What I Wish I Knew Before Getting Botox

Heed my advice to avoid the wrong kind of “puppy eyes.”

What I Wish I Knew Before Getting Botox
Injecting a chemical into your face isn’t the kind of thing you should do on a whim. But when I found myself champagne-drunk at a Botox party on my 27th birthday, my one pesky wrinkle smack in the upper middle of my forehead that seemed to appear overnight had to go. I told my injector I just wanted that one wrinkle gone and took another swig of champagne. And like magic, less than a week later, it was almost invisible.

Little did I know that that injection was considered an off-label use of Botox. Meaning Botox is FDA-approved to treat crow’s-feet and frown lines (those lines between the eyebrows), but not elsewhere on the face. That might have been OK, as off-label uses are not forbidden and are often super helpful, but since the injector didn’t think to give me a frown injection to balance it out, the treatment caused my muscles to relax too far down my forehead, pushing down on my eyelids, and giving me what my doctor called “puppy eyes” for weeks following (it was not cute). And there was nothing I could do except wait for it to wear off.

Here’s everything else I wish I knew before getting a neurotoxin injection (Xeomin and Dysport are two others). I learned the hard way, so you don’t have to!

Finding the right injector takes time

Make sure you’re at the offices of a board-certified physician who injects very frequently (like every day), to whom you feel 100 percent comfortable entrusting your face. In some states, it doesnt have to be the doctor who does the actual injecting; there are some very talented and experienced nurse practitioners, but personally, I prefer to go to the doctors themselves. After a few consultations with injectors that felt too rushed, I found Dr. Anna Avaliani, a board-certified injector practicing in Manhattan. She talked through my concerns (particularly my bad past experience), and the equipment in her office was clearly state-of-the-art. She even used a machine called a vein viewer to scan my forehead and see where my veins were so she wouldn’t hit one (yes, please!).

Know the basics about units

None of us wants to hear that we need 100 units of neurotoxin injected into our face. But your injector shouldn’t be going below the official recommended minimums for efficacy. “Twenty units is the minimum dose needed in frown lines; 24 units is the minimum dose needed around your eyes,” Dr. Avaliani told me about Botox specifically. Factors like your natural metabolism and how expressive you are impact how much you’ll need—so what worked for a friend might not be right for you. “I have certain patients that need 100 units to achieve relaxation for an area,” Dr. Avaliani explained, “so I need to look at the muscle and the way you animate, and adjust accordingly.”

It’s not a one-and-done procedure

Because each patient responds to neurotoxins differently, it’s tough for even the most skilled injector to decipher the exact right amount on your first treatment. In a perfect world, your injector would evaluate your needs and achieve the look you’re going for in one shot. I was happy with my results, but Dr. Avaliani still saw me two weeks later to assess the look, taking notes for my next treatment.

It’s OK to do your research—but trust your injector

Don’t micromanage your treatment. Once you’ve found a reputable, experienced professional, trust that they’ve gone through the proper training and have the necessary certifications and experience (which you’re not going to get from a few hours reading on the internet). In other words, you shouldn’t be the one telling your injector what to do. Something I wish I had done my first time rather than drunkenly insisting on injecting just one wrinkle.

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