Botox and Aesthetic Wellness
Written by Melissa Schenkman, MPH, MSJ
Are you always on the lookout for the latest skincare products or exercises to keep you healthy and equally as important…keep you young? If so, you are not alone.
Fighting the anti-aging battle is a topic of discussion that can begin as early as 22 with Botox becoming a fixture of that conversation with friends by the time you reach age 30.
It’s not all about reducing our fine lines and wrinkles though. As Women’s Health Nurse Practitioner and Founder of belev.co, Isabel Bogdan, DNP, WHNP, taught us, Botox and other cosmetic procedures are one part of your ‘aesthetic wellness. An area of health with growing interest, especially to prevention-minded millennials and Gen Z.
After specializing in this area and functional medicine, Bogdan gives us a Botox 101, walking us through how it works, treatment options, techniques, considerations, and what to keep in mind when choosing your provider.
Understanding Botox
Botox has become astoundingly popular, so much so, that you would be hard pressed to not know at least one person in your life who is doing it.
In 2021, 6.2 million Botox treatments were administered in the United States, deeming it the most popular non-surgical treatment on the market. By comparison, in the year 2000 when many of the oldest millennials were just 19 years old, less than 800,000 Botox procedures were performed. So needless to say, its popularity has soared.
The mechanism by which Botox works is that it blocks signals to the surrounding muscles. Specifically, it’s an injection of a neurotoxin which affects the nerves in the area it's injected into, causing muscle weakening so that they cannot contract. These effects are temporary, which is why periodic treatments are needed.
Botox is not only used for cosmetic purposes where it is effective at smoothing wrinkles and fine lines in the face, but it is also used to treat migraine headaches and other health conditions.
There are multiple types of neurotoxins available for the procedure.
"There's four different types of toxins that are manufactured,” Bogdan said. “Three of them are manufactured in the US, one is in Korea. Most of them except Xeomin have antibodies." The antibodies could produce inflammatory reactions and/or resistance to neurotoxins.
The other three types of neurotoxins used in Botox injections are: botulinum toxin Type A, Dysport, Jeuveau, and Daxxify. Each is formulated a little differently, which influences the dosage used and how much it spreads, which affects how quickly a patient may see results.
When to consider Botox
While there is no specific age recommended to start Botox, first-timers tend to range in age from 20-60 with people in their 30s being the most common age group.
Every patient is different, but Botox treatment falls into two categories: to prevent lines and wrinkles from developing or developing further and maintain the current appearance of your skin even as you age (for example, having your 20-year-old forehead at 30 by preventing wrinkles from forming) or for correction of lines and wrinkles that have already developed. Even with preventive Botox, there is still much to consider from a healthcare provider’s perspective.
“When someone in their 20s or 30s wants preventive Botox, we do that, but whatever you do you don’t want to target just one area. That’s bad practice, in my opinion,” Bogdan said. “If you are going to do ‘Baby Botox,’ you need to put it anywhere, where there is actual expression.”
In addition to improving the appearance of your skin, there is growing evidence that Botox provides psychological benefits.
“There have been some studies that show that when you do inject a little bit of toxin, women that were feeling a little bit depressed actually felt better,” Bogdan said. “They had better sensation, and they felt more optimistic."
Isabel Bogdan, DNP, WHNP, is a Doctor of Nursing Practice with more than two decades of experience in women’s healthcare. She is also the Founder of belev.co, Modern Women’s Health, a practice specializing in both aesthetic wellness and functional medicine for women in Westport, Connecticut.
Dr. Bogdan received her Doctorate in Nursing Practice from Columbia University where she has cared for women throughout the different stages of their lives, as well as at NYU and Lenox Hill.
You can also find her @drisabelbogdan on Instagram.
Botox treatment areas and techniques
Common treatment areas in which Botox injections are used cosmetically and effectively are to treat frown lines between the eyebrows, to treat crow’s feet around the eyes or smile lines, and to treat horizontal lines on the forehead.
Your practitioner’s technique matters.
“I’ve seen people who have had Botox in just one area, and you can tell that it was just done there because everything else is moving,” Bogdan explained. “You want to spread it very thinly, lift nicely, and don’t overdo it. They should still have some movement in the face.”
