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A woman said to me last week—I think she was joking a bit though—that her life was marked by “before botox” and “after botox” because this substance, or really the botox procedure, had made such a positive change in her appearance and life. While such a reaction seems a bit extreme, millions of women and men every year faithfully march to doctor’s offices, typically a couple times per year, making botox injection the #1 most popular cosmetic procedure performed by physicians in the United States.

(this is not me)

One of my best friends is a cosmetic dermatologist, and two weeks ago I got a call from his nurse: could I come in right now? My friend had an unexpected opening, and he knew I “needed” a botox treatment. Since it had been about six months since my last treatment and the worry lines in my forehead had returned, I jumped at the chance and the appointment time.

(photos from http://www.botoxcosmetic.com)

I like botox for myself because over the years I developed (a family characteristic) “worry lines” in my forehead and particularly between my eyes, and when I looked in the mirror, I didn’t appreciate the stressed-worried look, even when I wasn’t. With a few botox shots, the lines literally melted away, making me feel at least more relaxed, and friends would occasionally comment (after botox) that I looked like I had a good vacation.

Botox is actually one of the strongest toxic substances known to man—a small quantity can kill you by arresting your respiratory muscles, but in very small, super-diluted doses and when applied with a fine needle into muscles, only those muscles will stop contracting, for up to six months, leaving the overlying skin free of the characteristic furrows from muscular contraction. Botox is FDA approved only for the lines on the lower forehead between your eyes (the glabellar region), but most doctors use it elsewhere around the forehead and eyes with good results. Botox can work to cut the “crows feet” lines at the corners of your eyes, but it has no place around your mouth (injection there could disturb your eating and speech functions, besides making you look bizarre), and it won’t help for the fine wrinkles caused by sun damage and inelastic, saggy skin (which sunscreens help prevent and other measures like laser could improve.)

My experience a couple weeks ago was uneventful, as my doctor friend is a true artist with the needle, ever careful not to overdue things…the best results just take the tenseness out of the forehead area without impeding facial expressions. You certainly don’t want an overdone “frozen” look, commonly seen for example in United States senators.

The procedure starts by the nurse applying a local anesthetic cream and then I lay back for about 45 minutes so the cream works to maximum effect. (A couple times I had the procedure done without anesthesia, and it’s tolerable, but much more comfortable with the cream first.) Then I sit up and make expressions as my friend carefully marks out the points for the needle sticks. Then—my eyes are closed so I don’t see the needles—about eight shots, mild pain only, a bit more in the center at the root of the nose. As for most medical procedures, the best approach while having something done is just try to be still and concentrate on slow breathing.

Then a couple superficial shots near the corners of my eyes (to kill the crows feet lines). For the actual needle part, less than 10 minutes total. Done. Then, no pain or problems at all, just slight mosquito-bite sized swellings at the site of each shot, which disappear in an hour, and for four hours, I’m conscious to keep my head higher than my heart level. In a day or so, the lines start flattening but the full result takes about two weeks. Then I’m good for a number of months. About four months from now I’ll notice the worry lines starting to return, and at about six months I’ll bother my friend again to fit me in for another session.

If you’re interested in botox, talk to any friends who may have had the procedure, and find an experienced, licensed M.D. and make an appointment. Not everyone is a good candidate, and there are risks.  While you can find family practice doctors, nurses and even skin spa personnel who do this procedure, I would only have it done by a board-certified plastic surgeon, dermatologist, or otolaryngologist (ear, nose, throat surgeon).

So for me, I’m hooked. It’s a quite simple, relatively painless procedure and I like the results. It’s a lot cheaper, easier, less risky, and more effective than many of the alternatives in the world of medical aesthetics.