Inside the murky world of free Botox, where influencers and beauty editors get plumped and poked without spending a dime

• Cosmetic surgery - specifically Botox injections - has shot up in popularity over the last 20 years.
• The increase can be partly attributed to influencers and beauty editors, who often post about the procedure.
• But the relationship between the two parties can be murky, raising ethical questions about the responsibility of disclosure.

In media, influencer, and fashion-adjacent circles, it often feels like everyone - or close to everyone - is poking, lifting, and plumping their way to facial perfection.

According to the American Society of Plastic Surgeons, the total number of cosmetic procedures has increased 131% since 2000. Botox, an injection made from botulinum toxin that's primarily used to slow the development of fine lines and wrinkles, is near the top of the pack: it has skyrocketed in popularity by 459% in the past 20 years. In 2020, it became the most popular non-invasive cosmetic procedure in America.

This surge can be partly attributed to influencers and beauty editors, who often get the service - which can cost as much as a median monthly mortgage payment - comped.

Comped, or "complimentary," is another way to say "gifted." But unlike an actual gift, comped products and services from expensive beauty brands, aestheticians, dermatology offices, and medical spas have invisible strings attached. Editors and influencers are often compelled to "pay back" the places that offer these services. Typically, this gifting is undisclosed; influencers will post on social media about receiving an expensive service and fail to mention that they didn't pay a penny.

"It's just kind of like it's an invisible contract almost," a New York-based beauty editor who has received comped beauty services and used to work in traditional media told Insider. (She requested anonymity so she could speak openly without jeopardizing her position in the industry.)

But even actual contracts can be tricky, according to Kelsey Kotzur, an influencer based in New York who said she always pays for her own filler and Botox. She told Insider she heard from a fellow influencer recently that a brand wanted to "minimize the hashtag ad so it wasn't as noticeable." The influencer declined to partner with the brand, Kotzur added.

"It gives me the kind of stress that I have to divulge to my therapist," because the relationships between those offering the services and the editors, writers, or influencers can be so "tricky to navigate," the New York-based beauty editor said. "If more editors talked about it, then maybe we would all know how to handle it better."

For beauty editors, these comped services can occur in a number of ways. Typically, an editor decides to write a story about a particular cosmetic procedure. After reaching out to a handful of places, the editor will receive the cosmetic procedure and then write a story about their experience. Ideally, they'll disclose that the service was comped, but that doesn't always happen.

Occasionally, however, the method by which the editor received the service is more ethically murky.

"I've known about editors who get services that are comped. And then they'll require other writers to then talk about it, and to slip it into a story," the beauty editor said. "So it's like the chicken or the egg - does the story come first, [or] the service?"

It's difficult to know precisely how many influencers and editors receive gifted Botox or other cosmetic procedures, but it's clearly critical to beauty trends when they do: surveys and studies show that social media plays a dominant role in sending people under the knife (or needle).

Caroline Hirons, a popular beauty blogger based in the United Kingdom, said she gets offered free cosmetic procedures "daily. All the bloody time." But she always pays, she said. "I paid for my veneers while literally everyone around me was flashing their teeth all over the internet. I am told it's highly unusual, though."

According to Sarah Mendelsohn, a beauty and fashion influencer, brands typically reach out to influencers offering free services like Botox. Some influencers will disclose that a service was gifted, and some won't. Mendelsohn has a partnership with Ever/body, a New York-based medical spa that offers Botox, fillers, laser facials, and other cosmetic procedures. Mendelsohn received Botox injections in exchange for clearly-labeled partner content on her Instagram, an exchange that she said was financially fair: the cost of the Botox was roughly what she would charge for a standard ad on her Instagram page.

Some influencers make a habit of practice-hopping, too. When Insider asked Corey Hartman, an Alabama-based dermatologist with a popular Instagram account, if he ever has influencers reach out in search of free or discounted services, his response was blunt. "Um, yes. At least once a week," he says. "I'm wary of people who hop from practice to practice. I think it costs credibility when that's done."

The New York-based beauty editor said some editors will "milk" the relationships they have with PR agencies and get comped Botox or other services, such as lip fillers or facials, for weddings or bachelorette parties. The hope - typically unstated - on the part of the folks offering the services is that the editor will mention their Botox or other treatment on social media, or, ideally, in a story.

If the relationship is positive enough, or if the editor is made to feel guilty enough about the free service, there will be a kind of quid pro quo situation: the editor will continue to get undisclosed free services in exchange for the occasional social media post or write-up.

"At the very least, there's an expectation that beauty editors - many of whom are at least micro-influencers on social media - promote Botox on their Instagram. But I imagine there's a lot of nudging and encouragement to promote the product in the magazine or in the publication," said one former women's lifestyle editor.

This editor said that she's aware of one instance of literal pay-for-play, in which a print magazine beauty editor signed a deal with Botox to promote it on her personal social media account. This contract complicated the magazine's own attempts at closing a deal with the brand, though eventually the editor was allowed to keep her own relationship with Botox because "it was seen as sort of sweetening the brand's relationship with Botox." (Allergan, Botox's parent company at the time, did not respond to a request for comment.)

But mostly, she said, these relationships are more along the lines of, "'We'll give you free Botox and be very happy if you give us coverage, and if you do we'll continue to give you free Botox' and/or 'Botox bought some advertising, let's make sure they get a mention in an editorial piece - oh, and by the way, they'd be happy to give our beauty editor a free treatment.'"

Both Sarah Mendelsohn and Nicole Loher, a beauty and fitness influencer, said it's unfair and unethical to pretend to audiences that Botox and other cosmetic procedures are accessible to everybody.

"What I see a lot of influencers do, even if they get a lip filler, or Botox, they're just doing it on camera and showing the befores and afters. But they're not really talking about everything else that comes with it," Mendelsohn said, like the risks, cost, and upkeep.

Botox can cost up to $500 per area of the face, so if a client gets Botox in their forehead, around the eyes, and along the sides of the mouth, they're looking at a $1500 office visit. The effects fade, and most people need to go in every few months to refresh the Botox. Overall, the potential cost is $6,000 a year for Botox, which is out of reach for most people - even influencers and beauty editors.

Russell Frank, an associate professor of communications at Penn State University, said beauty editors receiving comped services - especially with the implicit expectation that the product will be promoted - is "a fail, ethics-wise ... if a story is worth doing, there ought to be money in the newsroom budget to pay for the treatments," he said. "Any positive review of the treatment may be tainted by the suspicion that the writer was returning a favor." There's the additional complicating factor that a journalist might receive special treatment that an ordinary, paying customer doesn't.

Disclosing that a service is gifted helps clarify to audiences that the beauty flickering across their iPhone screens takes money and time that most people don't have. It's also required: the FTC stipulates that influencers must disclose free or discounted products, whether or not the influencer was asked to post specifically about that product or service. Instagram's Branded Content guidelines, meanwhile, make clear that posts featuring gifted products should feature branded content tags.

Nicole Loher, for her part, is concerned about the normalization of these procedures through what she calls the "social media dystopia."

"The altering of our faces to look like Kim Kardashian and dropping thousands of dollars on it is a normal thing now," she says. "I have 14,000 followers, and even I consider every single thing that I post, how detrimental it could be. I just wish that people with [large] audiences would actually consider those things."

Disclosure: The author of this piece received a gifted non-invasive facial four years ago, while working at a fashion publication.

Angela Lashbrook is a health, tech, and books writer. Her work has appeared in Vox, VICE, Slate, The Atlantic, and elsewhere.