All Things Botox!

Today I wanted to have a little chit chat about one of the bigger changes I made to my beauty routine this year… Botox! I was always really scared to get Botox. I thought it would change my face or make me look permanently surprised. But then one day my best friend got it and her experience (and really natural looking results) made me want to try it. Also, if I’m being honest, I was experiencing what a lot of people are describing as the “pandemic uglies.” a term I’ve seen thrown around by friends, the media, and in the Facebook group. I just felt… not great about my appearance. And now here we are… fully obsessed.

My friend and I both see Christina Nalbone who is a Nurse Practitioner at Ever/Body. I go probably every 5-6 months? My first time was in February and I went back again in August. I will probably try to go again in late December or in the New Year.

I love the results so much. And I still do all of my other beauty treatments, but this has been an amazing addition to my routine. I personally see skincare as preventative and Botox as corrective, if that makes any sense!

All Things Botox!

Today I am interviewing Christina with questions sourced from YOU. I could rave on and on about my experience (keep scrolling for before and after photos!) but I thought having a pro on would be more beneficial. Also, my code for Ever/Body still works! GraceAtwood10 gets you 10% off your first service! Also, check out the Botox highlight on my instagram for even more photos, questions, etc!

Tell us a little bit about you – what’s your background, and how did you get into aesthetics?

Christina: After a few years of working as a pediatric nurse, I decided to go back for my Masters of Nursing at Georgetown University to become a Nurse Practitioner. It was tough! I was getting burnt out working nights and attending classes during the daytime, so I decided to take a semester off. During that time, I was invited for amazing opportunity to go on a medical mission to the Philippines for an organization called Operation Smile, which provides free surgeries to fix cleft lips and facial deformities in children.

There was a very special moment during the mission where I saw an 8 year old boy before surgery who had a cleft lip. Within 24 hours after surgery, he was dancing in a post-operative room full of 40 people or so. I happened to see a woman watching them and low key crying. When asked if she was OK, she responded, “I’ve never seen my boy want to be the center of attention” and proceeded to explain that he has avoided attention all his life and usually stays to himself. The change in this kid’s confidence was tangible and that was the moment I decided to specialize in aesthetics. It may not be life saving, but it is definitely life changing.

At what age do you recommend starting Botox? Are there any times where it’s not right to do it (i.e. pregnancy, breastfeeding etc.).

Christina: There is no perfect age to start Botox, but the goal is to prevent deep lines from forming and we see this happening mid to late 20s. I’m super expressive (it’s the Italian side of me) and I started Botox at age 27 because I was seeing my forehead lines in photos and it was making me look older than I was. Luckily, my wrinkles weren’t deep yet so botox completely smoothed my skin on the first treatment. There are certain times people can’t do Botox, during pregnancy, breastfeeding, and certain other medical conditions. It’s imperative to go to a licensed medical provider who will do a thorough medical history prior to treatment.

What about preventative botox? What’s that all about?

Christina: Over time, the constant contraction of your muscles can cause the skin on top to permanently wrinkle. This is called ‘static’ lines as opposed to ‘dynamic’ lines which you only see when animating.

By reducing the muscle movement with botox early on, you can prevent permanent lines from developing in the skin. This is what is meant by preventative botox.
The good news is if you have deeper lines, you can still get rid of them but will take longer with additional treatment modalities. This is why prevention has become the focus of optimal skin health and anti-aging. I love Clear and Brilliant Lasers and Vi Peels for skin rejuvenation and improvement of the deeper lines.

before and after… resting.

Getting Botox for the first time.

How can I express my needs in terms of botox vocabulary?

Christina: It’s simple! It’s less about the vocabulary and more about being honest with how you feel. Have your provider give you a mirror, and start discussing what you want to improve. This can be specific such as “I hate this line” or general as in “I just feel that I look tired”. A good provider will extract this information and curate a specific plan to address your concerns. After all, it is our passion to help you look and feel great.

How do you decide how many units someone needs?

Christina: There are a lot of factors that go into calculating a dose such as muscle strength and size, treatment goals, and more. There are standardized doses and placements out there, but to get the best results for your face it should be customized and take all factors into account to achieve the best outcome for you.

