Healthy Habits: Busting Botox Myths

By: Dr. Winnie Moses, Founder and Medical Director of Parfaire

Many patients are afraid of getting Botulinum toxin treatments because of common myths. 

They may believe that anti-wrinkle injections will freeze their facial expressions, leaving them unable to lift their eyebrows naturally; that Botox injections are extremely painful; or that if you stop Botox, your face may look more wrinkled than before you started. These myths have been debunked time and again in the media. 

But what’s rarely acknowledged is that even patients who choose to get Botulinum toxin treatments often harbor misunderstandings about it. As clinicians, it is our responsibility and even moral duty to ensure that our patients fully understand the treatments we give them, so they can make fully informed choices about their own faces, skin and bodies. But it is also in our interests, in order to prevent our patients feeling disappointment, unhappiness and even anger down the road.

The following are the two most damaging misunderstandings about Botox which I hear in clinic, usually from patients who are new to injectable treatments but also from more seasoned aesthetic patients. They both have a common theme: Expecting too much from Botox treatments.

1. If you start Botox early enough, your face won’t age at all.

Many patients seem to believe that Botox freezes the aging process, and that by acting early to combat fine lines and wrinkles, their face will look exactly the same for years to come.

Discovering that this isn’t true can come as a shock. Some patients find it hard to hear that, after several years of Botox, they’ll need more advanced treatments in order to keep their face youthful.

We need to make sure that patients fully understand the way their skin and face will age, before starting Botox (particularly if they start relatively early). Once they reach their early 40s, their collagen will have deteriorated significantly. The ligaments which support their skin start to loosen. The fat pads which keep their skin nice and plump start to shrivel and move around. 

As a result, they’ll start to see some sagging that wasn’t there before. They may start to lose volume on their face, making them look more haggard. Their skin will thin. 

In short, the signs of aging will start appearing whether or not they’ve had wrinkle-relaxing injections.  That doesn’t mean that all those years of Botox “didn’t work” - as some patients believe. And it’s a terrible mistake to resist treatments to address skin laxity because “I just need a bit of Botox.”

Botox is often the beginning of our patients’ anti-aging journey – but it’s usually not the end of it.

2. Botox treats all wrinkles

Similarly, many patients over-estimate the ability of Botox to fix the wrinkles they’re already seeing on their face. They come into clinic expecting their faces to appear completely smooth after their anti-wrinkle injections.

They fail to understand Botox’s limits. For example, Botulinum toxin can only treat dynamic wrinkles, not static lines. I frequently have patients demanding Botox for deep-set nasolabial lines, who are astonished to hear that’s not a useful remedy. Botox is used in the upper part of the face, not in the lower face. And even in areas where Botox is cleared for treatment, it will not necessarily get rid of your wrinkles entirely, particularly if they are deep. Other treatments may be necessary as well. Again, these misunderstandings are a recipe for deep disappointment if left unchecked. I’ve even seen cases where clinicians have been blamed by resentful patients for “withholding” or “denying them” Botox treatments, while in reality Botox simply could not help their wrinkles. That’s why, before treatment, I show patients a diagram illustrating the different layers of our face and how it’s structured. They need to see the layers of bone, collagen, fat and muscle in order to understand how different wrinkles are formed, where Botox goes and when and how it can help. (If you can make your explanations visual, they are more likely to stick.)

Yes, this education piece takes time. And it can be frustrating for patients who are not necessarily scientifically oriented, and who are eager to cut to the chase, to hear about our solutions or (if you’re treating them on the same day) to get on with their treatment. 

But ultimately, managing your patients’ expectations and making sure they are realistic about their results is critical to their happiness - and to your success.