Everything You Need to Know About Botox

All About Botox

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?

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  1. EM said:

    Of course “you do you” (that goes for everyone on this topic) but personally I never have and don’t think I ever would use such treatments/procedures.

    People tell me that I look younger than the milestone birthday that is coming up– and yes when I look at photos I look different than I did 10 or 20 years ago– but I’ve lived in that time, have earned those little lines that may be on my forehead and the greys sprouting from my head. I am happy I am not 20 anymore (even thought it was a great time in my life) and am grateful to have been able to live in these years/decades.

    And I’d rather spend the money such procedures cost on plane tickets to a place that I love or to see something new, or to stash away for a rainy day.

    2.13.19 · Reply
    • Kristin said:

      I swear I could’ve written this myself. Well said and fully agree!

      2.13.19 · Reply
    • Julia said:

      I love this!

      2.13.19 · Reply
  2. Kristin F. said:

    Agreed with Em above. I was blown away when I was at a party with my friends at the ripe of 33 and the conversation turned to everyone’s lines on their face. It reminded me of the Mean Girls scene when they’re all calling out their flaws lol. Turns out a large amount of ladies at the party had Botox and were sharing their experiences.

    I have a deeper forehead line that I wish wasn’t there but it is. Honestly, I’m so used to it that I don’t even really notice it until the inevitable Botox discussion comes up with friends these days. I think there is something to be said about aging naturally and if you’re taking care of yourself through a healthy lifestyle, it shows. My forehead line is not high on my list of priorities.

    My friends who have been practicing Botox (with great doctors albeit) are starting to look not like themselves and they’re only in their 30s! I wish ladies in this age range would take it a bit easier on all the procedures but as you say, to each their own. It just seems more of a frivolous distraction from life’s bigger issues IMHO.

    2.13.19 · Reply
  3. amy said:

    Botox is amazing. Makes me feel like a better, fresher version of myself. No shame in my game.

    2.13.19 · Reply
    • Julia said:

      Get it girl!

      2.19.19 · Reply
  4. Britt said:

    Love that you included this topic in your blog. I also thought there was such a stigma around Botox but tried it for the first time at 30 and really loved the results. Due to the price I am trying to limit how frequently I get it, but I saw the results and truly loved them!

    2.13.19 · Reply
    • Julia said:

      So great to hear that! Whatever makes you feel great is my motto 🙂

      2.13.19 · Reply
  5. Britta said:

    It’s really just not up my alley! Personally I can’t imagine injecting a foreign substance into my face not knowing long term potential side effects. I feel like in a lot of cases it ends up looking unnatural and like plastic. The price tag doesn’t make it any more enticing! No judging here though because we ladies fought long and hard to have control over our own bodies, but I look at my mom’s smile lines and sunspots and I hope I’m lucky enough to get those same ones in 30 years!

    2.13.19 · Reply
    • amy said:

      You sound cheap and judge-y but keep admiring sunspot!!!

      2.14.19 · Reply
  6. Libby said:

    I loooove all this good info!! I totally agree that if something makes you feel positive, and good about yourself, then do it!! Everyone deserves to feel that way!! I will admit that I had Botox done while working in a clinic, but I had it done for headaches, and it ended up having some extra cosmetic effects too 🙂 I wish I would have kept up with it on the face because my skin looked so good after that!

    xoxo Libby

    2.13.19 · Reply
    • Julia said:

      Did it work for the headaches?

      2.19.19 · Reply
  7. Kim said:

    I just got my first Botox (I’m 32) and love it. For those scared of the procedure and price, it was quite painless (teeniest pinch) and my doctor gave me the minimum dose possible since it was my first time and I was doing it preventatively. He charged “by the unit” (not all providers do this) and since it was such a small dose, it turned out to be only $110 per area (forehead, crows feet). Oh and that forehead line is gone! I understand it’s not for everyone, but I wanted to share my experience for those looking to make the leap.

    2.13.19 · Reply
    • Julia said:

      Agreed on the pain! It didn’t hurt at all.

      2.19.19 · Reply
  8. Monica said:

    I’m in a young physician and in at our social gatherings, everyone talks about “preventive” botox, which can mean starting injections in your early to mid-20s! For me, a frown was basically my resting face and after getting botox, I looked so much happier at baseline. It was worth it for me to not look so angry all the time! I started Botox in my late 20s and plan to continue for a while.

    If you’re planning on getting botox, the key is finding a trusted physician to inject your botox so that don’t end up with the frozen-face look. I would stick to plastic surgeons and dermatologists because they actually understand the anatomy, and start practicing botox during their residencies.

    That being said, there is a lot of stigma that comes with getting botox; I don’t tell some of my friends that I’ve had injections. I truly believe it should be totally up to each individual whether they want botox, just like any other skincare treatment or product! Women can choose to do, or not do, whatever they want with their amazing bodies 🙂

    2.13.19 · Reply
  9. veronika said:

    I got botox for the first time at age 34 and LOVE it. I get it about twice a year. I waited until I was done having kids and nursing. It really makes you look more awake and smooths the skin out. I didn’t have any deep lines, but doing it now serves as a preventative measure, meaning I will have to do it less often and spend less as I age. I know it’s not for everyone, but I love it and the results are undeniable.

    2.13.19 · Reply
    • Julia said:

      So good to know! Do you feel like you can still express yourself?

      2.13.19 · Reply
  10. Megan said:

    The only thing that I’ve considered is dermal fillers for my hereditary, very dark under eye circles. I’m not really worried about wrinkles right now at 26.

    2.13.19 · Reply
    • Julia said:

      I have done those in the past as well (not for years because they last a long time) and it completely changed the way my face looked… in a good way!

