Busting Botox Myths And Misconceptions

Can Botox treatments really cause paralysis or botulism? We talked to experts to find out what Botox actually does and how safe it is.

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I had never been nervous about going to the dermatologist until the morning of my first Botox appointment. I was 26 years old and about to pay a lot of money for someone to inject tiny doses of a toxin into my armpits to prevent me from sweating. I’d spent weeks doing research—how did Botox work? Did it hurt? How long would it last? What were the potential side effects? Most of all, would I regret this? Botox, or Botulinum toxin, comes from a bacteria called Clostridium botulinum. In large doses, the toxin is lethal, but small doses have been FDA approved for a variety of cosmetic and medical purposes. Until I started thinking about underarm Botox, I didn’t know much about Botox—at all. There are so many myths and misconceptions surrounding Botox, so let’s set the record straight.

MYTH: Botox can get rid of all facial lines and wrinkles.

REALITY: Only certain facial lines and wrinkles can be treated with Botox.

Wrinkles and lines on your face are completely natural, and a variety of things can cause them—including normal muscle movements, sun damage, the aging process, smoking, and some medications. Botox works by blocking nerve signals to the muscles it’s injected into, which stops those muscles from moving and causes wrinkles to relax. So, Botox only really works on lines and wrinkles caused by muscle movement in the first place, like forehead lines, crow’s feet, and frown lines. “Botox treats dynamic wrinkles, which develop from movement,” says Joseph Cruise, MD, a board-certified plastic surgeon. “Botox improves the appearance of these wrinkles by relaxing the muscles. Static wrinkles are the result of sun exposure and aging. These wrinkles do not respond well to Botox treatment.” There are some other cosmetic uses for Botox, too. “Botox can also be used to elevate downturned corners of the mouth, to reduce a cobblestone or dimpling on the chin, to sculpt the jawline, prevent the tip of the nose from moving downward when smiling, and to prevent vertical neck bands from showing,” says Cruise. And if you do have static wrinkles that you’re self-conscious about, Cruise says you can get fillers to help lessen their appearance. And no, Botox and fillers are not the same thing—more on that later.

MYTH: Botox is only useful for cosmetic treatments and is just for women.

REALITY: Botox is a great cosmetic tool, but it has a number of medical uses for people of all genders.

Botox is an awesome cosmetic tool if you choose to go that route, and there’s absolutely nothing wrong with making informed aesthetic changes to your own body. It also has some medical benefits that aren’t related to appearance. Dacy Gaston, a registered nurse trained in injectables, says Botox can be used to help clients suffering from hyperhidrosis (excessive perspiration), bladder spasms, and eye spasms. Botox is also approved by the FDA to treat migraines (link opens PDF). And according to the Botox Cosmetic website, approximately 1 in 10 people who use Botox for cosmetic reasons are men. There’s nothing inherently feminine about wanting to feel confident about yourself, and something like Botox can address insecurities for people of all genders.

MYTH: Botox and fillers are the same thing.

REALITY: The two have very different purposes.

Botox and fillers are both things you inject into your face, but they serve different purposes. “Botox relaxes wrinkles, and fillers replace volume; two different products for two different problems,” says Susan O’Malley, MD, owner and medical director of Madison Med Spa in Madison, Connecticut. “Botox works very nicely from the eyes up, and fillers work wonders from the eyes down.” Katerina Gallus, MD, a board-certified plastic surgeon, explains it like this: “Fillers do what they suggest: ‘fill’ or restore volume to an area of the face that is lacking volume, like a wrinkle or region such as the cheeks.” This isn’t the same thing as Botox, which, as mentioned earlier, blocks nerve signals to certain muscles.

MYTH: Botox will “freeze” your face and stop you from emoting.

REALITY: It totally depends on how much Botox you have injected and where.

While using too much Botox can occasionally make it difficult for people to emote, it’s not a given that Botox injections will “freeze” your face or prevent you from making natural facial movements. “Botox, performed properly, should not get rid of your important facial expressions,” explains Jacob Steiger, MD, a board-certified facial plastic surgeon.

