Questions you should ask before getting Botox

Ever since Botox was approved for cosmetic purposes in 2002, it's become one of the most popular non-surgical ways to look younger. According to stats released by the American Society of Plastic Surgeons, there were 6.7 million Botox procedures performed in 2015.

But what is exactly is Botox? Allergan, the company that manufactures the drug defines it as "a prescription medicine that is injected into muscles and used to temporarily improve the look of both moderate to severe crow's feet lines and frown lines between the eyebrows in adults."

So how do you know if Botox is right for you? I asked Dr. Babak Dadvand, a double board-certified plastic surgeon in Beverly Hills, who says the first step is taking a long hard look at yourself in the mirror. "The best candidate for Botox is someone who has lines even when they are not making expressions," he recommends. Here are some questions to consider asking yourself — and the professional performing the procedure — before taking the plunge (of the needle, that is). 

Is your medical professional qualified?

While it's becoming just as easy to book an appointment for Botox, as it is for a manicure, that doesn't mean everyone is qualified. Dr. Sal Nadkarni, aka Dr. Sal, is a Los Angeles-based Botox expert who previously conducted research studies on the drug. He currently owns mobile medspa Rejuvenation in Motion. "These days it seems like everywhere you look there's a new medspa opening up, with anybody and everybody administering Botox. Each state however has specific regulations that describe who can, and can't, administer Botox," he revealed. "In California, licensed physicians (MD or DO) are allowed to administer Botox, regardless of board certification. Physician's Assistants (PA), Nurses (RN), and Nurse Practitioners (NP) are also allowed to administer Botox if they are under the supervision of a licensed physician. In California however, estheticians and medical assistants are not allowed to administer Botox."

Even other types of medical professionals are starting to offer these services, as Dr. Sal revealed, "Some dentists these days are administering Botox for cosmetic purposes. Dentists are also governed by state regulations though on their ability to cosmetically administer Botox."

Dr. Sal shared one more tip to keep in mind, "Regardless though of whether your Botox injector is a physician, PA, RN, NP, or dentist, it's important to ensure that the person has had official training in cosmetic injections, and is a certified injector." Never be afraid to ask. 

Are there any risks or side affects?

According to Dr. Dadvand, "There are no significant risks with Botox." But that doesn't mean you shouldn't consider a few things before having the procedure. He says, "There is a risk of bruising or swelling at the injection site, but this is temporary." So if you have an event coming up, it's probably a good idea to schedule your Botox a few days in advance.

Dr. Dadvand also suggests planning your day around the procedure, "Typically patients should not exercise or lie down a couple hours after the injection. When people exercise they usually activate their facial muscles, which might cause the Botox to move to adjacent muscles. The same with laying down right after the injections." 

If you suffer from certain medical conditions, Dr. Dadvand suggests getting approval from your regular doctors first, advising, "Patients who have a neuromuscular disorder like myasthenia gravis or multiple sclerosis should get clearance from their neurologists." He also warns that pregnant women should not receive Botox injections.

Do I need Botox or something else?

Some people think they need Botox, when they really need fillers instead. I spoke with Nurse Nataly of iGlow Med Spa in Beverly Hills to clarify the difference. She explained, "Botox is used widely for dynamic wrinkles. For instance, in between the eyebrows, around the forehead and wrinkles around the eyes to stop muscle movement that results in wrinkles."

She continued, "Botox, though it delivers magnificent skin-smoothing results, will not be able to fill sagging or drooping skin. Dermal fillers including Restylane and Juvederm use a substance called Hyaluronic Acid that is produced naturally by your own body to fill the volume loss due to signs of early aging. Depending on the filler chosen by your professional, it can last you six months to two years. Fillers can be used to fix many concerns related to aging, including volume and smoothing out the deep creases that run from the nose to the mouth, plumping lips and smoothing out lines around the edges of the lips, augmenting cheeks to enhance the shape, filling out hollows under the eye area and increasing volume to fill out gauntness in the lower cheek or temple area."

To make your face look its best, Nurse Nataly suggests using a combination of both, "Botox and fillers work in different ways and many people choose to use them simultaneously because the combination can produce a remarkably more youthful appearance."

Is this the right time to be doing this?

