Botox for Beginners (a Clinician's Opinion)



In this video, I discuss my thoughts on neuromodulators and provide insight that can help the beginner make an informed decision when consulting a proper health care provider. I pull back the veil a bit with the full intention of interrupting the cultural stigma we have created when discussing any aesthetic procedures that we do to improve our appearance, feel more confident, etc. The purpose of this video is to be as transparent with you as possible and to create a safe place for discussing all things health, wellness, beauty, and lifestyle! I touch on the history of Botox, how it works, research concepts (including its effect on mood), common side effects, whether or not it hurts--and of course, whether or not I have experimented with it. I give you tips on how to find the right qualified injector as well. You'll want to watch the full video to get a comprehensive overview. Please feel free to share this video or comment below to keep the conversation going!


Welcome back my fellow lifestyle enthusiasts! Today we are going to discuss my take on Botox and I aim to provide perspective that perhaps you haven’t heard before. This is part one of a two part series. In the next video, I’ll discuss fillers with you. As a physician who sees patients in a medical day spa, I am often asked about ways to age gracefully and slow down the hands of time; but most often new patients are interested in learning more about Botox and fillers.  My goal in this video is not to convince you that you need them or must try them. My objective is to help you understand their purpose so that you can talk intelligently about what you prefer with your practitioner or with your friends. I want to help you make more of an informed decision when considering your options and what is best for you. In addition, I want to be transparent with my JOURNEYTOWARDJOY family about what I personally do, how much I do, and why I do it.  I have noticed that there is a lot of stigma with my generation. “Older” women and men feel it is vain to discuss their aging well practices. I want to stop the stigma of Botox and fillers and create a safe, open environment for you, here on this channel.  

So, if you are ready to talk shop with me today, keep an open mind and feel free to give this blog post a thumbs and share it with your friends. Hang on because we’re going to discuss some fun stuff today.

Have you watched a reality TV show and thought to yourself, “She has too much Botox!”  Have you ever wondered why people either love it or hate it? Have you been curious about what it does but you feel that experimenting may be too vain of thing to do? Perhaps, you secretly judge those women and men who get Botox and fillers because you think it is very unnatural. I used to think this way.  In fact, when I first started working in the medical aesthetics realm, I subscribed to all of these thought processes. We all want to age well, but most of us don’t know what is truly working when it comes to aesthetics. 


When I was in my 20’s and thirties, I didn’t know much about Botox and fillers. In fact, none of my friends tried it or talked about it. Now that I am in my forties, it is a little more common;  but, I’ve noticed that with some folks in their twenties and thirties, they see it more as part of their beauty routine: you get your nails done, your hair colored, your teeth bleached, your regular facials, your lash extensions, and your Botox. On the flip side, women in their forties and older tend to discuss their beauty maintenance less, and I am told that some women feel it is vain to discuss their injectables, even with their significant other. So, there is definitely a generational difference in how we approach these things; therefore, I want to pull back the veil and allow you to make the educated decision that is best for you. More importantly, I want us to have open discussions, without shame, about what we like to do to enhance our beauty and feel more rejuvenated.


In our twenties and thirties, our collagen formation slows significantly and we begin breaking down our collagen about 1-2% every year. In addition, we start to lose bone density and when this happens we begin to lose the structure and foundation that our overlying tissues are supported by. To add to the fun, we have fat pads —both deep and superficial— that help to create volume in our face. However, they shrink as we age and start to slip as the supporting collagen fibers weaken over time. While we have 43 muscles in our face, these tend to strengthen over time (because we are constantly “working them out” while the collagen fibers of the cutaneous tissues begin to weaken over time. This allows your muscles to “pull” wrinkles into being.

We have four zones of the face: upper face, mid-face, lower-face, and submentum (or chin and neck).  If we treat just one area of the face, let’s say upper face, and neglect the other three areas, we run the risk of looking 5-10 years younger in one area, and our actual age in the other three. This is how we unintentionally create an unnatural look. It is very important that with treating the face, that we touch on all four areas, if needed, to create the most natural, refreshed and rejuvenated appearance. 


The most common brand we hear about is Botox. There are three common neuromodulators on the market (Botox, Dysport, and Xeomin) with a few emerging products that have recently been released. For the sake of simplicity, let’s use Botox, for just as Kleenex is the brand we use to describe facial tissue, so is Botox for the neuromodulator category. 


Botox was originally indicated for the treatment of strabismus and blepharospasm in 1989. IN 2002 it was approved for the treatment of cervical dystonia, then excessive sweating in 2004, chronic migraines in 2010, urinary incontinence in 2011. The application of the face was actually a positive side effect of the strabismus treatments as clinicians noted that that there was less wrinkling in the glabella (the area between each eye). Over the years, there have been thousands of clinical trials using neuromodulators and to date, this category of drugs is one of the most studied and tested. 


