1. Will it hurt?
It is uncomfortable but not too sore. I’m constantly surprised by how brave patients having this treatment are! The injections are done using insulin syringes, which have a very narrow diameter, so are as painless as can be – but they are still needles.
I find the use of local anaesthetic cream beforehand helps a great deal if someone is particularly worried about pain.
Tip: If using the cream, give it enough time to work and don’t miss out the hairline – that’s often the sorest part.
2. How does it work?
Muscles respond to instructions from your brain via signals transmitted by nerves. Nerves communicate with muscles by means of a chemical called acetylcholine. Botox works by blocking the release of acetylcholine from nerve endings, meaning that whilst it is working the nerve can no longer stimulate its muscle to twitch.
3. How long does the treatment take?
The treatment takes around 15 minutes, depending on how many areas are being treated. The very first time may take a little longer as a thorough health questionnaire will need to be completed. An effect is first seen after a few days, and the maximal effect usually occurs around 10 days after treatment.
4. Will I need a top-up? How long before I need it redone?
Because the effect is not seen at the time of treatment, it’s sometimes necessary to have a top-up at around two weeks, to obtain precisely the result you want. As you and your practitioner get to know each other, the need for this will probably reduce.
Botox lasts three or four months usually, although some people who have used it continuously for a long time find the effects last significantly longer (up to six months in some cases).
5. Where on your face/body can you have Botox?
People have been very inventive, with more or less success. The best areas for Botoxremain the upper third of the face (brow, frown area, crow’s feet). I also like to treat ‘bunny lines’ (on the sides of the nose) for a more natural result. It should be impossible to wrinkle bunny lines without frowning, so anyone who does so must have had Botox.
But there are lots of other areas that can be Botoxed. There is a Botox brow lift, Botox around the eyes to change their shape, Botox to the chin to reduce wrinkling when you speak and Botox to the palms, soles of feet and armpits (to prevent sweating). A few canny people do the latter once a year at the start of summer, and don’t need anti perspirant for the rest of the season! Then there’s Botox to the neck for overactive vertical bands (‘platysma bands’) and for migraine treatment (it really works for the right kinds of migraine) and, of course, the many other medical uses of Botox. There’s some evidence that it is effective for abnormally thick, itchy scars, certainly for symmetrisation of partial facial palsy, and even for the treatment of anal fissures (I’ve never tried it). Beyond that, some people have even tried ‘Botox breast lifts’, although both the evidence and the science for that is severely lacking.
6. Who usually has this treatment? Have you noticed an increase in men having Botox?
I still have relatively few males compared to female patients – in the order of around ten to one and, whilst women become totally ‘hooked’ and book in by the calendar, men tend to let it go and then get back into it when they eventually remember. Women also tend to have it younger than men. Women will start in their 20s, whereas men tend to come along in their 40s onwards.
The other difference I’ve noticed is that younger women (in their 20s and 30s) often ask to be totally paralysed or for an eyebrow flare (that was really big this summer), whereas older ladies and men often want to preserve some movement, just without the wrinkles.
7. Can anyone have this treatment?
Not anyone – and your practitioner should take a detailed medical history from you to check you are eligible. Botox is not recommended in pregnancy or if you are breast-feeding (although some women have inadvertently had it before they knew they were pregnant with no ill-effect).
It’s also not recommended in the presence of some neurological conditions and, of course, if you are known to be allergic to it (although there are different formulations which you may be able to use). Finally, a skin infection at the Botox site precludes its use until the infection has been treated.
8. Will people notice?
Only if you want them to! With a good practitioner, if you want it to be subtle then that’s possible, whereas if you want it to be noticed then that’s also possible (much easier in fact). The commonest giveaways are bunny lines and patchy areas of forehead wrinkling, The other more subtle giveaway is just a disharmonious look – a very active frown area combined with a less active brow area. Since cost is determined by the number of areas treated, some patients ask for just one area to be treated (the brow) although ideally they should have two (the brow and frown area). These patients need quite a complex combination of areas of full-strength and diluted Botox to achieve a subtle, ‘feathered out’ and natural-looking result.
9. Will I be able to show emotion in my face?
Yes! This is usually requested by actors for obvious reasons, and less obviously by GPs (doctors have Botox, too). My GP clients tell me that they empathise with their patients by making eye contact and frowning, as if to non-verbally say ‘how awful that must be for you’. They really struggle at their job if they can’t frown! Just tell your practitioner that you don’t want to be totally frozen! If there’s any doubt, I recommend going ‘light’ at first and topping up if necessary at a two-week check.
10. Are there any long-term side effects?
Much is made of the fact that Botoxis an exceptionally potent neurotoxin – it is – and that it could cause muscle wasting with repeated use – it could, although it appears to be temporary (if it weren’t then people wouldn’t need to come back for top-ups). However, there have been no known long-term physical side effects of Botox, despite people really looking quite hard for them. Remember it’s been in use since the early 1980s so, actually, we have quite a lot of experience of it.
There are other kinds of side effect though. First of all, if a patient has a psychological condition in which they are unreasonably preoccupied with their appearance (body dysmorphia), Botox treatments could fuel it.
Really, for the patient’s own sake they should instead be referred to a psychologist. The other long-term side effect could be on your bank balance – once you start and like what you see, it can be really hard to give up!