The Over-Anxious Angeleno’s Guide to Going Back to Botox

Dr. Dennis Gross gives his top tips and do’s and don’ts for those getting back in the chair after a pandemic-induced hiatus.

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Tilda Swinton photographed by Tim Walker for W Magazine

Finding a good Botox doctor can be a frustrating endeavor—one I like to describe as tricky. Do you choose a plastic surgeon, or do you go to a dermatologist for such a procedure? How do you communicate to the doctor that you actually like your face, but just want someone to enhance what you’ve already got, rather than having someone with a God complex impose their signature look on you? On the other side of the spectrum, what if you want to completely transform your look? How do you find the right medical professional who won’t make your face into a punchline? I’ve learned the hard way that the ones boasting “less is more” are usually those who leave you looking like a wide-eyed, startled-looking, frozen Phyllis Diller. Please do not let their stunning offices adorned with Calacatta Gold marble with backdrops of cascading waterfalls win you over until you’ve seen results on your own face.

For quite some time now, famed New York-based dermatologist Dr. Dennis Gross has managed to keep a steadfastly loyal clientele largely based on two things: his longtime medical expertise in the field of dermatology and his signature straightforward outspokenness on overhyped, ineffective skin procedures. At the tail end of winter, many will be taking care of beauty business that may have been put on pause due to the pandemic—in other words, bi-annual or quarterly Botox treatments. W thought it essential to provide some helpful reminders and direction on the do’s and don’ts of Botox—who better than Gross to give us insight into the important factors to keep in mind? Below, Gross outlines some of the most important guidelines and information we all need to bear in mind when getting ready to freshen up our faces.

First off, there are several Botox brands. Is there one that is far more superior in your mind, or one that you’ve had more success with than others? Are there some we should be wary of, or other which contain ingredients that you aren’t a fan of?

I personally use Dysport, which is one of the leading competitors to Botox. It temporarily decreases muscle movement in the target areas and softens the appearance of any glabellar lines between your eyebrows and your forehead. It's also used for specific muscle-based medical conditions such as muscle spasms and neck pain.

This question, of course, depends on one’s face and how much fat or muscle tone they may have—but is there a guideline for how often someone should get Botox?

Botox typically lasts about 3-6 months, but this varies person to person. A lot of it has to do with genetics and lifestyle choices. For example, I have some patients who use at-home LED devices combined with active ingredient-based skincare regimens and they will come in for Botox every nine months or so. I typically advise my patients to hold off on coming in for another treatment until 75-80 percent of the Botox wears off.

Many women bruise after treatment. Does this rely on the skill of the doctor performing the injection or is this because of a patient’s sensitivity to Botox? What do you advise your patients do to avoid bruising?

A skilled physician is less likely to cause bruising. However, that being said, some people are more prone to bruising and it does happen. To mitigate bruising, avoid alcohol and blood-thinning medications like Ibuprofen and Aspirin before your treatment. Taking Arnica before and after your treatment, applying ice to the injection site and taking a vitamin C supplement will help treat and prevent bruising.

Is Botox similar to filler where you can build treatment during the course of several weeks?

Absolutely. The biggest difference is that Botox takes about 5-10 days for you to see the full effects, while you can see filler results right away. You can always come in for a touch-up treatment—however, unlike filler, there is no way to go back if you overdo it.

The forehead is usually the first place someone notices visible signs of aging; then, they’ll turn to Botox. Are there places on the forehead your doctor should avoid?

Do not get shots directly in the middle of the forehead where the lines are visible—this will cause the eyes to droop. Instead, the shots should be administered in the upper forehead, lifting the brow. This is a treatment I have coined as the “Botox Brow Lift.”

Are there any less-commonly known uses for Botox?

A few examples are:

  • Treatment for overactive bladder: Botox injection into the bladder is an FDA-approved treatment for an overactive bladder, although this is really a last resort if other medications and therapies are not effective. You administer a series of injections into the wall of the bladder about every six months when the Botox wears off. However, this is not done by dermatologists.
  • Migraines: You can use Botox to decrease migraines, however this is done by a neurologist—not a dermatologist.
  • Hyperhidrosis: this is a term for excessive sweating. Botox blocks the nerves’ signals that cause sweating, in turn stopping the sweat glands from over-producing sweat. The most popular area is the under arms. You should seek another treatment every four to six months.
  • Non-surgical nose job: you can use Botox and filler to alter the shape of the nose without surgery. This is optimal for those who have a “droopy” nose. You inject an average of 2-4 units of Botox right underneath the septum of the nose. This gives the nose a lifted and lighter look by paralyzing the depressor septi nasi muscle.

Where on the face are absolute no-no’s to receive treatment?

I refuse to do Botox injections for masseter treatments—a shot that prevents your teeth from grinding. It is a blind shot. The muscle has two parts, one overlining the other. For the treatment to be done correctly, the needle has to only hit the top part; this reduces the ability to retract and grind teeth. However, there is no way to actually see the muscle and there is no way to tell how deep the needle should go. If it goes too deep, the muscle expands outward into a bulge—usually the size of a walnut, but can grow up to the size of a golf ball. The bulge is not correctable and will only go away once the Botox wears off. It can really be a disfiguring appearance. The treatment is too risky.

Who is better to administer Botox, a dermatologist or plastic surgeon? Does it matter?

When getting Botox, it is key to do your research and select a physician—either a dermatologist or plastic surgeon—who specializes in injectables and also matches the aesthetic that you are looking for. It is very personal. Botox truly is an art form and each physician has their own style. Look at the “before and afters” on their social media and websites.

Does bringing in pictures help a client convey a look they’d like to achieve with Botox, or is that nonsense?

Bringing in photos doesn’t hurt, but it’s important to keep your expectations in check. Personally, I look at each patient’s face and how to enhance their natural beauty—I am looking at symmetry and face shape, for example. That being said, be prepared to ask your physician questions and have a full discussion about your goals.

Thanks to filters and demented visual manipulations on social media, it’s only natural that in this day and age, there are many people who are generally unhappy with their appearance. Some will turn to injectables to try and fix their insecurities, but won’t see that it’s doing more harm than good. How much is too much? How often is too often?

As a dermatologist, my style is very natural. By overdoing fillers and Botox, you can actually end up looking older. The key to achieving the best results with injectables is to know how to enhance someone’s natural beauty. I am honest and upfront with my patients regarding how much or little I think needs to be done. Another important thing to remember is that Botox and filler are not a one-and-done fix. To really get your best, glowing skin, you need to be using topical skincare as well. For example, Botox and filler don’t fix acne, hyperpigmentation or uneven texture.

That said, is Botox reversible?

Botox is not reversible—the effects will wear off eventually. But this could take months. Like I said before, it is better to be conservative with Botox. You can always come in for a touch up.

How long should Botox last?

The standard is 3-6 months, however as I mentioned above, you can extend the longevity of Botox with a consistent at-home skincare regimen.

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