Neuromodulators are small amounts of the bacteria Botulin, that is diluted and then injected for therapeutic effects. You could compare this process to vaccinations, or antibiotics that contain trace amounts of viruses or bacteria to create the desired immune response for a therapeutic effect. There are some botanicals that operate very similarly, in that, they are toxic when ingested in large amounts but have healing therapeutic effects when given in minute dosages. And because Botox is a “natural substance” the body is safely able to metabolize it and remove it from the body. If you absolutely dislike the effect, it will wear off in 3-4 months for most individuals. 


Neuromodulators work at the junction where a nerve fiber meets a muscle fiber. There is a neurotransmitter that is released by the nerve called acetylcholine and when this reaches the muscle, the muscle can contract. A neuromodulator simply prevents the acetylcholine from reaching the muscle fiber and it then remains relaxed. Just like taking a folded pair of pants off of a hanger to let the wrinkle fall out, we are retraining the upper facial muscles to relax and let the lines “fall out”. It’ like taking a magic eraser to your face or walking around with a “healing brush” photoshop filter for three to four months, depending upon your metabolism. 


We know that the FDA approves 20 units for the glabella, 20 units of the forehead, and 12 units for each eye. This is primarily because the clinical studies demonstrated that these prescribed dosages allowed folks to get to the suggested 4-month duration. With that said, with every new patient, I personally like to find their minimum effective dose — that happy place somewhere between NO therapeutic effect and they are wasting their money with too little, and a completely FROZEN look. Starting out slow can help us find the magic prescription for each individual. But this is my style and may not be every injector’s method. Each person is entirely different. And, because our face forms from back to front in the womb, our faces are not perfectly symmetrical, nor is the strength of the musculature equal on our left and right side. Therefore, each side of the face requires a separate assessment. Sometimes, folks will have a stronger brow on one side and pull a little more. In such cases, the stronger side will need a few more units than the other.


We use insulin syringes for Botox application. The beauty of this is that the gauge is very high, making the size of the needle very small. Because of this, you don’t need numbing cream as it really doesn’t hurt. The needles we use hold 30 units or 0.3 mL. If you think of a 100 unit syringe or 1.0 mL as 1/5th of a teaspoon, then you can get an idea of how little is used on the facial muscles. 


Usually, the most common side effects are a little tingling or slight ache in the area of injection that wears off in a few hours. It is common to see pin-point bruising at the areas of injections (especially around the eye). It is important that you avoid fish oils alcohol, vitamin E, Ginko, etc. and any non-prescription that thins the blood, for 7-10 days before your appointment to avoid bruising. There have been known drops of the brow (called ptosis) and this is usually caused when part of the “no- fly zone” as we call it, is overly injected. The good news is that under such conditions a pharmaceutical drug can be prescribed, such as eye drops to help reverse the process, and worse case, the product will wear off in 3 months. Seeing a licensed practitioner trained in assessing the anatomy and who has obtained proper injection training, is really the best way to minimize your chances of ptosis.. 


I get asked a lot how many units I use. A unit is 0.01 mLs or 1/100 of a mL. I use a lot of Botox mostly because I work out every day and metabolize it quicker than most. In addition, I have what I like to call a “five or six head” versus a standard forehead so at any given treatment I will take between 55 and 65 units.


I was hooked the first time I tried it. I no longer had a resting angry face and people stopped asking me if I was angry about something and quit telling me I looked intimidating. I noticed that I looked more rested, and the mirror was reflecting how I felt inside. It was like a magic eraser turned back the clock 5-10 years.


Numerous studies have shown that folks who get neuromodulators tend to be happier. If I was to hypothesize as to why this is so, I would guess that because we can hold tension in our face, our 43 muscles can be sources of stress and strain. Just like a great massage relaxes the body, when we relax our face, we release any tension our face may be holding on to—and thus, we release any lines that are caused by this tension. So not only is the neuromodulator physically relaxing our face but mentally, we feel more relaxed due to how much more refreshed we look in the mirror (as though we had a two month tropical vacation). 


It is really important that you do your research when finding an injector. Looking at Yelp reviews is a good idea, going on to Real Self for recommended practitioners, or making appointments for consults, is the best method for finding your match. Start slow. After all, this is all elective. So, there is no rush. You can always add more as you dip your toes in the aesthetic waters. And if you are opposed to injectables, you can always look into facial acupuncture, PRPF injections, laser resurfacing, micro-needling, ultrasound, PDO threads, and even some medical-grade skincare products have the technology to relax micro muscles in the face or to soften lines, etc. The options are vast, with new options continually coming on the horizon. 

Congratulations! You made it through this post and I commend you for taking the time to educate yourself in the controversial world of injectables. Again, my goal in this video is not to convince you that you need them or must try them. My objective is to open up the conversation and help people feel more comfortable with discussing their options. I want everyone to freely ask questions in an effort to properly decide what is best for them. I want to stop the stigma of Botox and fillers and create a safe, open environment for you, here on this website.  

Your support means a lot to me. If you have made it through the post this far, I want to commend you, my friend. 

Don’t forget to give this post a thumbs up if you found it beneficial, share it with your friends, and leave your comments down below.

Be on the lookout for the next post where I will discuss fillers in detail with you.

And, as always, strive to supercharge your health by simplifying your lifestyle. 

Until the next video  my friend,

Dr. Linné

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