Will my friends and family know that I have had something done?
Hmm. This very much depends on what you have done. If you have something like microneedling or a stronger sort of laser that leaves your face very red or pocked with needle marks for the next day or two, they might, mightn’t they? Or if you have an expressive forehead full of well entrenched wrinkles and you have a huge dose of Botox so that suddenly it is immobile, again, they might spot it. But most practitioners take a cautious, stealthy approach to tweakments so that you will simply look a little fresher than before, rather than different. If you’re really worried that your friends and family will a) notice and b) judge you harshly, and that you aren’t able to tell them that it’s your face and your money and you’ll do as you like with it, then maybe try changing your hairstyle at the same time. People always notice when your hair is different, and they may think that is what looks different about you, rather than your face.
You can’t lie down or go shoe shopping for four hours after having Botox
Yes! This is not a myth, it’s absolutely true. It can take four hours for the neurotoxin to bind to the receptor sites on the neurons that it will affect, so patients are usually advised not to lie down or put their head upside down for that time. Not that the toxin is very likely to migrate from where it has been injected, and if it does, it will only be by millimetres, but it is technically possible that it could happen.
If I start having Botox, will I have to keep on doing it?
No! Reality check! There is no law that says you need to continue with Botox treatment! If you stop having treatment, your facial muscles will recover their full power and will return to bunching up your forehead and/or the eye area into normal-looking lines and wrinkles. I like the way Botox can soften lines on my forehead that are in danger of becoming embedded, but I always like to let my forehead return to its full range of expression before damping it down again, just so that I retain some rough idea of what is ‘normal’ for me. How often do I have treatment? Two or three times a year.
Botox freezes your face.
Technically, Botox doesn’t freeze your face. It just reduces the ability of the nerves that pass on signals to the muscles to do their job. So when it is used cautiously, Botox should just quieten down the muscles that are pulling the skin into folds on the face. But of course we have all seen pictures of over-treated celebrity foreheads that look unnaturally smooth and which are as good as frozen. In the olden days of Botox, 20 years ago, when the aim was to wipe out lines on the face, this happened a lot more than it does now. These days, most practitioners aim for a natural-looking result which is more about softening expression lines rather than eradicating them.
Are tweakments a slippery slope? If I start with a bit of Botox, will I get addicted to tweakments and end up wanting to have a full facelift?
Some people do get a bit too fond of cosmetic procedures and yes, it can be a slippery slope though this depends on how confident you are about your appearance and, of course, on your budget. These treatments aren’t cheap. But let’s just imagine. You start with a bit of Botox. Then you have a touch of filler. Then you try IPL to shift some pigment spots. Then you move on to a few peels, or laser resurfacing. Then you start to fret about your neck and décolletage and focus on treating these… Many people who work in the aesthetics industry and have the opportunity to try all the latest procedures do often start to look a bit strange, but most people in other walks of life don’t have the time or inclination to take their treatment schedule this far. If anything, having non-surgical procedures is more likely to result in putting off having a facelift, because they will soften and freshen the face and maybe, make you feel that there is no need to go as far as seeing a surgeon.
Does Botox give you wrinkles in other areas
Usually it doesn’t, but it’s not impossible. The most common example of this is when the forehead and the frown-lines between the eyebrows have been Botoxed. If you then try to frown or show surprise, some of the only muscles that can move are the ones at the top of the nose, which scrunch up into ‘bunny lines’ at the top of the nose – so called because it makes you look a bit like a rabbit twitching its nose.
Botox and fillers do the same thing
No, they absolutely don’t. The only similarity is that they both need needles to get them into the face. Botox is a toxin which is injected into muscles to reduce their ability to contract. Fillers are gel-type products that are used to add volume beneath the skin in the cheeks, the lips, the temples, the chin…
Botox is a deadly poison
Onabotulinum toxin A – the ingredient from which the branded drug Botox is made – is a purified form of the deadly botulinum toxin type A protein. Because it is such poisonous stuff, it has been studied extensively: there have been more than 400 peer-reviewed papers on Botox published in medical journals, and over 65 randomised, placebo-controlled clinical trials conducted on it.
Just how poisonous it is depends on the dose and for cosmetic work, Botox is used in tiny doses. When I have Botox in my forehead and around my crow’s feet wrinkles, I usually have around 40 units altogether. Botox has also been used, for decades, at around 100 times the cosmetic dose, to soften muscle spasms in children with cerebral palsy. It is life-changing when it enables a child to walk smoothly or lift an arm – but it is not an FDA-approved use of the drug and there have been a few incidents where, weeks after its use, children have developed life-threatening symptoms – so it is not risk-free.
If you go on having Botox your face muscles will waste away
Yes, if you persistently have the same muscles Botoxed into total submission, this can happen. But few people are that keen on having their face muscles totally and permanently knocked out, and each time a dose of Botox wears off, the muscles will pull themselves back into action which will remind them what they are there on your face to do.
Will Botox work for me?
I get asked this frequently – and the short answer is, Yes. A better question to consider is whether you will like the results, and that entirely depends on the artistic skill of the doctor who is treating you. Yes, artistic. Treating with Botox is partly a question of knowing how much toxin to inject in which specific muscles to gain the required result, but that’s not the whole of it. Do you want to just damp down the action of one muscle? Or take it out completely? And how will that affect the action of all the surrounding muscles? These are the considerations that every Botox doc has to bear in mind and learn to balance, along with the knowledge that every patient’s face behaves and responds slightly differently. That’s why any decent practitioner will insist that you come back for a check-up two weeks after treatment, to see how it has settled and whether any adjustments are needed.
