The WhatsApp group that I share with my best friends ebbs and flows with conversation. Some weeks there's a constant flurry of chatter—subjects range from prospective new jobs and disastrous dates to the latest TV show we're all binging—and at other times there are quiet whitterings between just two of the eleven members. However, there is one topic that always guarantees to get the entire group talking: Botox.
Since we hit our mid-30s, it has become something that we discuss far more frequently than we ever did before. Of the 11, only one has had the treatment. Which, considering how much we discuss it, is surprising. As the only beauty editor in the group, it might also surprise you to learn that up until two weeks ago, I was one of the ten who hadn't. I have avoided Botox for years, partly down to a needle phobia, partly because I didn't think I was ready. I was always quite happy with a slight crease here and there. But then a year ago, I really noticed a dramatic shift, not just in my skin, but the way I felt about it too. I obsessed over the deep 11 lines in between my brows, even after a decent night's sleep, I somehow always looked tired, and it seemed that my face, much like my boobs, had decided it was time to really embrace gravity. Where before I had been ambivalent, suddenly I was an enthusiastic contributor to the Botox chat.
The main Botox discussion points were, as you'd imagine: What's the difference between baby Botox and preventative Botox? Can you get it if you're trying to get pregnant? Where on the face do they inject? And really, truly, is it possible to get it and not look frozen?
So, I decided the time had come. I needed to pull on my big girl pants, take the plunge and overcome my fear. That way, the next time the conversation kicked off in the chat, I would be armed with the answers.
I went to visit one of my favourite people on Harley Street, Dr David Jack, an aesthetic doctor whom I've known for years and who has a stellar reputation for subtle tweaks. I knew he would do a fantastic job. I went armed with a forehead that creases when I'm at rest and a Notes app filled with questions.
So, please do consider this your handy guide on what to expect during a Botox treatment and onwards.
What happens in a Botox appointment?
My appointment was at 4.30 on a Thursday afternoon. I arrived a little beforehand and was told immediately to lie down on the bed by Dr Jack. At first, we discussed my main skin concerns and why I had come. He then asked me to raise my eyebrows, squint my eyes and frown whilst he filmed each movement to see what my range of movement was. Afterwards, he showed me where he would be injecting by drawing little dots in the exact spots and explained why. He applied numbing cream (which is not standard practice, but a welcome one) and then we chatted for a bit to let it take effect. After a little while, he got to work and injected the infamous potion across and between my brows, to the sides of my eyes and along the top of my forehead. Once it was all over, he wiped the area with a gentle cleaning solution, we talked about aftercare, and I was sent on my merry way. I was out the door by 4.45.
Does Botox hurt?
I consider myself someone with a very low pain threshold, and I can honestly say that it wasn't painful. I appreciate that I was fortunate to have numbing cream applied beforehand, but the needles are so fine and each injection is over faster than you have time to think about it. If you're nervous about pain, it might be worth considering numbing cream in your decision-making.
How much is injected?
This is completely dependent on a number of things that are assessed during the initial consultation: muscle strength, facial structure, age, gender and the desired effect. "Someone with a very expressive frown and strong glabellar muscles may need double the dose of a more petite individual with lighter expression," explains Dr Jack. "I always start by watching you talk, smile, frown and laugh to understand the dynamic movement of your face. Dosing is then individualised based on the response as some people will need more or less, depending on their response the first time." He says there is no longer a place for a 'one-size fits all' approach. Well-trained, properly experienced injectors have turned Botox "from something standardised into something much more of an art that is learned over time."
How many Botox injections should you expect in a single appointment?
Dr Jack says that for a standard upper-face treatment, there can be between 15 and 20 injections.
What happens to the fluid once it’s injected and then over time?
What's injected into the face is a saline solution that contains the freeze-dried form of the neurotoxin protein. The saline is absorbed by the body within minutes (which explains why you get little bumps directly after the injections), leaving the protein behind at the nerve-muscle junction. "The protein binds to the nerve endings within hours. Over the course of three to four months, your body naturally regenerates new nerve endings, and the blocked ones are bypassed," explains Dr Jack. Eventually, muscle activity returns to normal, which is why you have to get top-up treatments. Dr Jack was keen to stress that research has shown that nothing lingers or accumulates in the body.
