Dermatologists debunk 13 Botox myths

• Board-certified dermatologists Dr. Rita Linkner and Dr. Jordana Herschthal debunk 13 myths on Botox.
• They talk about why pregnant people shouldn't get Botox and if patients can exercise afterwards.
• They also give tips for choosing the right injector and why experience matters.

Following is a transcript of the video.

Rita Linkner: "The Botox chemical is physically addictive." I think Botox is like getting your hair colored or your nails done. It's not like you have to, but you're going to want to.

Jordana Herschthal: "Botox is so simple, anyone can give an injection." My 2-year-old can push a plunger, but it's also very easy to mess someone's face up.

"Botox will make you look emotionless." Rita, can you tell I'm happy right now?

Linkner: That's you happy?!

Hi, my name is Dr. Rita Linkner. I am a board-certified dermatologist from New York City. I spend the majority of my day doing injectables and lasers.

Herschthal: Hi, I'm Dr. Jordana Herschthal, and I'm a board-certified dermatologist in Boca Raton, Florida, and I love talking with patients about their aesthetic goals and helping them see the full picture. And we're here today to debunk myths about Botox.

Myths from social media.

"Botox is toxic to your body." This is not true, but it's good to know the history of Botox.

Linkner: Botox gets that name recognition. It was the first neuromodulator that was FDA approved, so it's a household name, like Kleenex and Xerox. And so today we're going to be referring to Botox as that umbrella term when we're discussing all of the neuromodulators that are currently FDA approved.

Herschthal: So, Botox contains a purified protein known as botulinum toxin, which is derived from a bacteria that causes botulism, which is toxic to your body. However, Botox used appropriately in appropriate dosing is very safe and very effective. There are over 3,000 studies proving its efficacy and safety. The other reason it is very safe to use is we know that it stays where we inject it. So it's not like you're getting Botox in your forehead and it's going all over your body. Botox is limited to where it is injected, and it is safely metabolized and excreted by your body in a few months.

Linkner: I always tell patients if Botox was dangerous, I literally wouldn't have a pulse. I'm someone who puts, like, 100 units of Botox into my face and neck every four and a half months. And I have so for over a decade.

Herschthal: So, there are certain medical conditions that are contraindicated to the use of Botox. So you should have a very thorough discussion with your provider before you receive a Botox treatment.

Linkner: "Botox is permanent." So, let's debunk this one. Botox is not permanent. Everybody metabolizes Botox differently.

Herschthal: One of the great things about Botox is if you don't like the way it looks, it's completely out of your system in three to six months. But it's also the worst thing, because if you like the way it looks, you have to do it again.

Linkner: There is a super-Botox that's out on the horizon, though, that's looking to get FDA approved later this year. It's going for FDA approval for 11s in between the eyebrows, and I can tell you confidently that it works and it's going to have an indication that's going to be longer than three to five months.

Herschthal: "Some creams and serums work like Botox." This is absolutely false. Botox works at the muscular level, at specifically the neuromuscular junction, to prevent the muscle from contracting. There is currently no serum, cream, or facial that can penetrate the skin deep enough to exert action at the level of the muscle. And if it were true, it would have to have FDA approval and it would not be available over the counter.

Linkner: I completely agree. I like to tell patients, you're genetically programmed to move your muscles in a certain way, and over time you get what we call dynamic wrinkles, which are lines associated with muscle movement. And the way Botox works is it builds in resistance so that you can't overutilize those muscles anymore, you can't crease them, and it basically helps to smooth everything out.

So, next myth, "Getting Botox is super painful." I would have to say this one's false.

Herschthal: The pain of a Botox needle is pretty minimal, but it is similar to if you got, like, a splinter in your finger or perhaps a beesting. Everybody's experience with pain is different.

Linkner: They're insulin needles. They're as small as you can get. And it goes faster than people think, also. Though I think location on the face does make a big difference in terms of sensitivity.

Herschthal: And this relates to how important it is for your provider to really have a deep understanding of anatomy when you're getting any sort of injectable on your face.

Linkner: I mean, I can do a full face, a full neck of Botox in probably under four minutes. And if people are really averse to needles, you could always topically numb someone to help that pain dissipate.

Herschthal: There are other little tricks, like vibration devices and also ice. And even for patients who are really sensitive, we break out the Pro-Nox, which is half-dose laughing gas, and that always calms patients down immediately and leaves your system within five minutes.

Linkner: "The Botox chemical is physically addictive." I think Botox is like getting your hair colored or your nails done. This is how I like to explain it to patients who ask me, "If I do this once, do I have to keep doing this for the rest of my life?" It's not like you have to, but you're going to want to.

Herschthal: So, I always liken aesthetic treatments like Botox, fillers, and lasers to maintaining any organ in your system. You get your teeth cleaned two to four times a year or whatever it is; you get your aesthetic treatments because you're always aging. These treatments do not stop the aging process, but these treatments will help you age the way you want to age.

Linkner: Myth experts hear the most.

Herschthal: "Botox is so simple, anyone can give an injection." On the one hand, giving an injection is very easy. Anyone can push a plunger, my 2-year-old can push a plunger, but it's also very easy to mess someone's face up. So it's really critical that your provider has a deep understanding of anatomy and how these medicines affect anatomy to give you reproducible, great aesthetic outcomes.

