Why so glum frownyface?

April 26, 2009 5:22 PM

What can I expect aesthetically and emotionally from Botox? How do I find a good Botox injector in NYC? Do you have any tips or suggestions?

I was reading this recent question about "sincerity face", and I face a similar issue. My brow is always furrowed. I'm just turning 30 but I'm developing a deep groove between my brows which skews slightly to the left. I'm aware that I furrow when I'm stressed, nervous or anxious, but I also do it when I sleep. I pretty much have a furrow all the time, and people ask me what's wrong even when I'm feeling pretty calm and content. I've tried Frownies, and they work somewhat in the short term, but I don't have the patience to use them daily. So I'm thinking of trying Botox.

I've read that facial muscle contractions are part of a feedback loop that both reflect and affect our emotions, so I'm also interested in seeing how Botox may affect my moods. I'm interested in any personal anectodes mefites may be willing to share about their experiences with Botox and how it affected their mood/life. Also any tips or specific reccomendations on picking a practitioner would be very helpful.

My (perhaps misguided) first impulse it to go someplace where a single practitioner does a lot of Botox injections. I see a lot of ads for this place and the $199 price is right, but the reviews seem mixed. Some of the negative reviews pick on the fact that the physician is trained in rehabilitation medicine rather than dermatology, but that actually seems like a potential positive since rehab's focus is neuro-muscular and Botox inhibits muscle contraction and doesn't have much to do with skin as far as I can tell. Still, I'd rather pick someone based on a personal recommendation.

Feel free to message me privately if you don't want to share publicly.

posted by ladypants to Health & Fitness (8 answers total)

I've had botox for the frown line between the brows. Mine isn't deep, but I'm near 40 and it's permanent. I do it when I sleep too, and hardly ever when I'm awake.

I've only ever had botox done by a friend, and only 2-3 times at that, so I can't help too much with picking just the right person. But I can tell you this: Most doctors, even dermatologists, do not learn botox & injectables until after they're done with med school, residency & internships. You probably already know this, but administering botox requires (from the regulatory perspective) very, very little training. My friend did her residency in family medicine but then started her "med spa" practice with only a few weekends of CE credits in cosmetic stuff.

Now, for the procedure itself: The good news is that if you're only trying to help the frown line, you don't need that much at all. Probably only right between the brows and maybe one or two inches outward from there. That's probably 3-5 needle sticks. This is relatively cheap, and it's quick. I have a tendency to get momentarily light-headed from needles in my face (including fainting when piercing my ears), and the needle [stop reading now if you're easily grossed out] makes a tiny bit of a crunching, gristly sound when it goes through a layer of something under my skin. The fascia, maybe? There are tiny droplets of blood wiped away with one swipe of a tissue. I'm very fair-skinned, and the first time I had miniscule, perhaps 1MM bruises the day afterward.

Do you go to a gym? That might be a good place to get a word of mouth recommendation. Or maybe try Angie's List?
posted by ImproviseOrDie at 5:57 PM on April 26, 2009

Dr Andrew Kornstein at 86th and 5th is very good for botox.
I've had botox injections randomly over the years from various docs, and he has a great eye and his seems to last the longest. He is also very good with a needle, I am a needle chicken and his injections are virtually pain free.
You will look more relaxed, less stressed, and with Kornstein, you won't look "frozen".
He is not cheap, make sure you get prices in advance, and also make sure he knows that money is an issue, if it is, that way he will suggest what will give you the best results for your money.
posted by newpotato at 6:34 PM on April 26, 2009 [1 favorite]

Response by poster: Thanks ImproviseOrDie for the very vivid description. I certainly wasn't expecting a crunching sound so thank you so much for warning me, that would have freaked me out if I wasn't expecting it.

You're lucky to have a friend who knows her way around a syringe full of Botox. Yeah, it seems like there isn't that much training required for Botox, but a certain degree of knowledge combined with a little art, a little patience, and a lot of practice is what I would guess is the magic recipe. I don't belong to a gym but I might check out Angie's list. I've heard their ads on NPR and have been meaning to check them out.
posted by ladypants at 6:37 PM on April 26, 2009

I've had Botox and there was no crunching sound, if that makes you feel any better.
posted by Maisie Jay at 7:24 PM on April 26, 2009

Have you looked into Restylane (hyaluronic acid)?

It's supposed to last longer; note, though, that it operates by leveling out wrinkles, rather than paralyzing muscles... so if you're attempting to dampen mood shifts by reducing muscle movement (an interesting idea), Botox might be a better bet.
posted by darth_tedious at 1:06 AM on April 27, 2009

I have no experience with botox, but a couple of small studies have claimed it causes an improvement in depression, presumably because it makes prolonged scowling impossible. Depression aside, I'm curious about how it feels to have botox - do everyday negative emotions feel different when you can't use your face to express them?
posted by embrangled at 4:33 AM on April 27, 2009

Response by poster: newpotato, thanks for the tip!

Thanks, Maisie Jay, I wonder if it varies by injection site.

darth_tedious; I am actually very squeamish about fillers. I hear they are the way to go for people who want to modify their labial folds, but I'm very curious about what it feels like to have restricted movement in the brow.

Thanks for the links embrangled. One of them led me to this article in the Journal of the American Academy of Dermatology: Botulinum toxin and the facial feedback hypothesis: can looking better make you feel happier?. I'm sure Allergan is happy to fund research in this field, and if they need study subjects, I'd be happy to volunteer.
posted by ladypants at 5:53 AM on April 27, 2009

I have had Botox 2x a year for 5 years, for just the lines you describe. I have never heard a crunching sound. Whomever you choose will give you a topical anaesthetic that will numb your forehead. You'll sit for five minutes while that takes effect. My doc then gives me an ice pack for extra numbing during this time. Close your eyes. You'll feel 3-8 pinches, or stings, depending on how much area you have decided to cover (some people do the horizontal forehead lines as well). It takes no time at all. I get the ice pack back, sit for a few minutes, and then I'm good to go. The injection sites may look like little stings, or just red. That subsides after an hour so. I don't know what you mean by how it affects mood --you look better and so feel better, I guess. There's no mood impact from the actual treatment, except, I guess, if you are easily freaked out or a worrier. It's no more uncomfortable than having a mad thorough dental hygenist clean your teeth and it lasts 1/3 the time.

Keep in mind that Botox does not take immediate effect. In fact, it kicks in after about 5 days. Depending on your skin (think Nicole Kidman) you may get a shiny dome-y effect. You can ask your doc to use less next time (you can get a half vial vs a full vial) if you feel it's too pronounced. My treatments last six months, YMMV. I have no frozen effect. I frown, squint, get surprised, cry, laugh, etc with no restriction that I feel or that is noticeable. It's just that the lines themselves occur with less definition, and don't hold their depth anymore.
posted by thinkpiece at 9:52 AM on April 27, 2009