As someone prone to oversharing, enthusing about Botox has resulted in maybe my most potent and sustained vulnerability hangover to date. I went under the needle at the tender age of 26. As a beauty writer, it was ostensibly for the story, but really it was so that I could rid my forehead of the 11s that gave me the permanent impression of being in a bad mood, and which had begun to chip away at my confidence. No one wants to look pissed off all the time. I spoke with three women for the article who held differing views on Botox—a friend and two fellow beauty editors—alongside my own experiences and opinions (it’s a personal decision, as women we have the right to choose what we do with our faces, etc). The year was 2017. Choice feminism was at its peak. I was all too happy to oblige.
I spent the intervening years in a period of willful ignorance, taking a smooth-brained approach to my smooth forehead, until I was forced to reflect when journalist and podcast host, Isabelle Truman, talked about going on a Botox diet on the ‘I’m Collecting Horcruxes’ episode of her show, After Work Drinks. While I still don’t entirely disagree with the sentiment of the original article I wrote and I don’t regret my decision, I have had more time to reflect on the grey areas. To delve deeper into the nuances, if you will. The whys, the hows, the whats. Why do we feel compelled to make the choice to get it done in the first place, what is it actually that we’re signing up for, and how will our faces look in decades to come as a result of these periodic Botox injections? In thinking about the future, questions like, ‘Am I just going to have to keep pumping a muscle paralysing substance into my forehead until I die?’ and ‘What happens when I’m bothered by the inevitable crevices that begin to pop up elsewhere on my face? Do I just keep on injecting and injecting and injecting?’ and ‘What would actually happen if I decided to go cold-turkey one day?’ have begun to surface.
In the intervening years, TikTok has emerged, perpetuating an intense obsession with anti-ageing akin to the body obsession of the 00s. Kids as young as eight have adopted 12-step skincare routines. Terms like ‘Snapchat dysmorphia’ and ‘perception drift’ have entered the chat—related concepts that describe how digital filters and constant exposure to idealised images, or even our own increasingly ‘tweaked faces,’ can distort our self-image. Gen-Z thinks they’re ageing like milk. Creators are pointing out that in their attempts to halt the hands of time through cosmetic work, certain celebrities are paradoxically starting to look older than their years.
We’ve seen the SATC sequel, And Just Like That, spark hideous mockery of Kristen
Davis for her attempts to preserve youth through cosmetic procedures, yet equal amounts of contempt for Sarah Jessica Parker for having the audacity to simply age. (The message: There aren’t any winners here.) Those of us working email jobs have been forced to stare at our mirrored faces for uncomfortably long periods of time on Microsoft Teams, often under frighteningly unforgiving dining room lighting where no ‘flaw’ is safe. ‘Tweakments’ have become so normalised that we seem to have collectively forgotten what a 30, 40, 50, or 60-year-old really looks like—if we’re even supposed to look any one way at all. Any woman in her late twenties or early thirties who participates in the ‘bare face’ trend online is met with scorn in the comments section. The main takeaway is that it is our own personal responsibility to halt the ageing process and age ‘gracefully,’ regardless of the mostly-overlooked matter of genetics or the inevitability that it will happen to us all at some point. Is it any wonder we’re flocking to the doctor’s office for a quick, relatively affordable fix?
Botox, a toxin derived from the bacterium Clostridium botulinum, was identified in the 1890s and was explored for medical use in the 1970s. Initially used to treat strabismus (misalignment of the eyes), it received FDA approval for these conditions in 1989, thanks to Dr. Alan Scott’s pioneering work. Its cosmetic potential was discovered by accident when patients reported reduced wrinkles after treatment. By 2002, the FDA approved Botox for cosmetic reasons (it’s still the only neurotoxin with FDA approval of this kind), which then led to its widespread use. Along with dermal fillers, Botox is now the most popular non-surgical cosmetic procedure globally, with an estimated 900,000 Botox-like injections carried out in the UK alone.
According to the Department of Health and Social Care, non-surgical treatments like Botox and dermal filler play a “hugely important” role in the UK’s economy, with an estimated value of £3.6 billion annually. As thousands report of ‘botched’ jobs, the government is stepping in to tighten up regulations around these non-surgical cosmetic treatments. The government’s first-ever consultation on aesthetic procedures will be used to shape a new licensing scheme for practitioners and cosmetic businesses, which could include age limits and restrictions for high-risk procedures. “Whether it’s Botox, dermal fillers or even a chemical peel, we have heard too many stories of people who’ve had bad experiences from getting a cosmetic procedure from someone who is inexperienced or underqualified,” Minister for the Women’s Health Strategy, Maria Caulfield, says. “There’s no doubt that the popularity of cosmetic procedures is increasing, so it’s our role to ensure consistent standards for consumers and a level playing field for businesses and practitioners.”