"Balance is everything when it comes to injections."
The micro-injection technique helps achieve that. It’s when Botox, which is diluted more than normal, is injected into the dermis layer of the skin (middle layer), using a ‘micro-channeling’ device with multiple needles. These micro-channels allow the diluted Botox to be infused into the skin.
“I do lots of little micro-Botox, tiny little droplets all over so that you don't get that ‘wham bam’ look. You still have nice movement." I like to take turns around the face and get very contoury and help women feel better.”
Choosing a provider
For anyone out there looking to start Botox treatments, Bogdan cannot emphasize enough how important it is to go with a practitioner who knows what they are doing.
“You need someone who can speak to what it is that you need and understands your anatomy,” she said. Here’s one reason why:
If a practitioner hits the same muscles over and over again, “you are going to get a dip and have an ‘angry bird’ look” she explained. “So, you want to avoid the muscles form getting too worn.” Again, why she has said that “balance is everything when it comes to injections.”
Bogdan recommends asking these questions when you have a consultation/your first visit with a practitioner:
How are you going to target the sphincters in different areas?
What is your goal going to be aesthetically for me?
What will the procedure involve?
Are there any potential risks?
What do you expect my outcome to be?
“If the person that you're hiring or the person that's going to inject you can’t speak to that, I would stay away,” Bogdan said. However, when you do find a good practitioner who is right for you it is very valuable to consistently have your Botox performed by the same injector.
Considerations and precautions
Like any procedure, Botox comes with benefits and potential side effects. That’s why while it’s good to do it consistently to reap the benefits, it’s important to do Botox in moderation.
Consistency does not necessarily mean every other week or even every month, for some it is something that can be spaced out during a year. And depending on the person, your age, and the state of your skin, you may only need a treatment twice a year.
That said, using Botox injections for many years will create muscle atrophy (decrease in muscle mass and strength).
“The muscles are going to get smaller and wrinkles in your face in the way that your face ages, even if you do it consistently all the time in your 20s, it might be different," Bogdan said.
Another long-term potential side effect is less frowning because injecting the muscles around the mouth prevents the muscles from frowning. So, they will forget how to do that.
Botox’s potential side effects after treatment that can last a day or two can include:
Pain, swelling, bruising, or redness at the treatment site.
Headache
Flu-like symptoms
Neck pain
Temporary drooping eyelids
Eye redness or irritation
Upset stomach
These vary based on the area being injected.
Alternative and complementary treatments
As your skin becomes a little bit more mature, there are several other aesthetic wellness treatment options that have emerged on the market that are worth considering.
These alternative and complementary treatments include:
Laser
Radio Frequency
Chemical Peels
“Lasers are good for hyperpigmentation. radio frequency is the best for sagging skin, but lasers are really good for that too,” Bogdan said. “They are pricey treatments.” So, she recommends that you start by asking what type of machine the doctor has (because you want to get the best machine) and how many treatments it will involve, as it will not be just one treatment.
On the other hand, chemical peels are cost friendly.
“In my book of work, my favorite thing to do are chemical peels because they're more accessible. They're very efficient and remove that dead layer of skin off the face. No questions asked. It's done, Bogdan said.
She does remind us that you are a little uncomfortable, a little itchy on day 5 as the skin falls off, but she said, “You look completely like a new baby.” So, she loves chemical peels.
The holistic approach to aesthetic wellness
As we each find our own path to achieving aesthetic wellness in our lives and our long-term plan for good health, it’s important to make sure to balance internal and external care.
“When it comes to the world of skin care, it's so important to feed your body. And if we haven't started taking omega 3’s, calcium…so just the basic things like water. If you're not hydrating your skin and your skin is not holding on to those molecules, naturally your skin is going to wrinkle,” Bogdan explained.
That’s why to achieve overall wellness, we must focus on both what we do on the outside and how we treat our bodies on the inside.
Despite what our society may say about aging and how we should fear it, it’s important to embrace natural aging while enhancing your appearance.
After all, wellness is not just about always looking young. It’s about feeling good inside and out, and helping you live your healthiest life for as many years as possible.
Let’s work to make that our mindset and one of our priorities.
Subscribe to the YMyHealth newsletter to stay up to date on everything that’s health-related for millennials!