Do they put numbing cream on you prior to the needles? I’m kind of a baby.

Christina: Botox is quick and the needles we use at Ever/Body are extremely small. Most patients are surprised how fast and painless the treatment is (sometimes 5 minutes or less). Some of my patients were numbed in the past at other offices, and when we treated them without numbing they reported not feeling much of a difference. A gentle and slower paced technique is the most important factor when talking about pain.

Christina to me – We didn’t numb you! LOL What did you think?

Me – I am also a huuuuge baby and I was fine. It felt like acupuncture, but slightly more intense!

What does it feel like?

Christina: It can feel pinchy or like little stings. Almost like plucking an eyebrow hair, but less intense. The feeling only lasts while the injection happens and then it’s over.

Is it recommended to do botox one area at a time, or to do all areas at once?

Christina: It’s all about facial balance. If your provider recommends multiple areas, I’d do it all at once.

Tips for not getting faint/nervous during appointments!

Christina: It may sound silly, but many times feeling faint is more emotional than it is physical. Two key things: Trust. Trusting your provider will make you feel way less anxious about both the treatment and the results. Hydration and sustenance. Drinking water and eating before your appointment will help stabilize you physically. Breath. Sometimes I will guide a patient’s breathing as we treat. Inhaling during each injection can distract and relax you.

What about bruising? I’ve seen bruising before on friends and worry!

Christina: It can happen. If it does, they are usually small and go away quickly. Personally, I’m a peach…if you touch me I bruise! You can reduce the chances by avoiding substances prior to treatment that ‘thin your blood’. This includes over-the-counter NSAIDs medications such as ibuprofen aspirin as well as omega-3/fish-oil. Avoid alcohol as well. Taking Arnica prior and after treatment helps reduce swelling and bruising as well.

Before and after… side view. This was the biggest thing for me, my crows feet have always really bothered me!

Cost Questions:

How much does it cost? Why is the cost different in different cities?

Christina: Cost is highly variable and there is no standard since each practice sets their own prices. An injector in the midwest may charge $9 per unit, while an injector in LA may charge $25. Experience and demand of the injector can raise prices as well but as the industry changes, we are seeing highly trained injectors coupling with business models that look to give access and affordability to the community. The highest cost doesn’t mean the best results.

Is pricing by area or units or vials?

Christina: Pricing is usually by area or units and not by vial. This is because vials typically come in 50 or 100 units per vial. It’s unlikely patients would need that exact dosing every time, so it doesn’t make too much sense to charge that way.

What’s the difference between Xeomin v dysport v botox v juveaux

Christina: They are all neuromodulators in that they reduce muscle movement with the same active ingredient, Botulinum Toxin A. Additionally, each product has nuances that make them slightly different. One may kick in quicker and one may give more flexibility for a softer look. Patients respond differently to them as well. A patient may say one lasted longer for them while a different patient would say the opposite.

Before and after – scrunching brows / mad!

More technical questions:

I feel like my face looks different than it used to – is this something botox helps?

Christina: Botox helps to smooth wrinkles and fine lines for an overall refreshed look. It can also lift and shape your eyebrows, help correct facial asymmetries, and improves skin quality for a healthy glow. Overall, the effects of botox gives an overall rejuvenated appearance.

Where to get it done for droopy eyelids?

Christina: On the right candidate you can achieve a ‘lifting effect’ by placing botox around the eyes or above the brows. Others may need to consult for more permanent options depending on the severity of the eyelids.

Can I get Botox for teeth grinding / clenched jaw?

Christina: Definitely. If the muscles become larger, botox can decrease the size and strength helping these issues.

My under-eye skin is so crepe-y, can botox help with that?

Christina: Other options, such as platelet-rich plasma (PRP), can address the issue of crepe-y skin better, as it will help strengthen the skin quality and improve the overall appearance of the under eye. That being said, botox can work synergistically with PRP to smooth the surrounding skin as well. We frequently do both together at Ever/Body for overall eye brightening and rejuvenation.

Does botox in your cheeks slim your cheeks?

Christina: No. Botox is good for SO many things, but should not be injected directly into your cheeks.

