I really only noticed it when I washed my face and rubbed the area.
7. Don’t Expect Results Right Away
Given our culture is one of instant gratification, it’s important to understand that Botox® results aren’t immediate. In fact, you’ll spend the first three or four days wondering if your doctor even did anything. But, come day five, you’ll be wondering why you didn’t try this sooner. Two weeks post-treatment, you’ll be enjoying the full effect of your injections.
“Basically, I feel frozen but don’t look it. My makeup wears better without any forehead creasing, and I generally find that I look more refreshed —whether I get enough sleep or not.”
I happened to be home with my family for Thanksgiving on day five, and the fact that I got Botox® had all but slipped my mind until my mom asked me if I noticed a change yet. To my delight, I looked in the mirror and saw that the small lines that had started to etch themselves above my brows were softened — almost to the point of invisibility. And, when I raised my eyebrows (yes, they still moved!), my forehead could no longer contract the way it once did. Additionally, I found it difficult to furrow my brow (though, as I mentioned, I am more of a brow raiser than a furrower), which means a temporary farewell to my eleven lines. Basically, I feel frozen but don’t look it. My makeup wears better without any forehead creasing, and I generally find that I look more refreshed (whether I get enough sleep or not!).
8. You’ll Need a Follow-Up Appointment
As Dr. Rabach explained to me during my initial appointment, not all muscles are created equal. As a result, one side of your face may be stronger than the other, which means that one side may require a bit more treatment than the other — though it will be hard for your provider to know that during your first meeting.
To ensure your injections are right for your facial structure, he or she will likely have you come about a week later (once the results have started to reveal themselves) to see if a touchup is necessary. I didn’t end up needing another needle, but the quick appointment was a good opportunity to have my ‘after’ photos taken and ask Dr. Rabach additional questions — chiefly, when I should come back for more because, in case you haven’t heard, Botox® isn’t permanent...
9. Results Are Temporary
No matter which neurotoxin you try, the results aren’t immediate and they don’t last forever. Depending on the amount injected and the way your body processes it, most patients will find that injections last three to four months, at which point it would be time for another treatment. “Botox® degrades over time and needs to be repeated,” Dr. Rabach says. “Individual results vary depending on each person, their metabolism, how many units the person received, as well as other factors.”
And don't bother asking what you can do to make it last longer. “I occasionally hear of it lasting longer than four months, but the industry standard is three to four months for the majority of people,” she shares. “There isn’t much we can do to make it last longer.”
As you can probably tell, I am very happy with my Botox® results and can see myself getting treatments two or three times a year in the future. With that said, I went into my appointment with a few hesitations and plenty of questions, all of which my doctor was able to talk me through. If you take but one thing from this article, let it be this: finding the right provider is key. “It is entirely normal to feel nervous about doing something new, especially on your face,” Dr. Rabach says. “You almost definitely will love the results because you will look exactly like yourself, only refreshed.”
To ensure the most optimal and natural-looking result, it is important to go to an experienced, board certified dermatologist or plastic surgeon who has intimate knowledge of the facial muscles.
More Related Articles
‘Try on’ aesthetic procedures and instantly visualize possible results with AEDIT and our patented 3D aesthetic simulator.