Alongside her reputation as a top injector, multi award-winning UK-based aesthetic doctor, Dr. Sophie Shotter, is renowned for providing free corrective work to victims of such botched procedures who can’t afford the necessary aftercare. “Unfortunately there are many people tempted into the hands of injectors with no medical knowledge or experience, because it’s cheap,” she says. “If they then develop problems, they’re in trouble because a complication needs medical diagnosis, possible medical or surgical intervention and prescription medication. This is made worse by the fact that there are not many doctors in the NHS who have knowledge of how to manage aesthetic complications, and patients are often also judged for having made a ‘bad decision’. These people were budget restricted in the first place, which is why they went to cheap practitioners, and so affording my prices isn’t possible for them. In such situations I’ve been proud to be able to help some victims of horrendous treatments.”
On a recent trip to my facialist Alejandra, I resist the urge to lie when she asks, with gentle concern, what has caused the slight bruise on my forehead to form. Alejandra is the founder of Aluna Beauty, a tranquil skincare and beauty studio in Amsterdam that “merges the worlds of beauty and holistic wellbeing, offering a safe space where clients can experience the transformative power of self-care.” A cocoon-like space completely incongruent with injectable toxins.
Alejandra isn’t the type to judge yet her stance on Botox is clear. She “doesn’t recommend anyone to use it as an ageing prevention.” As I’ve gotten older, I’ve become generally more fearful of everything. I lean into this by first asking Alejandra about potentially negative side effects in an attempt to scare myself into remission. “Botox has many short and long-term side effects that aren’t openly discussed, like dramatically changing the structure of your face,” she says. “I find it sad that people can no longer express their emotions because their muscles are paralysed, and the problem with constant paralysis is that your muscles become lazy over time and eventually won’t work, in what’s called ‘muscle atrophying’. I always explain to my clients, ‘Imagine that you have been using Botox for many years, but one day you can no longer use it for any reason. Your muscles have been paralysed for so long that they forgot what to do. Then the ageing will show even more than in a person who has never used Botox but has a great skincare routine.’”
“Botulinum toxin has been available for over 30 years. It is well-studied and has an excellent safety profile,” posits Dr. Sophie. “All medical procedures carry risks, but in experienced medical hands these are minimised. Botulinum toxin can lead to short term headaches, and can also cause temporary dropping of an eyelid or smile asymmetry if the product moves from where it was injected.”
“If you have big doses of botulinum toxin it can cause some muscles to become thinned and almost a little papery,” she continues. “But when it’s used in a way to soften movement rather than to eradicate movement, this is much less likely.”
While she’s had people bring in filtered images of themselves as references, most of her patients tend to be realistic. “I always say to people that a filtered image or indeed an image of someone else you’d aspire to look like isn’t useful for me. I’d like to see photos of you at a time you felt happy with your appearance,” she says.
If not done right or in excess, she believes cosmetic work can also cause people to look “strangely ageless, but certainly not youthful or fresh.”
Dr. Sophie stresses that all treatments have their unique place. Her approach is to “bring out the best in each individual through a mixture of treatments that address individual concerns.” She regularly says no to clients’ requests for Botox, recommending alternatives or advising against it, and believes this is an important skill for every injector to learn. For her, ageing well starts from the inside out: exercising, sleeping, eating well, hydrating, and reducing stress. “All of this shines through on the outside too, and is then complemented by great skincare and appropriate tweakments,” she says.
Dr. Sophie says while various options exist for people who mightn’t want to go down the injectables route, nothing can ‘replace’ botulinum toxin or filter. “There is a regenerative product coming to market imminently which will help to restore and rejuvenate the facial fat pads. You can also never go wrong by focusing on skin quality through devices like Sofwave and RF microneedling, which deliver energy into the skin to tighten and improve texture. Microneedling with SkinPen can also be an amazing solution for many people,” she says.
Alejandra advocates for more natural ways to stimulate the skin and create new collagen. “Facial massages are completely underrated, and one of my best secrets for
healthy skin,” she says. “The power of your hands can increase blood flow, remove toxins and waste, and give you glowing skin. Facial massages are great for all ages: the earlier you start, the better. I recommend doing it for at least five minutes in the evening with your favourite oil cleanser.”
Facial Microcurrent is also being pegged as the non-surgical alternative to a face lift, which Alejandra explains is a “safe, effective and non-invasive treatment that uses low-level electrical currents to stimulate facial muscles, promote toning and tightening.”
“If you’re looking to ween off Botox, it’s a great option,” she continues. “True microcurrent technology mimics the body’s natural electrical currents, promoting collagen and elastin synthesis. I recommend it for people over 30, and clients love the great results after one session, such as smoother lines and glowing skin. The electrical current stimulates your mitochondria cells and repairs the damage caused by Botox, and can easily be done with an at-home device or by a professional for better results.”
It bears remembering that whether or not we opt into cosmetic procedures, or decide to go cold turkey after years of use, appearing older is simply a byproduct of becoming older. A privilege in and of itself.