Botox, as a cosmetic treatment, has been around since the 1980s (in the US) and since the 90s in the UK. Less invasive and more subtle than the facelifts – which, astonishingly, have been around since the beginning of the 20th century – the introduction of Botox sparked a new wave of wrinkle-free faces.
Yet, the treatment isn’t critic-free. Some say that it creates a ‘frozen’ appearance, banishing lines, yes – but also many of the expressions that make faces so unique and appealing. The procedure isn’t always entirely successful, either – there can be unwanted results, such as asymmetry or eyelid drooping.
Below, we’ve taken a closer look at the treatment to help you make an informed choice about whether it may be right for you.
What is Botox?
It’s understandable that some people are alarmed by the idea of injecting Botox because of what’s in it. It’s made from the same toxin that causes a type of food poisoning (botulism), which can be life-threatening. The toxin itself is called Clostridium botulinum and is found in soil, dust, and river or sea sediments.
Due to concerns about injecting Botox, there’s a lot of noise around a synthetic substance called Argireline, which has been developed to mimic the effects of Botox. It’s being added to various skincare products, doesn’t need to be injected, is deemed relatively safe, and can smooth out “dynamic wrinkles”. Because of this, it’s often referred to as “the Botox of skincare” and is widely considered a less risky, less invasive alternative to injectables.
How does Botox work?
Small doses of Botox, delivered via injection, can affect the nerves that send ‘contraction’ signals to the muscle. With the muscles relaxed, the appearance of the skin is softened and smoothed. Practitioners target certain muscles to create this effect.
The results of Botox injections aren’t immediate. It usually takes around three to five days for the effects to be noticed – but can take longer. Practitioners will book you in for a review two weeks later so that any areas requiring a top-up can be re-injected.
The three areas most commonly targeted with Botox are on the forehead (to reduce horizontal brow wrinkles), between the eyebrows (to minimise vertical frown lines or ‘11s’), and at the outer corners of the eyes (to diminish so-called ‘crow’s feet’).
The therapist will generally ask you to make a range of expressions – raising your eyebrows, frowning, and smiling – and mark your face with a pen so they can inject the Botox in spots specific to your face.
Depending on your pain tolerance, the injections may feel slightly uncomfortable, and the practitioner may sometimes apply a numbing cream to the relevant areas.
As the practice has developed, Botox has come to be used for other parts of the body, too.
“Botox has become an increasingly versatile treatment, far beyond its traditional use for wrinkle reduction,” says Dr Razvan Vasilas, who is known as ‘Dr Botox’ and is the founder of DRV Clinic, DRV Academy, and TR Doctors.
“Modern Botox techniques include innovative applications like the ‘Barbie neck’ for a sculpted appearance, ‘trap Botox’ to slim the trapezius muscles, and even ‘Louboutin Botox’ to ease discomfort in the feet when wearing heels,” he says.
“Other options, such as shoulder Botox, calf slimming, and even nasal slimming, showcase the growing possibilities with this muscle relaxer. Botox can also target functional concerns, such as teeth grinding, which can be reduced by injecting the masseter muscles.”
Excessive sweating can also be treated with Botox, which can substantially improve quality of life in those for whom the problem is embarrassing and uncomfortable.
What are some of the risks and downsides of Botox?
Results are variable
Every person is different and, according to Dr Vasilas, everyone metabolises Botox differently – so it’s important to understand the limits on what one might reasonably achieve from using it.
“Choosing a qualified practitioner is of paramount importance,” says Dr Laura Geige who, as well as being a GDC registered dentist, is also an aesthetician with level 7 qualification in medical aesthetics.
“I’ve seen unfortunate consequences of poorly administered Botox, like drooping eyelids or a ‘frozen’ expression, often due to incorrect technique or overuse,” she warns. “ Botox is a medical procedure requiring in-depth anatomical knowledge.
“In my practice, thorough consultations are essential, where I listen to clients’ concerns, assess their facial structure, and fully explain the procedure, including potential risks.”
It can carry unrealistic expectations
The rise of social media has also played a role in how Botox, and expectations about its efficacy, have evolved. “There’s a need to address the pitfalls of overuse and unrealistic expectations,” says Dr Geige.
“I’ve observed a trend towards over-filled faces and unnatural appearances. I firmly believe less is more, aiming to enhance, not erase, natural features. I strive for subtle improvements, making clients look like refreshed versions of themselves. I caution against chasing perfection.”
Equally, she says, “while Botox improves wrinkles, it’s not a magic bullet. I encourage embracing natural ageing, viewing Botox as a tool for enhancement and not a complete transformation. This balanced approach, in my experience, yields the most satisfying and natural results.”