Many people want to get Botox before a big event such as their wedding. But in order for the drug to work properly, the timing needs to be right. According to Dr. Dadvand, "Botox typically lasts three months. This can vary by a few weeks from person to person. It can take up to seven days to fully work, but most people begin to notice the effects after two to three days."

In order to avoid any problems, Dr. Tsippora Shainhouse, Beverly Hills-based board-certified dermatologist and clinical instructor at the University of Southern California, suggested to me that it's best to have an open dialogue in advance. "Let your provider know your timeline, so that they can guide you regarding when you should come in for treatment," she says.

She also suggests being prepared, saying, "Know that you might bruise, and this can happen to anyone. It is usually obvious at the time of injection, so bring along some cover up makeup, if you want to hide any telltale signs."

How much will it cost?

Because Botox is a cosmetic procedure, it can get pricey. In general, cost is contingent upon your location, who's doing the injecting, their experience, and how much product is used. While asking about the price can be uncomfortable, Dr. Shainhouse suggests biting the bullet and asking beforehand, saying, "Some physicians have a set-amount that they charge for a single area on the face, such as the forehead, while others charge per unit of Botox administered. If it is the latter, ask how many units they intend to use, so that you know if you can afford the treatment."

LexRx is a Massachusetts-based cosmetic firm specializing in Botox and fillers, as well as lash enhancement. Modeled after Drybar's business plan, LexRx offers their customers a menu of choices with the pricing listed outright. Like Drybar, the services have clever names including Pretty Peepers (crow's feet Botox injections) and 86 Those 11's (for the visible lines between the eyes). This model means there will be no surprises when the bill comes, while avoiding the potential awkwardness of asking about what various procedures cost. 

What should I do before and after the procedure?

If you've ever had a shot, you know your skin does not always feel its best after getting injected. Luckily, Botox won't irritate your skin too much, but you can always take precautions. According to Dr. Dadvand, "Swelling is not very common, but using an ice pack for ten minutes or so right after the injections could help."

If you want to make your Botox last longer, Dr. Brian Dorner, a top plastic surgeon based in Columbus Ohio, shared an interesting tip with me. He suggests taking zinc supplements, "Zinc supplementation has been shown in studies to prolong the effects of Botox. Taking it for four days before your treatment can prolong its effect. Botox requires enzymes that rely on zinc so this does make intuitive sense. Further studies would need to be conducted to determine exactly how this works, but for patients that want a little extra boost from their Botox, I always recommend it."

Am I too young to get Botox?

If you've ever wondered if you are too young to get Botox because you're just starting to see wrinkles forming, you probably should have started it yesterday. According to Dr. Dorner, there isn't a specific age you should start getting Botox. It is entirely dependent on the condition of your skin. 

"Botox works best when started early," he says. "When you first see a wrinkle forming, it's best to have a consultation to determine whether Botox can be used to halt and reverse its progression. Botox works best as a preventative measure. If started early enough, wrinkles won't have a chance to form. I tell my patients to consider Botox when they first see a wrinkle that they do not like. Starting Botox before it has a chance to form works best." 

Can Botox help with other issues?

You might not realize that there are many non-cosmetic uses for Botox. Dr. Sal spent years working for the parent company of the drug, Allergen. During that time, he conducted a variety of research studies on how Botox can be used non-cosmetically. It turns out that for several conditions, Botox can really be life-changing. 

"Botox has been coined the wonderdrug of the last ten to fifteen years because of all of its approved uses as well as numerous off-label uses," he explained. "Botox has been FDA-approved to treat excessive underarm sweating, to prevent migraines, and to treat overactive bladder. It also has been used in numerous off-label uses as well, such as treating chronic pain, lock jaw, and plantar fasciitis (heel pain)." If you have, or believe you have any of those conditions, ask your physician if Botox could be part of your treatment plan. 

What is the future of Botox?

Everyone is always looking for the "fountain of youth" or newest thing when it comes to anti-aging products, but maybe the newest thing isn't always the best choice. 

For the time being, Botox is king, according to Dr. Sal, who says, "Although a few botulinum competitors have been approved since then, [such as] Dysport and Xeomin, as yet, no other non-botulinum drug has been developed that has better effectiveness to treat facial wrinkles. So until the next big thing comes along which still could be years away, millions of us will still have to rely on Botox to fight those forehead wrinkles, frown lines, and crow's feet!"