Who Should You Trust to Give You Botox?

Be sure that whomever you select has done a lot of injections in the part of the face you’re interested in treating.

Now Isn’t the Time to Be Shy

“Experience counts,” says Tanzi, “However, don’t discount good communication with your doctor.”

That means not only asking a lot of questions at consultations or visits but also being clear about what bothers you on your face and what you want to look like.

“I give the patient a mirror and let them talk,” says Lamba. “Some parts of the face can bother a patient more than others, and it’s those conversations that help us understand each separate case. That is just as important as the skill of the injector.”

Ask about pain, recovery, and follow-up visits. Botox can hurt: Although the needles are tiny and the pressure light, there’s still the pinching feeling of a sharp object injecting something into your skin. And even with the best physician, there can be light bruising afterward.

Doctors advise getting Botox a couple of weeks or more before an important event. Not only does that allow potential bruising to subside, but it also lets the neurotoxin take effect. A good physician should also encourage a patient to return for a follow-up appointment at the two-week point. “At that time,” Tanzi says, “we can check in to see if the patient is happy with the results or if there is a complication or concern.”

Kate Bennett writes about personalities, lifestyle trends, fashion, and beauty.

This article appears in our November 2015 issue of Washingtonian.

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6. Check your practitioner out

Check that the practitioner has registration with their relevant regulatory authority, which here in the UK will be the General Medical Council.

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7. Make sure you’re covered

To ensure you are protected if something should go wrong, you will want to check that the practitioner has appropriate insurance cover.

8. Have a consultation

Some of the more reliable clinics will always offer pre-consultations to clients at an extra cost who are new to the procedures and want to gain more knowledge before undergoing the procedure. A good practice allows you to check out the clinic premises beforehand, this is also a great opportunity to ask the doctor any questions and let them know of any concerns you may have.

9. Read reviews

Once you have had a consultation it’s a good idea to perhaps look into reviews of the clinic as well as the brand of injectables used. Sometimes one bad review can sway your decision and may help you dodge a bullet.

10. Ensure they have a follow-up service

You may want to make sure that the clinic you choose offers a follow-up service rather than just leaving you in the dark after the procedure. If you are having Botox for the first time you will want to make sure you are getting the right result and that the doctor who administrated the procedure is available to discuss the treatment further.

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The No BS Guide to Getting Natural-Looking Botox

1. How to choose the right clinic

Botox is currently the top nonsurgical cosmetic procedure in the United States. That means there are a lot of clinics out there. It’s up to you to choose the right one.

“Limit your search for a provider to board-certified dermatologists and plastic surgeons,” says Adrienne M. Haughton, MD, of Stony Brook Medicine in Commack, New York. “These physicians are experts in facial anatomy, and their training is not limited to a weekend course, as is the case for many other types of physicians or nonphysician injectors.”

Next, check social media and the doctor’s website to see if their work matches your desired aesthetic. Think of it in much the same way you would if getting a tattoo. You’d take a good look at the artist’s portfolio, right? Do the same with a Botox doc.

“Look at previous before and after results, or if possible, see a patient in person,” suggests Joshua D. Zuckerman, MD, of Zuckerman Plastic Surgery in New York City. “If the patient is totally ‘frozen,’ then you may not want to visit that physician.”

Although you likely aren’t going to become BFFs with your dermatologist, it’s also important that you like your provider in order to feel at ease. Read online reviews to get a take on a doctor’s bedside manner.

Once you’ve narrowed down your list, schedule a consultation to see if the doctor’s philosophy aligns with yours. “It’s your face, your budget, your decision,” stresses Keira L. Barr, MD, of Resilient Health Institute in Gig Harbor, Washington. “If you feel pressured by a provider, walk away — and fast. Finding a physician who listens to your concerns and desires is key. Your doctor should be your collaborator in helping you achieve your goals, not dictate your goals.”

Find the right Botox doc

  • Consider credentials and experience.
  • Research the doctor’s previous work.
  • Check online reviews.
  • Meet the doctor face to face for a consultation.
  • Does their philosophy align with your goals?