I’ve seen folks use botox to enhance their smile, which is better for that? Botox or fillers?

Christina: It’s all about your aesthetic goal. Some clients need fillers to achieve balance while others can use botox in precise amounts and locations around the mouth to enhance their smile. It comes down to the consultation and what you need for your unique face.

Will botox help my upper lip stay down when smiling and prevent a gummy smile?

Christina: Yes, botox can help lessen the severity of a gummy smile. It can be life changing and boost confidence.

Will botox help if I have lines “at rest” how deep is too deep of a wrinkle

Christina: Lines at rest are called ‘static lines’ vs lines you see only when expressing are called ‘dynamic lines’. Once you start seeing static lines, it’s time to think about Botox. If caught early, they can completely smooth out. If you wait too long, they’ll still be visible even with botox. Funny enough, I use the analogy of a folded shirt in the back of your dresser. The longer it’s there, the more difficult it is to get the folded crease out since the integrity of the shirt (or the skin) is compromised.

Will botox work for a deep line between the brow wrinkle or will it need filler as well?

Christina: Botox will definitely soften deep lines, but as mentioned before sometimes they so deep, they will need additional treatments. In this case, I suggest lasers, peels, microneedling, and medical grade skin care and prescriptions (such as retinoids).

I stay away from injecting filler into that region since it has one of the highest risks of complications, including blindness. IMHO the risks are not worth the reward in this case, and as a medical provider I want to be able to sleep at night!

Botox gave me a heavy brow and accentuated my under-eye bags, how can I avoid it?

Christina: Going to a highly trained provider off the bat is essential. Trained injectors can usually avoid that by precise placement and dosage, but you can’t always predict how someone will react to botox (again, it’s your unique face). It is important to return in 2 weeks for a follow up and be vocal about what you like and what you don’t. There are things we can do to tweak the injection plan according to how you react the first time.

Before and after – raising forehead / surprised.

Maintenance Q’s

My first time getting botox it wore off in around 2 months, what happened? Did I not get enough?

Christina:  There are a few things/factors that could be at play:
Dose: Dose can equal duration, and everyone reacts differently to dosing. Many providers will treat with ‘less is more’ mentality when seeing a patient for the first time with a complimentary 2 week follow up to add any units needed. You can always add but you can not take away.

Individual: I have patients that last 2.5 months and others 6 months, with most common being 3-4 months. We call the patients that last 6 months, unicorns. Ha.

Education: Think of it this way; prior to treatment, your muscles are contracting at, let’s just call it, 100%. At 2 weeks after treatment, the botox is fully kicked in. Now…over the next few months it is going to slowly wear off. At 2 months, it’s unlikely that movement will be back to 100%. However, people get so used to how smooth it looks that they think it fully wore off. At the next 4 month visit, we can also add more units to help with duration without compromising the look, now that the provider knows your unique reaction.

If you don’t top up on botox, will I be like before botox, or does it alter something permanently?

Christina: The good news about botox is that it wears off after a few months, leaving you in the same (actually slightly better) condition than prior. The bad news is that it wears off after a few months, leaving you in…you get the idea.

When it wears off, will new sagging occur since the muscles are weakened?

Christina: I’ve heard this before, but am unsure who started this rumor. Botox has not been shown to cause sagging. Since Botox can give a subtle lift, especially in the brows, maybe people perceive this ‘back to baseline’ brow as sagging since they are used to their lovely brow lift.

Provider Q’s

I am not in New York, near an Ever/body! Do you have any tips on how to research and select a qualified provider?

Christina: Yes. When selecting a provider look at both their license and any credentials specific to aesthetics. For example, you may see an “NP, CANS” which stands for Nurse Practitioner, Certified Aesthetic Nurse Specialist. Dig a little deeper and see what their aesthetic is. What do their before/afters look like and does their personal aesthetic match what you are looking for? This is someone you’re going to have a long term relationship with so choose someone you can vibe with and that will be honest with you. If you’re feeling cute and confident about the decision, go for a consultation.

A huge huge thank you to Christina for doing this! Follow her instagram for all things aesthetics and even more knowledge… and I cannot recommend Ever/Body enough. They do such an incredible job.