Do I really need to go back for a check-up two weeks after a Botox treatment?
Yes. However good an injector your Botox practitioner is, it is worth having that second appointment in the diary just in case they need to tweak the result of the treatment. Otherwise if, say, one eyebrow is arching a bit higher than the other, it will stay that way for months until the effects of the treatment wear off.
How long will it last?
There are allegedly some people who are ‘Botox resistant’ but every doctor I’ve asked about this says they have never come across anyone who fits this description. If you have a fast metabolism, your body may well disperse the toxin a great deal more quickly than average, in which case for you, Botox will be short-lived/ an expensive habit.
How much does it hurt?
Hardly at all. If you are anxious or extra sensitive to injections, you can have numbing cream applied beforehand. But Botox injections are done with a very fine needle, and most practitioners have honed their technique through years of practice,
I’ve heard you shouldn’t lie down for four hours after Botox treatment
This is one of those urban myths that is hard to dispel. The theory is that maybe if you lie down, Botox might ‘migrate’ to other areas of your face. Actually, Botox and other botulinum toxins bind swiftly to the receptor sites in nerve cells and lying on your back has never been shown to cause a problem. Though you shouldn’t lie down and press the newly injected area on your arm immediately after treatment, as that might encourage the injected toxin to shift a little.
I’ve heard fillers will give you a trout pout and hamster cheeks…
They shouldn’t, but they certainly can do if they’re over-done. All wise practitioners take a less-is-more approach to fillers on the grounds that you can always add more later.
When the effect of tweakments wears off you will look older than before.
It’s tempting to think that this will happen, in some sort of karmic retribution for being so vain as to have treatment in the first place. However, all that will happen as the Botox wears off, or the filler degrades and vanishes from the face, or the thread-lift threads are reabsorbed by your skin, is that your face will ease back towards looking how it did before. Actually, it will probably still look a bit better since your wrinkles will be less entrenched, and your skin quality will have been boosted by the fillers while they were doing their work.
Fillers stretch the skin, then when they break down they leave a dent in the face
Not true, even if it sounds vaguely logical. Fillers shouldn’t be used to fill the face out to bursting point. What they are intended to do is restore lost volume where the skin has become slack. Also, it has been shown repeatedly in clinical trials that the presence of hyaluronic acid-based dermal fillers in the skin improves the strength and quality of the skin above them. That means that the skin in the treated area will be more resilient and less prone to dents than it was before.
What can leave a dent is if a hyaluronic acid filler – say, in the tear trough area – is dissolved with hyaluronidase. This enzyme is supposed to only dissolve the injected filler but it has a habit of also dissolving your natural supplies of hyaluronic acid as well, which can leave the treated area looking ‘emptier’ than before
Tweakments are unnatural.
Fair enough. Cosmetic tweakments are a hugely unnatural thing to have done. But hair dye is hardly natural, nor is make-up, though our inclination to use these things to make ourselves look better goes back to the dawn of time, and it is hard-wired into us to want to look our best by whatever means available. Cave paintings from millennia into the past show the way early humans decorated their bodies with charcoal. Ritual scarification wasn’t particularly natural, either, but it was a popular look back in the mists of time.
Are tweakments addictive?
Not physically, but psychologically, perhaps. It’s quite possible that you could start feeling that you look so much better with fewer lines on your face, you need a regular fix.
How will I know if I’m allergic to Botox?
Allergies to Botox are extremely rare but include nausea, headache, flu-like symptoms, rash pruritus, visual disturbances, blepharitis, swelling, dry mouth, dizziness and dry skin.
Could I turn out to be allergic to Botox?
Allergies are extremely rare but allergic-type reactions which have been noted include nausea, headache, flu-like symptoms, rashes pruritus, visual disturbances, blepharitis, swelling, dry mouth, dizziness and dry skin.
What are the possible side effects of Botox treatments?
Common side-effects include bruising, muscle stiffness, swelling and redness at the injection site. Swelling and redness should be gone by the next day, bruises may take a week or more to clear.
I find that my forehead feels strange the day after treatment. It’s not exactly a headache, but more a sludgy, sluggish feeling in the muscles of the forehead (as if, as one friend put it, ‘my forehead has turned into a slab of fudge’). This clears after a day or so.
Overtreatment can lead to ptosis, the drooping of an eyebrow or the upper eyelid.
Rarer side effects include allergic reactions, headaches or itching, nausea and shortness of breath, occasional numbness, drooping of the eyebrow or upper eyelid.
Can ‘Botox effect’ creams and serums be as effective as Botox?
In a word, no. Botox works by being injected into a muscle. Creams, whatever their manufacturers claim, can’t have the same effect
Which are your favourite tweakments?
How long have you got? Seriously, though – I really like quite a few. If you go to the bottom of the page and subscribe to my newsletter, I’ll send you a list of my top five.
Can I get tweakments on the NHS?
No, because these treatments are being done for cosmetic enhancement, rather than out of medical necessity!