We hope you enjoy this article by Nicole Hardy, published in RealSelf Magazine
When a friend called last year asking if I wanted free Botox, of course I said yes. It seemed like a win-win: she’d started a new job as a nurse aesthetician and needed to learn how to give injections (under strict supervision), and I’d just been laid off. I was curious, broke, and free in the middle of the day—which is how I ended up getting neurotoxin injections from someone who’d never given them before. What could go wrong?
Injectables (including fillers) can go terribly wrong—as in tissue necrosis and permanent blindness, in the worst case scenarios, but I didn’t know that at the time. I just figured a bad outcome would mean four months of an unnaturally frozen forehead (which happened). That was a problem my bangs could easily solve (which they sort of did). But the issues didn’t stop there.
I’d imagined myself ending up with a natural but revitalized expression—one that exuded the confidence I’d need for upcoming job interviews. Instead, my brow and eyelids visibly fell. I had to hold my eyelids up to do my makeup—they cascaded down when I let go, not quite obscuring my peripheral vision. My forehead froze, and my skin, while extremely smooth, looked strangely thick. In short, I ended up a plastic-faced cavewoman. Worse yet, I lost the ability to emote. I’m an expressive person, and I didn’t like how my face refused to punctuate my jokes.
Since learning the hard way that you need to pay to get the best case scenario—preferably someone who’s done injections thousands of times, and has extensive medical training—I’ve loved having my face back. But looking ahead to a college reunion, I wondered: was I really done with Botox, or just with bad Botox?
I sat down with New York-based, board certified plastic surgeon Dr. Lara Devgan (chief medical officer at RealSelf) to talk about injectables: How to make sure they go right, and what people often get wrong. Understanding a few misconceptions about Botox and fillers, she said, can keep you from making a mistake like mine.
Misconception #1: They’re so easy, anyone can perform injections
“That’s not true,” Dr. Devgan said. “What looks very simple on a time-lapse Instagram video or a before and after photo on your Facebook feed is not simple at all. The procedure may take five minutes, but it really takes twenty years and five minutes.” Her advice? Ask injectors about their education, training, and credentials. “It’s surprising to me how many injectors are not familiar with facial anatomy. Whenever I give courses and master classes, I always tell people, ‘If you can’t draw this anatomy, don’t stick a needle into the face.’” Try to get your injections from a board-certified doctor. “I deal with the three-dimensional anatomy of the face every day,” she said, “which helps me understand its complex blood supply, nerve supply, innervation, and musculature. There’s no substitute for that type of three-dimensionality.” “Are there other benefits to getting injectables from doctors?” I asked. “Knowing that someone is a board-certified plastic surgeon or a board-certified dermatologist gives you a greater comfort level. They’ve focused on this profession as their life’s work, not just found a hobby after a weekend course because they think it’s an easy way to cash in on a billion-dollar beauty industry.” Well, when you say it like that, I thought, it seems so obvious. “Facial injections,” she said, are “like the wild west of medicine. Every state has regulations, but people are legally allowed to do things that are far beyond their scope of practice. That’s the fundamental problem with the world of cosmetics.” Know the risks. “While these products can give you great results—instant gratification with no downtime—they can also have very serious consequences,” Dr. Devgan said. “To me, it’s not something to bargain shop with. I would never Groupon my face. I would never get my nails and my tear troughs done by the same person.”
