Fear of Botox!

July 27, 2015
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                                                              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, that they would not do it again. This has perplexed dermatologists who know some of those celebrities did in fact have the procedure and were delighted with the results.

Some patients, celebrities included, 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 different emotions than one actually feels. For celebrities, there is fear that directors or producers will be dubious of an actor's ability to express a full range of emotions, or fear a change in facial expression over the course of filming.

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 arched freakishly. Also, facial expressions do not change dramatically over time. This result requires an advanced injector with years of experience who has an intimate knowledge of facial anatomy and function, and 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.  And in the hands of unscrupulous individuals who have injected counterfeit substances, the results can be worse than bad:  the results from this unlicensed, unapproved treatment with counterfeit products have ranged from lack of effect to dangerous side effects. The unfortunate patients who have had counterfeit treatments, or even just treatments by inexperienced individuals with unexpected or undesired results, stand out, but we don't see the far more numerous patients who have had a great result, because these results are invisible when performed well.

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, strabismus, torticollis, facial hemiparesis, overactive sphincters, and much more. Used for aesthetic purposes, it also improves self-confidence and makes one feel more in control and eases the distress of having one's emotions misinterpreted.

I will suggest to you what I would tell a member of my family or my closest friends: 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: with rare exceptions, 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 called5 Questions to Ask Before Choosing Your Botox Injector on Sheryl Clark MD's youtube channel , 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.

What are your thoughts on this topic?

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