2. Make a Botox plan with your doctor

When you’ve settled on a physician, make a Botox plan with them. Remember that your beautiful face is unique and attached to a unique individual — you! That means that your Botox plan will be different than your mom’s or even your bestie’s. And it should be.

“The most important part of creating any plan is understanding a patient’s goals and establishing realistic expectations for a patient,” Barr says. “To that end, a physician needs to educate about what Botox can and can’t do.”

And depending on your goals, you may need to visit the clinic up to six times a year for different treatments. Your dermatologist should outline all your options, including treatments not related to Botox.

Once you share your goals with your dermatologist, they should consider your age and look closely at the depth of your facial creases, says Caroline A. Chang, MD, of Dermatology Professionals in East Greenwich, Rhode Island. She prefers to use Botox to treat fine wrinkles. For deeper set lines, she looks to see how Botox could be used alongside additional procedures to achieve a person’s desired aesthetic.

Your doctor should also evaluate all your dynamic muscle movements. “I have the patient flex the muscles in the area of concern to see whether Botox is a good option and/or how much to inject,” Chang says.

In regard to forehead lines, for example, Chang examines how a patient looks with eyebrows raised, at rest, and with eyes closed.

“There are some people who have genetically heavy eyelids who compensate by keeping their eyebrows raised all the time,” she explains. “Botox of the forehead can weaken these muscles and prevent the compensatory raise.” As a result, the person would feel like their lids are even heavier. Not a good situation.

How to create your Botox plan

  • What are your goals?
  • Can your goals be achieved with Botox?
  • Consider your age.
  • Discuss supplementary treatments if necessary.
  • Consider your budget.
  • Discuss lifestyle factors.

3. Let your bank account — not you — guide your decision

What’s in your wallet also plays a role in your Botox plan of action. Botox is temporary, lasting about four to six months. If you like the results, you may decide to continue with several treatments a year.

“Respecting a patient’s budget is important, and devising a plan that accommodates both benefit and budget for a treatment is vital,” Barr says. Botox fees can range from $100 to $400 to treat a single area. Be honest with yourself if the commitment and fees are worth it to you.

Think about your lifestyle, too, and talk to your doctor about how it impacts your skin. Aging occurs because of both intrinsic and extrinsic factors, explains Barr. Our genes, ethnicity, and even certain medical conditions are intrinsic, and we don’t have control over them. We have more control over extrinsic factors, like air pollution, stress, or smoking.

“Educating the patient about the different types of aging and having a candid discussion about their particular habits, environmental exposures, as well as their diet and lifestyle choices will help guide the plan, maximize the benefits, and optimize the results,” Barr says.

Cost of Botox

  • Treatments can range from $100 to $400 to treat a single area.
  • Botox is more than one injection. Depending on your facial muscles, you may need to treat different areas of your face.
  • Botox upkeep may require anywhere from two to six sessions per year.

Botox for Beginners

A little about the author…

So a little about me I was raised in a family that eschewed anything unnatural. My mother had an organic garden, raised goats, and considered a daily shower an adequate skin care regimen. Except for the occasional concealer or blush, skin care products and make-up were non existent. Like most girls, my skin care journey started with teenage acne. My mother and two older sisters never had acne, so their advice was to scrub my face hard with Dove soap and stop eating chocolate…Skin care has certainly evolved since those days, and I am grateful that my daughter will have more effective regimens for her skin.

Why did I get Botox?

During residency, my husband Dr. Albright worked with two female plastic surgery residents who were so beautiful. Their foreheads were smooth, and it accentuated their face and brows. One time they happened to mention my husband injected them with Botox (Botulinum Toxin). This was my first exposure to Botox. After I had my second child, I noticed wrinkles on my forehead were starting to stay even when my face was a rest. Botox was so easy and worked so well! Although it is not cheap, it also was not as expensive as I thought. Since Botox weakens your facial muscles over time, it prevents wrinkles from progressing.

When should you get it?