If you are interested in Botox but worried about a frozen look, make sure you go to a qualified provider and discuss your concerns with them beforehand. They should be able to calculate the appropriate dosage amount for your desired result.

“Botox dosage has to be individually tailored to each patient, and the dose has to be left to the expert injector they have chosen. Getting the proper dose based on your individual needs is key to having a beautiful and successful result.” —Edward Alvarez, cosmetic dentist

“If injected by a qualified provider who listens to your goals and discusses expectations, you can create a softening and natural result with Botox,” says Gallus. “This is dependent on the dose and the technique of the injector and is an important reason to seek out credentialed providers and not the ‘discount’ deal.” Because Botox is so patient-dependent, it’s hard to predict how much you’ll need until you have spoken with your doctor about it. “Patients cannot base how much Botox they need because it’s the amount of units their friend gets,” says Edward Alvarez, a cosmetic dentist. “A 5-foot, 105-pound woman may look ‘perfect’ after 20 units of Botox, but those same 20 units will barely do anything to the 6’4” former pro linebacker that wants to look younger. Botox dosage has to be individually tailored to each patient, and the dose has to be left to the expert injector they have chosen. Getting the proper dose based on your individual needs is key to having a beautiful and successful result.” Basically, you can’t tell how much is too much by comparing yourself to other people.

MYTH: Botox can give you botulism, aka food poisoning.

REALITY: Botox is not botulism.

You may have heard of botulism—a rare but severe illness caused by a toxin that attacks the nerves in your body. According to the Centers for Disease Control and Prevention, botulism is usually spread by food (specifically, “improperly home-canned, preserved, or fermented foods”), and the symptoms include double vision, droopy eyelids, slurred speech, trouble breathing, and muscle paralysis. “Botox is made from the bacterium Clostridium botulinum, the bacteria that causes botulism,” Cruise says. “When certain foods are not stored properly, this bacteria can grow. When a person ingests the bacteria, it multiplies and spreads through the bloodstream. This process releases a protein named Botulinum toxin, which is the active ingredient in Botox. The toxin attaches to the nerves on large muscles such as those responsible for breathing or those in the arms and legs. This can make it difficult to breathe, walk, or perform other movements. For this to happen, the live bacteria must multiply and continue releasing large amounts of the toxin. When Botox is used for cosmetic purposes, more toxin is not produced. Also, such a low dose of Botox is used compared to the amount needed to cause these side effects, and the amount of Botox used in cosmetic treatments is not enough to enter the bloodstream and spread to other muscles.” So while cosmetic Botox and botulism are derived from the same bacteria, the two are very different: Botox used for cosmetic and medical purposes is approved by medical professionals and generally extremely safe. “The Botulinum toxin used for cosmetic and medical purposes is not the same concentration as that found in bubbled-up cans of food,” explains Tsippora Shainhouse, MD, a board-certified dermatologist. “It remains local in the muscle into which it was injected and has never been reported to cause systemic paralysis and respiratory failure.” To lessen your risk of getting botulism from food, the CDC recommends following safe home canning practices if you preserve food at home.

In conclusion, Botox is nothing to be scared of.

I was incredibly nervous going into my first appointment for underarm injections, but the whole thing was a breeze. My dermatologist put a numbing cream on each armpit and left it for a while to work, then came in 20 minutes later and gave me around 15 super quick injections on each side. It took less than two minutes, barely hurt at all, and there was no bruising or pain after the fact. And a few weeks after that first appointment, I danced the night away in my wedding dress without worrying about sweat patches appearing on my gown. If you’re into the idea of Botox, whether for cosmetic or medical reasons, just make sure you have done adequate research. Plus, you should get the treatment from a licensed medical professional who can talk you through your options and choose the right dosage for you. Some people may assign a value judgment to Botox, but the fact remains that it’s a safe, FDA-approved tool that can make a big difference for certain individuals. I know it did for me.