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?
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.
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.
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.
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.
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.
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.
"Botox is permanent."
So, let's debunk this one.
Botox is not permanent.
Everybody metabolizes Botox differently.
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.
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.
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.
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.
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.
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.
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.
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.
"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.
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.
"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.
"Botox injections need a lot of recovery time."
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.
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.
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.
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?
That's you happy?!
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.
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.
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.
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.
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."
[sighs] It's the Botox.
I can't show emotion for another hour and a half.
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.
I think we look natural.
I think we're doing a good job of looking natural.
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.
Yeah, we've gone over the edge.