      2.13.19 · Reply
  11. Jen said:

    Great post! No judgement towards anyone and their decisions like you said. I never thought I would ever do anything like this ever! Well I turned 47 last year (I am much older than the majority of your readers). I found myself at the dermatologist for some mole removal/skin check. I only have one friend who has ever done Botox (I think partially due to where I live and again my age, it is not common). Until this past year I felt no need at all. I completely trust my dermatologist and I loved it. We talked at length and she said that she uses enough so you benefit but are never frozen and can still express yourself. Looking back I wish I had started sooner but in the end I saved myself a lot of money. I have only had it done one time and go back tomorrow. I am excited for my second visit.

    Another tip is to use the app Brilliant Distinctions. I am not sure if every dermatologist office uses or qualifies for this. The receptionist set me up with an account and you get rewards based on how much the Doctor uses. It is not a huge savings but a nice little perk/reward.

    2.13.19 · Reply
  12. Sarah said:

    This is so interesting! I’d love to hear Dr. Howe’s thoughts on Botox for migraines/headaches. I’ve heard positive things about its use for chronic headaches, and quite honestly I would be more interested in using it for that than the fine lines and wrinkles (although a smoother forehead would be a pleasant bonus, ha!). Thanks for such an interesting post! 🙂

    2.13.19 · Reply
    • Ashley said:

      Hi Sarah,
      I have chronic migraines as well as TMJ and I get botox done for both. I go every 6 months and do a little over 50 units. It is pricey and insurance still does not cover it but it makes such a HUGE difference. I can tell exactly when the 6 months have passed and it is time for my next appointment. And I will say tat even though I am 24, I have seen the benefits cosmetically in that I cannot scowl my forehead like I used to to focus and it helps with potential crows feet by my temples.


      2.18.19 · Reply
      • Elle said:

        Ashley I’d love to hear more about if it still helps with TMJ! I’m considering getting it

        2.12.21 · Reply
  13. Kelly said:

    I love this post! I am on the fence but I really hate the 11’s between my eyes and think of getting botox to alleviate them regularly! Just nervous about if it will freeze my face in some weird way:)

    2.15.19 · Reply
    • Julia said:

      Just tell your doctor that and they should be able to do it in a way where that doesn’t happen.

      2.19.19 · Reply
  14. Jenny said:

    I’m 45 and just recently had Botox done for the first time! I wanted to soften my crows feet and did only that area. I did a small amount and am thrilled with the results! My dermatologist did the procedure and she knew I wanted nothing drastic – just enough to give me a rested and softened look. (I had three units done on each side, for a total of $216). I never thought I would be someone to do this, but decided to give it a try. I have three teenagers and am tired and feel this has definitely refreshed my eye area!

    2.15.19 · Reply
    • Julia said:

      So glad it worked out for you! And sounds like it was more affordable than most places so double win.

      2.19.19 · Reply
  15. Ashley said:

    Hi Julia,

    I love this post! I am 24 and I currently do Botox for my TMJ. I go every 6 months and I get abut 50 units placed in my jaw muscles and my temples which does actually help with fine lines that could form around my eyes so yay added bonus! I think it is amazing how botox can not only work for cosmetic purposes (which I am very muhc for anything that will make a woman feel more confident) but for medicinal purposes like TMJ and migraines.

    Thanks for the post!

    2.18.19 · Reply
    • Julia said:

      Wait really? I have TMJ and would love some relief! I’m going to ask my doc about it. Thank you so much!

      2.19.19 · Reply
      • Ashley said:

        Yes! It is a life saver! Before I started doing it, my doctor said he has never seen someone with such large and strong jaw muscles on someone of my size (I am 5’3″ and about 120 pounds with a small frame). It has worked wonders and my jaw is a million times better!

        2.20.19 · Reply
  16. Margo said:

    I tried botox for a line on my forehead and it only cost 55.00. Yes, she was a certified board dermatologist! I just had a small area done as an experiment and therefore used only a small amount of filler. But it taught me a lot. What she did on my forehead caused my eyelid to temporarily droop. If I did it again, I wouldn’t go back to the same doctor and I would do more research.

    3.13.19 · Reply
  17. Margo said:

    I tried botox for a line on my forehead and it only cost 55.00. Yes, she was a certified USA board dermatologist! I just had a small area done as an experiment and therefore used only a small amount of filler. But it taught me a lot. What she did on my forehead caused my eyelid to temporarily droop. I didn’t exercise, get a facial or do any of the things you are not supposed to do when you get Botox. If I did it again, I obviously wouldn’t go back to the same doctor and I would do more research. It taught me that not all dermatologists are created equal and that I would never go the botox route again without more research.

    3.13.19 · Reply
  18. Andrea Swift said:

    Nice post.. Thanks for this
    I also thought there was such a stigma around Botox but tried it for the first time at 30 and really loved the results. Due to the price I am trying to limit how frequently I get it, but I saw the results and truly loved them!

    5.6.19 · Reply
  19. Mjr said:

    Can you get Botox more often then 3 months?

    6.27.19 · Reply
  20. K said:

    I have made and canceled two appointments already (which I am so embarrassed by).
    And I have scheduled a third but am so, so nervous. The problem: Family planning..
    We aren’t actively “trying,” but are planning to do so next cycle. I really appreciate your details on timing pregnancy and getting Botox. But I do wonder—is it better just to wait until I’m done having babies, or would it make no difference?
    It would destroy me if I did anything to my body that would affect a baby 🙁
    But my forehead lines are much deeper than someone my age—can you tell I worry a lot? Ha!

    5.20.21 · Reply