Temporary side effects can include bruising, swelling, headaches, and a ‘frozen expression’
A 2019 study published by PMC (PubMed Central) distinguished between two types of “Botox-related adverse events” – one of which related to short-term, harmless events, and one of which had to do with more serious issues.
As far as the former is concerned, Dr Raffaella Gabassi says that “some potential downsides include temporary side effects like bruising, swelling, or headaches. There’s also the risk of looking ‘frozen’ if too much is used or if it’s not done by a skilled professional.”
Another aesthetic implication – usually linked to improperly administered Botox in the forehead – is blepharoptosis, a condition in which the upper eyelid droops.
“Crooked eyebrows are another possibility,” advises Dr Veronika Matutyte, MD. “These potential side effects are why I strongly emphasise the importance of having Botox administered by a licensed and experienced healthcare provider. I believe this is the only way to ensure the highest standards of safety and efficacy.”
Injectors aren’t always regulated
Recent events in Sydney, Australia, add weight to her words of caution, with three women having been admitted to hospital after receiving Botox injections from an unregulated injector at home.
The PMC study also points out the overall risk of infection from improper injecting. To avoid this, therapists should properly clean the area to be injected and instruct clients about aftercare, such as not touching the area or applying makeup for at least six hours.
Dr Joseph Ambani, of Glow Bar London, is at pains to reiterate the fact it’s critical to consider the qualifications of the practitioner. “Botox should only be administered by someone with comprehensive knowledge of facial anatomy and a deep understanding of the technique,” he says.
“The risk of side effects can be minimised with proper assessment, including understanding your medical history and personal goals.”
How long does Botox last?
“It’s important to remember that Botox’s effects are temporary, typically lasting between three to six months, necessitating repeat treatments for sustained results,” cautions Dr Matutyte. After this, the ‘frozen’ muscles will relax, and fine lines and wrinkles will be visible again.
“The ongoing cost needs to be considered,” agrees Dr Gabassi. “It can add up over time since treatments typically need to be repeated every few months.”
Therefore, unless you’re looking to use Botox as an occasional treatment – before an important event where you want to look your best, for instance – you’ll need to factor in upkeep and the attendant costs. In the UK, you can typically expect to pay around £200 for the three most common areas: forehead, crows feet, and frown lines.
Over the course of a year, this could be in the region of £800. But can you cut costs and just have one area injected? Regular Botox user Louise Paxton* says that she learned the hard way when it came to this.
“My main area of concern was the horizontal lines across my forehead, so that’s what I went in to have treated,” she says. “When the therapist suggested that I have my frown lines and the outer corners of my eyes done at the same time, I felt as if I was being upsold, so I declined.
“Within a few days, my forehead had smoothed out, but I’d developed a brow that I’d describe as Neanderthal – jutting and low-hanging. When I went back to the therapist, they told me that when one area of the face is deactivated, it can over-activate another area. This is why all three areas are advised, and that’s what I’ve done ever since – with no ill effects.”
What other considerations should I have when using Botox?
According to Dr Vasilas, there’s been an alarming rise in the use of ‘fake Botox.’
A report published by the University of Rochester last year claimed that consumers in New York and eight other states [had] experienced serious symptoms after receiving injections of what appear to be “fake” versions of the anti-ageing cosmetic treatment. Some required hospitalization.”
But how are you to know that you’re being injected with less than the real deal? Again, putting yourself in the hands of a licensed and reputable practitioner is a must – but, even then, says Dr Vasilas, clients should “always ensure the practitioner opens the Botox vial in their presence, safeguarding authenticity and trust.”
Another warning signal could be cost: if the price seems too good to be true, it probably is. It’s worth doing your research into average clinic costs in your area to gauge whether a ‘bargain’ is really a bargain.
And – as the recent event in Sydney has demonstrated – a home setting is not the appropriate place for an invasive procedure. “To prevent getting botched Botox shots, injections should be performed in a medical setting that is hygienic, safe, and medically equipped,” writes Barb Ficarra, for the University of Rochester report.
“Beware of anyone offering to do Botox injections in someone’s home. That’s not an appropriate place for a medical procedure.”
Final thoughts …
When administered correctly by a qualified practitioner, it seems that Botox can have pleasing results, resulting in a more youthful appearance without looking mask-like.
However, there are cautionary tales to be aware of, as well as a recognition of ongoing costs.
If you decide to try Botox, be sure to do your research first, and perhaps speak to a handful of different practitioners, so that you get a feel for the ones who will address your concerns in a professional, informative, and reassuring way.
Do you have any experience with Botox? We’d be interested to hear from you in the comments below.
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