Used for spot treatments, forehead lines which don’t disappear when the face is at rest, to create a smooth forehead look, or for general wrinkles.

The answer like most things in life is it depends….Don’t you hate that answer? Seriously though, I have tried to create a few rules of thumb. Of course this is based on my non-medical experience and reflects my own personal opinion:

  1. Spot Treatment Botox- You are constantly bothered by a line or wrinkle in your face or neck. I have a friend who spent the last two years trying every wrinkle cream and also Amazon night strips to hold the skin taunt at night. Needless to say nothing worked. To me, it was not extremely obvious, but to her, it was all she saw on her face. She was worried that she would develop deep furrows between her brows like her mother. The great thing about Botox is it temporarily paralyzes the muscles where it is injected. It will also weaken that muscle to prevent a wrinkle or line appearing or deepening in the future. After one treatment with Botox (very small amount so thus not expensive) she was hooked.
  1. Forehead Lines / Crows Feet- By late 30s most people are affected by forehead lines / creases which don’t disappear immediately when you stop raising your eyebrows. For me it was after my second kid at age 32. I noticed my forehead lines seemed to linger longer and become deeper. One round of botox, and I was hooked. After that I was starting to develop crows feet which did not seem to be fixed with skin care products. Botox treatments easily fixed them as well.
  1. ‍General Wrinkles – When I started botox I was 32, and I could not believe the results. At only 32, I had spent a fair amount of money on skin care promising great results in one area or another. Some delivered and some didn’t, but for the money and results, botox injected by a qualified medical professional can’t be beat. Usually Botox will be ~$250 for your forehead which lasts up to six months (really closer to 3-5 months) but weakens those muscles so you will have less severe wrinkles in the future. You can easily spend $100+ on a cream promising wrinkle prevention / mitigation which hardly does anything in the best case scenario and lasts three months. So what I am trying to say is, for me, botox is really more economical! …

Does Botox hurt?

So my first time, I was completely unprepared for the actual injections themselves. In my mind, Botox would be injected in a couple of places, and that would be it. My husband did my forehead and glabella, about ~10 injection sites. By the fifth shot, I was starting to hyperventilate. I was just too anxious and started breathing too rapidly. I made it through without passing out (thankfully), but the nurse had to bring me juice and cold packs. Once I was made aware of the importance of regulating my breathing, I have not had another experience like that again.

Botox has 5 – 20 Injection Sites

Although some advocate applying a numbing cream (topical anesthetic) for your first time, I have found this is not necessary after the first treatment. Topical anesthetics can require more than 30 minutes before they take affect. Not worth the wait.

The botox needle is very small. Each injection is accompanied by a slight sting which quickly fades. The number and amount of Botox to be injected depends on the area to be treated among other factors. The area between your brows (glabella) will be ~5 injections and the forehead plus glabella may be ~10 injections. A good injector should rub or hold the injection site to quickly dissipate the pain (similar to eyebrow waxing), while being careful not to displace the Botox toward the eyelids. After the first time, I think you quickly get used to the sensation. The most common side effect is a mild headache. I felt a little funny after the first time, but did not have any issues after the second time. A little bruising and bleeding around the injection site is also normal.

Who is getting Botox?

Last year over 1.5 million people had injections in the United States. After getting Botox, it is fairly easier to spot other people who have been treated, as their forehead or glabella do not move like normal facial expressions. Look around and you will quickly be able to tell too! Women who are pregnant or breastfeeding should not receive botox injections.

Where to go for Botox?

Alamo Plastic Surgery offers botox in San Antonio. In general, however, I would look for a board certified plastic surgeon or dermatologists with good online reviews (https://www.realself.com/procedures). I prefer a physician to inject my Botox. Although Botox should wear off in 3-6 months, lopsided eyebrows are not particularly attractive! Which brings up another important point, make sure you know what your injector’s revision or ‘touch up’ policy is.

Exercise / General Care after Botox?

Do not exercise or wear hats for 24 hours after Botox!