Linkner: So, Jordana and I are board-certified dermatologists. It took each of us over a decade to get to the point where we were able to put a syringe in our hands and utilize the medicine in it to create facial aesthetics. Both Jordana and I, still to this day, we take courses religiously where we're learning from the best international patients and doing dissection courses. And we're still reading every day to really be the best teachers that we can be for our patients.

Herschthal: "Botox and fillers are the same." I love this myth, because I probably address it at least once a day. Almost every line on your face can be addressed with filler, but not every line can be addressed with Botox. Botox works at the level of the muscle to relax muscles of contraction. It is preventing and diminishing those static lines, or lines at rest. Fillers, on the other hand, are used to address volume loss that occurs in our face as we age. So, we all have fat compartments all over our face. And as we age, they deflate and descend with time, so we use fillers to restore that lost volume and give a more youthful shape to the face.

Linkner: "Botox injections need a lot of recovery time."

Herschthal: The only issue with Botox is if you get a bruise, but there really isn't downtime. There's about an hour after the procedure where you will see little bumps under the skin, and that's the solution of the Botox that was placed under the skin.

Linkner: You are taking a needle and putting it into your skin, so you just want to make sure that you're not doing anything to really thin your blood, which would increase the chances of getting a bruise. So ideally not drinking alcohol the night before or even caffeine the morning of really helps. If you have really high tendency towards bruising, it's nice to take oral arnica.

Herschthal: I can always tell when I'm injecting a patient. I call it the booze ooze. It's like this slow ooze after you inject, and I know that they've had a glass of wine or a martini the night before.

Linkner: My only rule that I have for my patients when Botox goes in is no exercising for six hours.

Herschthal: My only rule is don't touch the Botox, because I don't want you spreading it to a different area in the forehead or the glabella area, because you could get into trouble with dropping somebody's lid. So, the muscles that keep the brow elevated will drop, and then the patient will appear to have a heavier lid. Again, these are not permanent side effects, but they are undesirable side effects.

"Botox accumulates in the body." I wish that was true, but unfortunately it does not.

Linkner: Every week that your Botox is in, it incrementally decreases. It's not like it just turns off overnight. I will tell you, in this pandemic, I'm noticing people are exercising more, and that's making their Botox metabolize a little bit faster. So I get that question a lot. You know, "How do we make my Botox last longer?" And it is dose dependent. So if you put more in, it might not look so natural for those first few weeks, but it should get you to last a couple of weeks longer than when you were using a lower dose.

Herschthal: Myths from pop culture. "Botox will make you look emotionless." I'm hearing the hate, but I'm not seeing the hate. Rita, can you tell I'm happy right now?

Linkner: That's you happy?!

Herschthal: So, I think "emotionless" is a little bit of a strong word to describe the effects of Botox. If you have an open conversation with your provider about what your desires are for your Botox treatment, you can easily get a treatment that is more natural looking where you still preserve some movement in the upper face.

Linkner: It's been exactly eight days since Jordana put my Botox in. It hasn't peaked out yet, but it's starting to get tighter on me every single day. Do I love how it looks? I mean, I do. Do I love how my children can't tell what I'm thinking? I love that. So you really have to figure out where you want to run on that spectrum.

Herschthal: "Botox is only used cosmetically." So, Botox was actually first FDA approved in 1989. And that was for the use of two medical disorders of the eye, which is called strabismus and blepharospasm. It wasn't actually until 2002 that Botox got its first FDA approval for cosmetic indication.

Linkner: Well, thank goodness those oculoplastic surgeons were trying to treat these overexercising eye muscles, because that's when they saw that the 11s in between the eyebrows were disappearing. So it's because of strabismus that all of us don't have lines on our face anymore.

Herschthal: So, Botox has actually been around for over 30 years, and it has over 27 indications, most of which are medical.

Linkner: A very common use is for oversweating. So in the underarms, hands, and feet are places, because Botox does attack that little muscle on every sweat gland that helps you to sweat. It can turn that off so that you can decrease sweating. I've also used it medically for migraines. The list of FDA indications for medical Botox is so long.

"Only older women get Botox." Ugh! No, that's so false. I was 27 the first time that I put Botox into my crow's-feet. And I will tell you, it's something that I do religiously and have done every four and a half months for the past decade.

Herschthal: So, I like to say that Botox is not gender nor is it age specific. There's also a huge increase in male patients coming in, specifically for their crow's-feet. People are wanting to look their best, feel their best. So Botox is not age and it is not gender specific.

Linkner: "Botox works right away."

Fiona: [sighs] It's the Botox. I can't show emotion for another hour and a half.

Linkner: So, truthfully, Botox can take, it takes a couple of days to kick in. So let's say your Botox goes in Friday; you're not going to start to really feel those results into Sunday, into Monday. It takes a full two weeks to peak out. And at that two-week period, incrementally every single week you'll gain a little bit of movement back. Everybody metabolizes this stuff differently.

Herschthal: I think we look natural. I think we're doing a good job of looking natural.

Linkner: We have code words with each other. So if, like, Jordana tells me the code word, then I know I've gone to over the line.

Herschthal: Yeah, we've gone over the edge.