Botox: The Ultimate Guide

Posted by Azadeh Shirazi MD on

They say age is just a number, and with Botox, it's a number you can confidently redefine. Despite the controversy surrounding this topic, it sparks countless questions and curiosity. So let’s TOX about it and answer some of the most common questions I get as a Dermatologist. I have a few different Youtube videos and an in depth podcast episode if you’re wanting to know more throughout this blog. Check them out below!

What Is Botox?

We know people get botox to diminish fine lines and wrinkles but what is it really? Botox is a neuromodulator, a protein produced by the bacterium clostridium botulinum, but now manufactured in a lab. It is known for its medical and cosmetic applications where it blocks nerve signals from communicating with the muscles it’s injected with, temporarily paralyzing or “relaxing” those specific muscles. This prevents facial muscles from wrinkling up the skin, making your skin appear smoother and tighter.  It also helps reduce the appearance of pores, lifts and open up the eyes, treats facial asymmetry, and makes small adjustments to facial structures like the lips and eyebrows. It is commonly used for cosmetic purposes to reduce or eliminate facial wrinkles and fine lines but most of all botox is used for treating medical conditions such as chronic migraines, hyperhidrosis, muscle spasms, bladder disorders, eye muscle conditions, and so much more.

Check out one of our recent More Than A Pretty Face Podcast episodes where we discuss injectables and different brands of Botox. 

 Does Botox Really Slow Down The Ageing Process?

This is a tricky question to unpack. Botox is not going to slow down the natural aging process in a broader sense. It can however slow down the formation of wrinkles, a common physical sign of aging. With great preventative care, a bi-annual trip to your dermatologist can make you appear quite a bit younger than your stated age. By injecting Botox into the facial muscles responsible for heavier expressions, (crows feet, forehead, etc.) the muscles are temporarily relaxed, they cannot wrinkle the skin, they can pull on the skin, leading to a smoother complexion. 

 When Is The Best Time To Start Botox?

I see a lot of controversy about starting Botox in your 20’s. There truthfully is nothing wrong with this, It’s not about the toxin itself, it’s more about the frequency, the dosage, and how you maintain the botox injections. If you start botox in your 20’s the odds of developing wrinkles at a younger age is definitely less likely since you are preventing the skin from wrinkling up. But hypothetically, let’s say you start getting significant doses of botox in your early twenties every 3 months. (We’ve previously said this just means you’re temporarily relaxing the muscle to prevent it from wrinkling the skin.) After 10 years of constant injections, you might start to notice signs of muscle atrophy. As they say, if you don’t use it you lose it, and this is why the facial muscles start to thin after constant sessions of botox. In short, it’s okay to start in your 20’s and you’re not going to get muscle atrophy after 4 sessions. Just be sure to take breaks and don’t over do it. In moderation it can be a beneficial preventative treatment to fight the signs of aging.

 Can you become resistant to Botox?

Possible, but highly unlikely according to the research.. It’s possible to develop some degree of resistance or a reduced response overtime, and in some people their muscles are so strong that it can take larger doses and multiple sessions to train their muscles. Let’s go into more detail as to possible causes why botox doesn’t work for you: 

  1. Antibody Response: your body starts to make antibodies to the Botox protein therefore preventing it from working.  If this is the cause, then stop treatment for 3-6 months to allow the antibodies to resolve and try again perhaps with an alternative such as Xeomin or Dysport. Avoid small doses frequently if you think you have true antibody formation. 
  2. Tolerance: People who get botox regularly may find that the muscles become less responsive after building a tolerance. As your muscles become trained they can no longer contract so even if you inject them with botox, you may not notice a significant difference.  Or the opposite can happen. Your muscles haven't been trained to relax and they are too strong for the dosage.  
  3. Variability: this can apply to dosage and individual responses. Resistance may be attributed to the incorrect dosage or administration technique. It's essential to receive Botox injections from a trained and experienced healthcare professional to ensure proper dosage and placement. It can also vary based on the individual as some people have a higher metabolism to breaks botox down faster. 

 I have a Youtube video dedicated to this that goes into more detail! Linked below.

 What Are The Potential Side Effects?

Before we dive into this question I’ll say it’s imperative to see a trained and experienced healthcare professional as botox injections are more than just beauty treatments, they are still considered medical procedures. You might experience mild pain, bruising, and temporary swelling at the injection site. In very rare cases, people may have an allergic reaction which may look like mild flu symptoms, a rash, or itching. Botox is generally safe and fortunately the results are temporary so there are no long term side effects. So if you’re thinking about taking the leap, just relax and find a trusted professional who knows what they’re doing. Read up on the reviews!

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Dr. Azadeh Shirazi, MD is a Board-Certified Dermatologist.

Specializing in medical, surgical, and cosmetic dermatology, Dr. Shirazi received her undergraduate and medical degrees from the University Of Kentucky College of Medicine. After doing a Research Fellowship at Harvard Medical School at the Wellman Center for Photomedicine, she completed her residency training in Dermatology and Cutaneous Surgery at the prestigious Mayo Clinic in addition to completing her training in dermatology and cosmetic surgery at the University of California San Diego.

She has received multiple research scholarships from iconic institutions including Harvard University and the University Of Texas Southwestern Medical Center and has several peer-reviewed publications to her name.