Your Guide to Getting Preventative Botox


Botox is everywhere. Your mom, sister, co-worker or friend has probably mentioned getting or thought about getting botox. And it’s no wonder since the American Society of Plastic Surgeons Statistics reported last year alone that Botulinum Toxin Type A, the number one minimally invasive procedure in the US, was injected into over 6.7 million faces. Safe to say it’s popular and definitely not slowing down.

What once started out as a stigmatized treatment associated with frozen faced women well past their fifties has now become a cosmetic industry darling accepted and used among various age groups. The latest trend dubbed “preventative botox” has even twenty-something-year-olds opting for the neurotoxin in an attempt to stave off the deepening of fine lines by preventing, well, facial movements. But is it ever too early to start botox treatments? And is there a way to prevent without looking frozen? We reached out to Beverly Hills board certified facial plastic surgeon, Dr. Sarmela Sunder, for the full scoop.

Is it ever..too early to start preventative botox?

When to start depends on ethnicity (Asians and African Americans wrinkle slower than caucasians) and genetics (did deep grooves happen early to mom?), explains Dr. Sunder. But recommends that a good rule of thumb to go by is when a line becomes static, not just visible in dynamic movement. “When you’re in your early twenties you raise your brows and see lines, but when you relax your face they disappear. Then comes a day, typically, in your late twenties/early thirties when you relax and the line is still there, or a faint etching of the line is still there. That’s a wake up call that if you keep going on how you are without an anti-aging regiment that line will get deeper,” says Dr. Sunder.

Is it possible for botox injections to look…natural? Or at least not frozen…

“The way to achieve a natural look, so people don’t realize you had botox injections is by using less ‘units’ and placing them strategically. So say, instead of doing 25 units total in 5 spots on the forehead, you would do 12 units spread out over 10 spots. Placing them this way allows you to maintain movement.”

What’s the average dosage recommendation for say, someone in their twenties?

“Typically, but it’s very individualized, around 4-6 units for someone looking to prevent the horizontal lines in their forehead. Other areas of the face may take less or more. And as you age you end up needing more units since you are fighting the effects of gravity.”

How long do results last?

“2-4 months.”

Any accumulative benefits?

“I have noticed in addition to weakening the muscles, patients subconsciously retrain their muscles. For example, if you’re concerned with frown lines and you get botox, you physically can’t frown intensely anymore. A lot of people get those frown lines because they hold stress there and tense those facial muscles. But since you can’t frown anymore after the botox you train yourself to hold the stress somewhere else. Then when the botox wears off, at least in the first few months, you are less likely to vigorously frown.”

Online there are some scary tales of people getting botox and looking like they had a stroke…what’s that about?

“In our field, when you are dealing with areas lower on the face (around the mouth, jaw, chin) we call these areas ‘expert injector sites’ because there is a high likelihood you could inject the wrong spot and get a poor result. If you are a few millimeters off and hit the wrong muscle you could have a bad outcome. That is why it’s extremely important to go to a plastic surgeon or dermatologist who understands facial muscle anatomy. Your doctor needs to be able to almost see through the skin at the muscles to know the right spots to inject.”

Most common side effects?

Some bruising, injection site irritation, redness or bumps sometimes appear, she says, but usually fade after 30mins to 1hour. “The biggest concern is making sure the botox doesn’t move from the injection site, which means no exercising post treatment for 24 hours, no lying down and no touching the area injected,” says Dr. Sunder. 

-by Amy Chang
Image source: Vogue Japan