Misconception #2: You’ll always look fake or overdone
That’s not true, Dr. Devgan said. “The best work is work you don’t see, and by and large, injectables have become so omnipresent that everybody knows people who do them, whether or not they know that they know people who do them.” I asked what she’d recommend for my face, and she said that because of my naturally low brow, I’m not a great candidate for forehead Botox—which my inexperienced injector didn’t know to warn me about. When I told Dr. Devgan I wanted something small but impactful, she recommended smoothing out my crow’s feet with 25 units of Botox, and assured me I’d still have really expressive eyes. My results turned out better than I expected: You can watch the procedure here, and see my crow’s feet up close; a few days later, my eyes are still a bit crinkly (which I like) but the crinkles don’t extend into my temples or down my cheeks anymore. I like that, too. Don’t lose sight of the big picture. “My take is that subtle is the new dramatic. I believe that a natural result is the most beautiful result. I’d rather enhance a person’s global facial beauty than chase every little imperfection. We know our own faces so well that often we skip right past the first several layers of observation, the basics of bone structure and symmetry and overall gestalt. We jump right to critiquing our nasolabial folds and wrinkles and pores—the minutia. But that’s how people can end up with a puffy filler-face instead of looking like themselves—because they’re trying to make every line go away. Less really is more.” Most importantly, though, Dr. Devgan thinks every person should define her own beauty. “Botox is like the dimmer switch on a light. You can turn it all the way up and have no movement, and be very frozen and smooth, or you can turn it all the way down and have lots of movement and only a tiny effect. That’s part of the art and science of what we do in plastic surgery—we individualize the patient’s experience. It routinely happens that I’ll see one patient, who’ll want the exact opposite result that the prior patient wanted. Who’s right or wrong? Nobody. It’s your body, your business, your decision about what’s beautiful.” This is what I most appreciate most about her. If you follow Dr. Devgan’s Instagram feed, you’ll hear it again and again—that beautiful is what you decide it is.
Misconception #3: Get injections once, and you’ll have to maintain them forever
“That couldn’t be further from the truth,” Dr. Devgan said. “You can get Botox just once in your life and never again. You can experiment with lip augmentation, and after it goes away, you’ll have no lasting consequences. I’ve had people ask, “If I do my lips once, are they going to be stretched out and messed up forever?” No, that’s not going to happen.”
Misconception #4: You should go in knowing exactly which product you want
“Just because a certain product was great for your best friend doesn’t necessarily mean it’s great for you,” Dr. Devgan said. “It depends on your unique anatomic characteristics, tissue types, goals, budget, and expectations.” Rely on your doctor’s expertise. “Like most plastic surgeons, I carry the entire spectrum of neuromodulators and fillers in my office,” she said. “I think of it like having different paint brushes—every injectable filler has unique properties. Each one has a different viscosity, cohesivity, G prime, and duration. Some are more structured, some are softer, some have more movement and flexibility, and there’s a lot that goes into making the choice. I want to be able to offer the best thing for each particular patient.” She makes this comparison: “If you’re going to go see your plastic surgeon for a tummy-tuck, you’re not going to tell them that you want a prolamine stitch in the abdominal wall, followed by a merceline tacking stitch in the vicryl and nylon.” “No matter how many episodes of Grey’s Anatomy you’ve seen?” I said. “Right.” But don’t be afraid to speak up. “Some people know that a certain product works really well for them. If you’re that person, don’t hesitate to say, “Oh, once in the past I had a great experience with X, and I’d love to use that,” or, “I had a horrible experience with Y.” It could be a fluke, or something real, so have a dialogue with the person who’s caring for you.
Misconception #5: Anyone’s a good candidate for injectable fillers and wrinkle-reducers
Not necessarily. Dr. Devgan’s advice is to “avoid injectables if you’re pregnant or breast-feeding, because they haven’t been studied in that patient population, and it’s best to err on the side of being safe for your baby. Or if you’re actively ill, with a fever or systemic illness. That includes people going through radiation therapy or chemotherapy. But if you’re a non-pregnant, non-breastfeeding, healthy adult, then you could be a candidate for most injectable fillers or neurotoxins.” Finally, Dr. Devgan recommends we all choose our injectors in real life. “Social media is very powerful in giving you a sense of who someone is, but you always want to go into someone’s office before you make a decision. If they give you a bad first impression, seem like they don’t care, or like their heart’s not in it—those are all bad things.”