I had always thought Botox was for older women and socialites, but when my friends and I started turning 30, it was suddenly a topic of discussion at every dinner party and girls night out. It felt like there was no longer question of “if”— but only a question of “when”— for many of my friends.
Around that same time, I started getting questions from you guys about my thoughts on the matter. And I’ve never really had a good answer. So I tapped my friend Dr. Whitney Bowe to answer the most frequently asked question I get about the injections that everyone loves to hate. She has been working with Botox and Dysport for years on literally hundreds of patients and can explain the science behind it in a way that helps us better understand what all the fuss is about.
I love Dr. Bowe’s approach to skincare in general because she is one of the few derms I’ve met who truly preaches and believes in beauty from the inside out and touts the benefits of a healthy diet and lifestyle on your skin. If you’re at all interested in skincare and wellness, her book, The Beauty of Dirty Skin, is a must-read.
Full disclosure, I have done Dysport in the past and loved the results, but that doesn’t mean I’m encouraging any of you to do the same. My personal belief is that if something makes you feel good, beautiful, and happy, go for it. But if you want to age gracefully and naturally, there’s something really beautiful about that. Basically… you do you!
That said, I haven’t done enough research to know how safe it is or what the long-term effects might be. Is it a great idea to inject chemicals into your face? Probably not. But neither is painting your nails or dying your hair. And it goes without saying that the price tag would be astronomical. $1,500/year (or more) is unrealistic for most of us.
For everyone who wants to know more, I’ll let Dr. Bowe take it from here.
What is the difference between Botox and Dysport?
It’s basically like comparing Coke and Pepsi. Both are trusted brands that deliver consistently safe and effective results. In my patients who have tried using both over the years, most cannot tell them apart. Botox came out first, so it has more name recognition.
The main ingredient in both Botox and Dysport (Botulinum Toxin A) is exactly the same. The carrier proteins, or small proteins that are found alongside the main protein in the vial before the powder is mixed with saline, are the ones that differ slightly between the two products. The main molecule, the Botulinum Toxin A, actually dissociates from these other, small proteins even before it even reaches the nerves in your skin. Consequently, the carrier proteins don’t impact the efficacy of the product.
The difference between the two only becomes relevant if you have a true allergy to milk, because one of the carrier proteins in Dysport is a milk protein. However, having a lactose intolerance doesn’t count and shouldn’t stop you from using Dysport. I’m talking about a true milk allergy, and, quite honestly, I’ve never met an adult with a true allergy to milk. Some of my patients think Dysport kicks in a few days faster than Botox, and most practices offer Dysport at a discounted rate compared to Botox, so I would advise you to try each one and see if you prefer one over the other.
Very rarely, I’ll have a patient who finds that one works better than the other, or one lasts longer. You won’t know till you try. The catch is, though, you want to try both with the same doctor. If you switch doctors, then you are introducing many other variables including technique, so it’s like comparing apples to oranges.
Note from Julia: In a previous blog post I had called Dysport “Botox light” because that was my understanding of it. My bad! I didn’t realize how similar they were.
Once you start Botox, is it something you need to keep up indefinitely?
The opposite! In fact, most of my Botox patients find that they can actually decrease the dose, or space out their injections over time. Botox can rebalance and retrain your muscles so that you weaken the muscles that pull down and make you look angry, and you strengthen the muscles that open your eyes and give you that relaxed, well rested appearance.
One of my favorite moments, which happens for many of my patients over time, is when they actually forget how to frown. Then come in to see me 3-4 months after their last appointment, ready for their Botox. As always, I mark the face prior to injecting, and I ask my patients to make expressions while I make those markings to ensure I’m targeting each muscle in the right spot, with the perfect dose. I’ll say, “Ok, can you frown for me?” and I’ve got my white marking pencil poised. Inevitably, some patients will respond with “Wait, am I frowning?” and it’s clear that they can’t even remember how to make the expression anymore. That’s when I tell them to go home and to wait another month. I can usually space out appointments longer and longer over time.
How often do you need to get it?
If you’re trying to reverse damage, or smooth out etched lines, you want to start by coming every 3-4 months. However, once we reverse that damage, most patients can space their injections out every 4-5 months or sometimes even longer. Patients who smoke, live stressful lives, or don’t get restful sleep tend to need more frequent treatments. Those who are really good about sun protection, meditation, and nutrition tend to get an effect for a longer period of time. If you’re looking to prevent lines from forming in the first place, and are taking a prophylactic approach, you can get away with every 6 months.
I’m 29 and want to start in my forehead. Is it too soon?
I started when I was in my mid 20’s. Everyone is different. As soon as you start seeing your makeup settle into your creases, that’s a good time to consider starting.
Is it safe to get when you’re trying to get pregnant? What about breastfeeding?
Botox gets absorbed within hours of the procedure, so technically if you were to conceive the night of your Botox injection, there’s no risk. That being said, most people who are conceiving naturally are not sure exactly when they are ovulating, etc. So if someone is actively trying to get pregnant, I would not inject them, just to err on the side of safety. However, in my patients who are going through IVF and are acutely aware of the exact place they are in their cycle, we can time Botox injections up to the day before the embryo is transferred.
I don’t inject my patients who are breastfeeding unless they are willing to pump and dump on the day of, and 4 days following, their appointment with me. They have to throw away that milk and feed the baby with formula or a backlog of pumped milk during those days. But after four days of pumping and discarding the milk, they can resume breastfeeding.
Is there a natural alternative to Botox that works?
I wish! As of now, there is no natural or topical ingredient that comes close to achieving what Botox can. I do love relying on skincare products that work synergistically with Botox, and help extend the benefits of Botox. However, nothing has replaced Botox or even come close as of today.
How much does it cost?
It depends on how many areas you want to treat, and how powerful your muscles are. Prices start at $550 and go up from there.
What are the possible negative side effects and how likely are they?
Right after you get injected, you have what look like tiny mosquito bites on your skin, but those little points of swelling go down after 10 minutes and are gone by the time you get into your car. If you’ve taken ibuprofen or fish oil in the week prior to your appointment, you might end up with a tiny bruise the size of a pencil point, but those are easy to cover up with a little foundation. The biggest risk is an eyelid droop, and that’s either technique dependent (why you want to go to an experienced injector who understands anatomy), or it’s because of what you did in the post-procedure. I always tell my patients “No downward dog, no massage, and no facial” for four hours after the procedure.
Would you ever get Botox? What are your thoughts on this topic?