It is important to remember botox is administered in liquid forms in the areas you want to paralyze. Until the Botox binds to the nerves, the liquid can shift with movement. Therefore do not work out for 24 hours after receiving botox. I know this can be hard for everyone with a routine, but it is not worth messing it up. I do sometimes go early in the day and then still work out the next morning, but I make sure not to do any handstands! Also do not wear any hats or sweat bands for a couple of days until you see the Botox taking affect. I thought it felt a little weird to apply mascara or eyeliner at first, but after a couple of weeks I was used to it.

Frequency of Botox injections?

Botox is effective for 3 – 6 months for most people. I like to go every 6 months, but I have a good friend that says she metabolizes botox very quickly so she goes every three months.

Hope this was helpful!

Who should administer Botox injections?

Plastic surgeons, dermatologists, ophthalmologists, and otolaryngologists can perform Botox injections. For those doctors, as long as they have a thorough understanding of the anatomy of the facial muscles and have an artistic sense, Botox is easy. Other physicians, such as family doctors, nurses, physician assistants, dentists, and even podiatrists, have begun injecting Botox. I have even heard of cosmetologists injecting Botox. Let the buyer beware! These individuals have not operated on the muscles they are treating, and probably have not seen those muscles since anatomy lab, if ever. Besides, they have no formal training in facial aesthetics.
Taking advantage of the current fascination with Botox, unscrupulous physicians have even held parties with alcohol, food, and… Botox! Intimate groups of women gather at a neighborhood house, hotel room, or office and receive Botox from an enterprising doctor. There are even Botox bridal parties. The phenomenon of Botox parties shows how far some physicians will go to make money.
Medical procedures are private, not public, affairs. Procedures are performed for medical reasons, not entertainment. Botox should be injected in a medical facility, not a home or a hotel room. Very occasionally, patients develop fainting reactions. These can take place with blood drawing and do sometimes occur during Botox injections. Without proper medical equipment, this type of reaction can be life threatening. Doctors’ offices are regulated by state licensing boards for good reasons. Rules for cleanliness, safety, record keeping, and privacy are necessary; they are moot when medicine is practiced outside of the office. In a group session, privacy is impossible.
Steer clear of grandstanding doctors who offer Botox in a home or a salon. Medicine and surgery belong in appropriate settings.

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Botox is the country’s leading noninvasive cosmetic treatment.

Approved by the Food and Drug Administration (FDA) over a decade ago, Botox is designed to erase fine lines and wrinkles to create a more youthful appearance.

Millions of people receive Botox treatments each year, but despite what you may have heard not everyone can administer Botox injections.

In order to legally administer Botox in the United States, you must meet certain requirements and attend a certified Botox training course.

How to Get Certified in Botox Injections

In the steps below, we outline how to get certified in Botox injections:

1. Meet the Requirements

If you are not a physician, nurse or medical professional, you cannot administer Botox. You will need to need to show your degree, transcripts or both upon enrolling in a Botox training course, which brings us to step 2.

2. Enroll in a Botox Certification Course

There are many Botox and dermal filler training courses out there. However, you’re going to want to find one that is reputable, accredited and meets all the proper requirements. It’s also best to seek out a Botox course that has expert professionals with many years of experience teaching your classes.

Another thing to keep in mind is hands-on training. Although classroom (didactic) education teaches you a lot, it’s important to choose a course that also provides you with clinicals. This will help you become comfortable with the Botox and dermal filler injection process. There are also many esthetic schools that offer medical professionals CE/CME credits once you’ve completed training.

3. Attend Botox Training & Earn Your Botox Certification

It’s normal for medical aesthetic schools to ask for a deposit upon enrolling in Botox injection training. Once you’ve done that, you’re ready to attend.

Once you’ve completed your Botox training course, you’ve earned your Botox certification. There are states that require PAs and RNs to inject Botox under the supervision of a physician. Otherwise, as long as you’ve met your state-required training hours, you are good to offer Botox treatments to clients in a professional, clinical setting.

