The Botox Experience


The majority of our dermatology training is in medical dermatology, but we do get exposure to aspects of cosmetic dermatology as well during residency. Last week we had our Botox practice session in which an attending walked us through the facial anatomy, the science behind Botox, and demonstrated proper injecting techniques. As a bonus, two of us volunteered to be the subjects for the live demo. Here’s what I experienced and what I learned!

What is Botox?

Botox is derived from the Botulinum toxin, a neurotoxic protein that is produced by the bacteria C. botulinum. Botulism as an infectious disease causing paralysis of the muscles, a potentially life threatening infection if respiratory failure occurs. I have seen a real life case of Botulism in the hospital before, and it was incredibly scary. In the cosmetic world, that same toxin is diluted and then injected into facial muscles to cause temporary paralysis, thereby preventing dynamic wrinkles from showing with muscle movement. Botox does NOT get rid of static wrinkles, meaning wrinkles that are present at rest, so do not seek out botox for those kinds of lines!

Botox takes around 4-7 days to start working and the effects last 3-4 months (varies from person to person). It is FDA approved to treat horizontal forehead lines, glabellar frown lines, and crow’s feet on the sides of the eyes. Your dermatologist may choose to treat other areas off label depending on the specific problem areas that are bothering you.

Who should NOT get Botox?

  • Anyone with a personal or family history of neuromuscular disease (think of how Botox works – paralyzing muscles, which can worsen your condition)
  • Peripheral nerve disease
  • Double vision
  • Pregnant or breastfeeding
  • Allergy to botox
  • Rash, open sores on the face, or any skin condition affecting the areas of injection

This is not an exhaustive list so if you have any other questions or concerns, ask your doctor before getting Botox.


botox before photos

Targeted muscle groups are highlighted here: the frontalis, the corrugators (left and right), and the procerus in the middle of the forehead

The actual injection process was more painful than I thought. We used the smallest needles, the ones that diabetics use to inject insulin into themselves daily. But getting stuck 11 times in one sitting was not pleasant. It is still a needle going into your skin. If you have ever had a TB test placed on your skin, getting Botox injected felt kind of similar, just many many more shots.

Day 1 Post-Botox









Yes, I make really weird faces when I frown. My mouth seems to need to get involved on the frowning action!

Day 4 Post-Botox








I straight up look like I’m just smizing at the camera when in reality I’m trying hard to frown. You can see that my corrugators and procerus were already weakened by this point!

Day 7 Post-Botox







Day 9 Post-Botox





Sorry these shots are so blurry! #Bathroomselfiefail

As you can see, the Botox injected into the area between my brows (procerus muscle) and the corrugators on top of the eyebrows was more effective than the injections in my forehead. I’m pretty expressive when I speak so I’m glad I can still lift my eyebrows. I don’t frown too often in real life but now when I try to frown now, I actually can’t – all that ends up happening is I squint my eyes together. It’s a strange feeling that takes some getting used to.

That’s all good and interesting but what are some of the side effects? Because Botox is a toxin that basically paralyzes the muscles temporarily, you can get some unwanted side effects. These include asymmetry of wrinkling depending on how the Botox works, uneven smile, inability to move your muscles normally, allergic reactions (rashes, itching), injection site reactions (bleeding, bruising, pain, redness, swelling), and double vision. If you experience any of these side effects definitely seek medical attention. Many times your doctor may help you fix or touch up your Botox for you for free if it’s a correctable procedure.

Any long term effects? I couldn’t find too many studies on it in the medical literature, but there was one paper looking at long term safety of Botox injections for treatment of forehead wrinkles. Over a span of 24 months, 1415 patients in this study were injected with Botox up to 9 times, women receiving 50-70 units and men 60-80 units (for comparison, I got a mere 17 units this first time). After 2 years, they found no serious adverse events. I couldn’t find any data on longer studies spanning decades, probably because Botox only became FDA-approved for treatment of facial wrinkles in 2002.

Would I recommend it?

There are many many factors to consider before deciding to get Botox injections. I don’t have any static wrinkles (lines at rest) yet, but I do have dynamic wrinkles with muscle movement. These wrinkles have never bothered me, so I would not have gone out to get Botox if not for this training session. It is controversial whether or not getting Botox before you develop static wrinkles can help prevent them from forming, since paralyzing the muscles temporarily will prevent you from moving that area a lot and causing deep lines. Once you develop static wrinkles, Botox cannot help erase those lines.

I personally would not get botox at my age (turning 29 this June) because it was kind of painful, my wrinkles don’t bother me, and it’s super expensive. My session was free since it was a practice session, but out in the real world it can go for ~$18 a unit in New York City. I got a baby dose of 17 units, but most women typically get around 30-50 units at a time, and they have to repeat it every 3 months. That comes out to $540 to $900 a session, four times a year! I’d rather spend that money on other things!

Have you ever considered getting Botox, or have you had experience with these injections? What do you think?

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