Why I’m Taking a Break From Botox
By Carita Rizzo
October 27th was the last time I did Botox. It may not seem that long ago, nor may the exact date feel important, but it set in motion a stopwatch inside my brain. It wasn’t my first time getting injected with the neuromodulator; I’ve been swearing by wine, cheese, and Botox as my skincare routine since Zoom revealed the truth about my aging process. It also wasn’t my first visit to this derm — a highly recommended cosmetic doctor I saw on the regular. This was, however, the first time I couldn’t move my forehead for almost six months.
Every day, week after week, I would wake up, stand in front of the mirror, and try to frown or raise my now-heavy eyebrows. Nothing. I’d run my microcurrent device over my forehead. Nothing. An hour of downward dogs would result in a few expressions, then it was back to our regularly scheduled programming of nothing. For three months, my Teflon-like forehead was solid as a rock. If I didn’t normally emote like Animal from the Muppets, it might not have been an issue. For some, maybe this is the desired effect. I, however, felt like a Klingon: Taut, shiny (or glassy, as they say), with the sides of my forehead bulging ever-so-slightly.
I blame myself. When my French doctor said, “You want it American-style?” I should not have answered, “We don’t have to go crazy.” I should have said, “No,” or at least made him articulate what that meant. It was not unlike the time another Botox provider said injecting the dimple in my chin would lower it nicely. This was in conjunction with a conversation about how I could preserve my jawline as middle age set in. Not once did we discuss how that is the muscle that controls the lower half of your mouth. It was several days later, when I found it tiring to talk and difficult to smile with my mouth open, that I discovered its purpose. Thankfully, the lesson lasted only one month. And my jawline did look great, even if I appeared smug for weeks.
Now I felt like a spokesperson for the “What did she do to her face?” movement. It made me wonder if we all weren’t being a little too quick on the draw when it comes to Botox, and if more conversations should be had about the effects of paralyzing the muscles in your face and neck. They do, after all, have a job. Like, for example, helping you swallow, which I’d also found difficult after my last appointment.
When I tell LA-based aesthetic nurse practitioner Ginille Brown, who has not treated me nor any of the women in this article, about my experiences, she tells me that injecting Botox in the center of the platysmal bands is likely to make swallowing harder, a fact that comes as news to me. “I give patients that warning,” she says. “It’s the responsibility of providers to educate, because patients just might not know. That’s what I would want when I’m going to get my car fixed, to get a pap smear. I don’t know what’s happening. I am really relying on that expert to give me feedback on what I should be looking for. That’s our duty, because if something comes up and the patient didn’t know this could have happened, that’s not fair.”
The thing about cosmetic procedures is that you always feel alone in discovering their downside the hard way. It was not until my own “mishaps” that I started polling friends for theirs. It turns out that while we all love the perks of Botox, almost everyone has at least one story to tell of paralysis gone wrong.
Valentina, 40, swears her first experience with Botox is likely to be her last. “It was the year leading up to my 40th birthday, and I thought, this would be a good age to try it,” she says.“Everybody else I knew raved about it.” She went to a personal acquaintance and, after her first visit created no results at all, received a top-up two weeks later. “Within a few weeks both of my eyelids were drooping, my left eyelid more noticeably so – and I could still see all the lines in my forehead, which was the whole point,” she recalls. It took around three months for her face to return to normal. “I literally wanted to stay inside for a month,” she says. “I hated the whole thing and swore I’d never do it again.”
While Valentina’s experience could be chalked up to an unfamiliar provider, Lisa, 50, has been going to her cosmetic doctor for 20 years. “He is one of the foremost experts on injectables,” she says. “I have never had a problem before.” But the last time she went in for her standard injections, she, too, ended up with a droopy eyelid. “I needed to use special drops for glaucoma that raised my lid, just to get through the day,” she says. “And you get horrible headaches from having a droopy eye. It was traumatizing.” Similarly, Botox injections from her regular provider to her marionette lines turned Ava’s smile into a grimace. “I hid my mouth behind my hand for months,” says the 35-year-old. “Exercise and face yoga helped move it along, but it was about five or six months until I could smile properly.”
Brown points out most adverse effects can be corrected but, more importantly, no provider should rely purely on patient history when injecting neuromodulators. “Every time my patients come in, even ladies that I’ve been treating for 10 plus years, it’s a conversation about where they are at right now. Their face is different,” she says. “It’s not just, ‘Do what you did last time.’ We’re talking about, ‘Should we adjust the dose?’ I’m really trying to get information from my patient to clue me in on how I drive their treatment.”
She also has reservations about injecting certain muscles, like the marionette lines. “This muscle is so tiny, so there is a possibility your smile could become asymmetric. I don’t know if it’s worth it,” she says. “I’ve had patients come in from other providers asking, ‘Can you fix it?’ That one you kind of have to wear off. You can put glaucoma drops in the gum line and it will help, but it also gives you diarrhea.”
Again, information that might be better received beforehand. And it is, of course, not just neuromodulators that can have undesired consequences. Filler, which I have also used, can come with rare, but scary, side effects.
Jennifer, 39, had received injections to the tip of her nose multiple times from the same plastic surgeon, but a few days after her latest appointment she noticed swelling and redness on the side of her nose. “My nose was sore, like a sunburn. I noticed the red getting darker, almost blue, and small pimples appearing in the same area,” she recalls. “I started to panic. Nothing like this had ever happened to me in the days after an injection.” At 10pm, she messaged her surgeon, who didn’t return her call until the next morning, when he arranged to meet her at his office. He confirmed her worst fears: The filler had created a vascular occlusion, but the surgeon himself had little personal experience with the situation. Anxious to get a second opinion before – as Google suggested – necrosis set it, Jennifer asked two close friends to contact every plastic surgeon they could find. On a Saturday, only one responded. Thankfully, a hyaluronidase flush, four days in a hyperbaric oxygen chamber, oral steroids, and nitroglycerin cream lowered the swelling that had blocked a blood vessel in her nose. In this case, everything turned out okay. “A year later, I still have nightmares about that weekend,” she says. “Another plastic surgeon, as well as a leading expert in the field, confirmed I almost lost my nose.”
Brown reiterates that the risks are rare, but can be serious. “You want to be mindful for typically the first 48 hours,” she says. “Patients need to be able to reach their provider in case of an emergency. Our phones are covered twenty-four seven.” She also recommends clients be vocal during their consultations. “Ask questions, be active in the treatment planning. Do the consult. You should feel like when you’re asking questions, they’re not annoyed – that they want the questions and they’re able to answer them,” she says. “And make sure you’re doing your part, too, following the post-care instructions.”
Thankfully, in my case, the muscles in my face are slowly starting to regain movement – it is, as Brown says, only a temporary commitment. That also means the lines will be returning. I feel a craving for my biannual Nefertiti lift, but can’t yet make peace with the inability to swallow that I experienced last time.
Don’t get me wrong, this is no attempt to promote “graceful aging.” That would be hypocritical of me. After all, I’m still armed with an arsenal of serums and at-home devices, and an endless fascination for advances in skincare. If I could stop the clock now, I would. But will I go back under the needle? If I do, I’ll definitely be a lot more discerning.