Learn How to Inject Botox at National Laser Institute

National Laser Institute is the leading medical aesthetics school in the country that offers cosmetic laser, Botox and cosmetic injectable certification. Courses range from as little as one weekend to a 2-week course.

Botox training with National Laser Institute includes learning from industry experts (nurses, physicians and other professionals in this field), hands-on training in a luxury medical spa and CE/CME credits upon course completion.

National Laser Institute also provides access to our online medical esthetic library for further information and resources once you complete your course.

By the end of the course, you will feel comfortable and confident performing a variety of cosmetic treatments, including:

  • Botox
  • Dermal fillers
  • Platelet-Rich Plasma (PRP)
  • Sclerotherapy
  • PDO Threads
  • Kybella
  • And more!

To learn more about National Laser Institute’s Botox Training courses, simply fill out the form on your right or give us a call at 800-982-6817.

The injection site could swell or get red or bruised, but not if you and your doctor are careful.

Expect to resume your normal daily activities right after the procedure. Be forewarned, though: Swelling could result “because the Botox is diluted with saline,” Sobel tells SELF, “but that type of bump should mostly go down within an hour. Within several hours any residual swelling should be gone.”

Alternatively, bruising could occur, though is less likely, says Rowe, especially in the hands of an experienced doctor. While he says it’s “dumb luck” whether or not one bruises from an injection, he also notes that good technique helps reduce the chances. Sobel says that “if you inject too deep, very often you can hit a blood vessel and bruise.” What you do after the injection can also make a difference: Take care not to rub or massage the treated areas, as this can cause the toxin to migrate.

In a few days (think anywhere from three to seven), you’ll have noticeably smoother skin.

“Botox inactivates the muscle,” Rowe tells SELF, “and therefore the muscle doesn’t fire and pull on skin, thus reducing animation.” However, when I asked Sobel what was happening during the exact incubation, he told SELF that “I’m not sure if anyone can give you an answer&we’ve noticed that when we inject it, it just takes three of four days for you to see the muscle contract.”

Botox can also help future wrinkles from forming.

“It has a prophylactic effect,” says Rowe. “If you can inactivate a muscle before it pulls the skin, it’ll prevent any lines from forming or getting worse.”

And once it’s in, it’s in—for about four months, until it dissipates, and treatment is needed again.

Once the protein stops functioning at the neuromuscular junction, it is broken down into its harmless components (amino acids) and either recycled for use in other proteins or excreted by the kidneys. “The bigger the muscle, the quicker you’ll see motion return,” says Rowe. “Likewise, the smaller the muscle, the longer the effect of botox lasts.” It doesn’t have a tolerance effect, either—your body never gets used to Botox.

It’s not just about wrinkles and frown lines: Botox is used to treat a variety of conditions.

The biological blocking powers of Botox are used to treat migraines, muscular disorders, and some and bowel disorders. It can treat muscle stiffness, muscle spasms, overactive bladder, or loss of bladder control, too. It’s also used to stop excessive sweating. “Botox blocks glands the same way it blocks nerves in muscles,” Sobel tells SELF. However, don’t expect to stop sweating entirely, he says. “You’ve got to sweat somewhere.” What’s more, Botox will last far longer in these sweaty situations since the glands are far smaller than the muscles treated, says Rowe.

When it comes to headaches, “the effects of Botox on migraines was actually stumbled upon,” Rowe tells SELF. “Patients who had wanted wrinkles taken care of and had migraines who got injections reported headache relief,” he says.

And its uses are growing in number.

In some cases known as off-label use, doctors are safely administering it for conditions other than what it is officially approved for, including prostate issues, and eye-crossing (known medically as strabismus) cerebral palsy—which had my jaw on the floor. Rowe even went on to tell me it’s the drug of the twenty-first century. “It’s like Tylenol or aspirin,” he marveled to SELF. “It’s what penicillin was in the mid-twentieth century.”

And while I’m personally still torn as to whether to go under the needle, at least I can effectively argue to my husband that Botox is safe for your body. And if I can win even one argument in my marriage, that’s a huge victory, am I right?

— Written by Rachel Jacoby Zoldan

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