Needles can be scary, but don’t be scared of Botox.

Botox treatments offered by David Ross Smart, MD in Salt Lake City

Whenever I meet people and tell them what I do, a conversation about skin health usually ensues. I love what I do, and contrary to what you might think, I tend to enjoy these conversations. Sometimes we talk about past or current skin problems, what their friends have done before, or what they’d like to have done in the future. Some people get excited about cosmetic work, and some downplay it.

Botox is one of the first things people seem to think about when discussing cosmetic dermatology, often gets mentioned. Usually, people say they need it or want it, but frequently I also hear people say that they would never do it. They’ll play it off and say that while may be fun to think about, they wouldn’t want to do it because they don’t want to look plastic or overdone. Now, I’m not saying that everybody should want botox, and clearly wanting to avoid that look is reasonable. It’s what any normal person would think after seeing horrible pictures of now alienesque appearing celebrities that clearly have a problem overindulging in cosmetic procedures.

But to think that this horrendous appearance is the result of Botox injection is completely false. It’s a misconception, and I want to fix it.

Botulinum toxin is possibly the fundamental intervention of minimally invasive cosmetic medicine. It is a simple, quick, and affordable procedure with proven and reliable results. In the hands of an experienced or well-trained injector, the results of botulinum toxin injection can be wonderfully impressive.

The skin is like highly specialized, bio-engineered wrapping paper. And wrinkles in the skin are caused by the repeated contraction of underlying musculature that causes that wrapping paper to crease. Botox can be used to stop the underlying muscles from contracting which results in the resolution of the wrinkles in the overlying skin. The puffed-up look does not happen with a judicious Botox injection.

However, it can also be used in smaller concentrations to simply weaken those muscle contractions, rather than causing complete paralysis. I’m a big fan of this approach, especially in men. It’s also nice in younger women who want to prevent the wrinkles from appearing or becoming deeper but don’t like either the look or feel of an unexpressive upper face. That’s right people. Preventative Botox is a thing.

Another benefit of the injections is the decrease in sweat production that botulinum toxin causes in the areas in which it is injected. In my experience, this can be a nice side benefit for those that like it. It gives the face a smooth matte finish instead of the shiny glisten.

In short, the benefits are clear in a wide age range of patients, the side effects are minimal and, in the worst case, it’s only temporary. Don’t be scared of Botox!

As a side note, to make certain we’re all on the same page, Botox is a brand name. My use of the term does not refer solely to that brand, but I use it as more of a shorthand referring to the injection of botulin toxins in general for medical purposes. We also inject Xeomin or Dysport in the cosmetic clinic.

Below I’ve included a shortlist of the commercially available varieties by their molecular names followed by a shortlist of their approved medical uses.

• OnabotulinumtoxinA (Botox®, Botox Cosmetic®) – Cervical dystonia, severe primary axillary hyperhidrosis, strabismus, blepharospasm, neurogenic detrusor overactivity, chronic migraine, upper limb spasticity, Moderate to severe glabellar lines, moderate to severe lateral canthal lines, known as crow’s feet.
• AbobotulinumtoxinA (Dysport®) – Cervical dystonia, moderate to severe glabellar lines.
• IncobotulinumtoxinA (Xeomin®) – Cervical dystonia, blepharospasm, moderate to severe glabellar lines.
• RimabotulinumtoxinB (Myobloc®) – Cervical dystonia