How long does Botox take to kick in?
I filmed myself doing the three movements—squint, frown and raise my eyebrows—that Dr Jack asked me to perform in the initial consultation, almost every day following my appointment. I noticed a big change to my eleven lines four days after, which plays nicely into Dr Jack's suggestion that it takes between three and five days for the early effects to kick in. The full effect, however, is seen two weeks later, which is when you should be offered a follow-up appointment (especially if you are new to Botox) to check that you are happy with the results. It also gives the practitioner an opportunity to check that the balance and dosage are exactly right.
How long does Botox last?
According to Dr Jack the average is around three to four months. However, he also said that everyone metabolises it differently. Some people might see the results last up to six months, where others, often those who are very athletic, might see them drop off much faster.
What is the four hour rule?
After your treatment it is recommended that you stay upright for four hours. "The theory is this reduces the very small risk of the product diffusing into unintended muscles," explains Dr Jack. "Which could affect the result, although there is no actual evidence for this rule."
What are the Dos and Don'ts before Botox?
It's best to avoid alcohol, aspirin and ibuprofen for a day or two beforehand, as they can increase the likelihood of bruising. Arrive with a relatively clean face, no heavy make-up. Always talk to the practitioner about any medications you're taking.
What are the Dos and Don'ts after Botox?
Dr Jack tells me to avoid touching or applying pressure to the area for the rest of the day. It's also not advised that you get a facial, go to a sauna or do any intense exercise for 24 hours. I was quite surprised when he told me that I could carry on with my normal make-up and skincare routine straight away.
What happens if you decide you don't like it?
As Botox is temporary, your face will return to how it was after a few months.
What happens if you have it regularly and then just stop?
"If you stop, your muscles regain their full activity and your face continues to age as it did before," says Dr Jack. "There’s no rebound or accelerated ageing. In fact, you’ll probably be slightly better off than if you’d never had Botox at all, because you’ve reduced the tension of the muscles on skin during the time you were having treatment."
How do you find a good practitioner?
This is the question that constantly comes up amongst my friends. I was incredibly lucky to visit Dr Jack, but how do people, like my friends, who don't have Dr Jack on speed dial, find someone guaranteed to do a good job? Dr Jack stresses that it's so important to seek out a qualified medical professional and not a beauty therapist. He recommends a GMC-registered doctor, GDC-registered dentist or in some cases an NMC-registered nurse prescriber. "They should have proper medical experience with specific training in aesthetics," he says. "Ideally, they should specialise in this field rather than offering it as a sideline. Look at before-and-after photos of their own patients (not stock images) and ask how long they’ve been practising. You should also see them for a consultation and make sure you feel comfortable with their approach. You should also check your clinic is Care Quality Commission registered (CQC)." He also says that there's nothing better than a personal recommendation, so if you know a friend who is happy with their results, that's a great place to start.
What's baby Botox?
Baby Botox and preventative Botox are both marketing terms. Baby Botox refers to a more delicate approach, using smaller doses vs the traditional freezing method. This is something that Dr Jack likes to do for his patients, especially the new ones and the ones who still want to be able to move their faces.
Preventative Botox is the idea of softening fine lines before they become deeply etched into the skin. "By keeping movement lighter in your twenties and thirties," says Dr Jack. "You can significantly slow the progression of static wrinkles." However, he's slightly on the fence about this one, as he only really does Botox on people when lines have appeared.
Can you get Botox when you are or trying to get pregnant?
Botox isn't recommended if you are trying to get pregnant or are in the process of doing IVF. "There’s no clinical evidence that it’s harmful, but because no ethical proactive study will ever be done in this group, we err on the side of caution. I always advise waiting until after pregnancy and breastfeeding."
It has been two weeks since my Botox appointment, and I am thrilled with the results so far. My brows look a little lifted, my 11 lines are a thing of the past (well, for the next three months or so), and I look smooth, not taut.
The next time I get a message from a friend asking if I would recommend it, I will know how to answer.
