Botox myths take up more of my consultation time than almost any other subject. Botox is probably the treatment we perform most often in medical aesthetics, and it's also the one surrounded by the most bad information.
I hear the same questions over and over, and most of them come from something a patient was told secondhand. Below I take the six most common botox myths one at a time.
1. "Botox is snake venom"
No, botox isn't snake venom.
The honest answer isn't entirely innocent either: botox itself is a toxin. It comes from a bacterium called Clostridium botulinum.
Here's the part that matters: what we use is that strong, pure form diluted billions of times over. Same substance, completely different quantity. Plenty of drugs in medicine work on exactly this logic. What decides the outcome isn't the substance, it's the dose.
What this substance does is cut the connection between nerve and muscle. It stops the nerve from signaling the muscle, which means the muscle is temporarily paralyzed.
So how do we use that in aesthetics? We target the specific muscles that fold your skin into wrinkles. We reduce how hard those muscles work, in a controlled way and without flattening your expressions, and that keeps the wrinkles from setting in.
2. "Once you start botox, your face gets worse when you stop"
No, it doesn't get worse.
To see why, look at how the muscle behaves. After the injection the muscle loses working strength. The effect lasts 4 to 6 months. Once that time is up the muscle starts working again and comes back to exactly the same strength.
So when you stop botox your muscle doesn't end up stronger than it was. There's no rebound.
Then why do people feel otherwise? Because when the botox wears off you lose the smooth look you'd gotten used to. What you lost is the improvement. Nothing got worse. It only feels that way because your reference point moved.
3. "I've had it for years, it doesn't work anymore, let's raise the dose"
This is the riskiest myth on the list.
Some patients do build immunity to botox over time. The body produces antibodies and the substance can no longer do its job.
Doubling the dose sounds reasonable at that point, but it's wrong and it's risky. For two reasons.
The first is safety. Botulinum toxin has to be given within safe intervals and at a defined quantity. Pushing the dose up to beat immunity means stepping outside that range.
The second is simple logic. If there are antibodies in your body, however much toxin you inject will go and bind to them. The substance still won't do its job. More dose doesn't change the result.
So what do we do instead? In patients who have built immunity we wait a while. Waiting for the immunity to fade is both safer and more sensible than raising the dose.
4. "My eyelids are droopy, botox will open them up"
No. Botox doesn't do that. It can do the opposite.
Droopy eyelid has a name in medicine: ptosis. It happens because the muscle that opens the eye has lost working strength. So what you need is to strengthen that muscle.
Botox is a substance that reduces muscle strength. Inject it into that area and the muscle that opens your eye gets weaker still, and the droop increases.
There are some medical treatments for ptosis, but the real treatment is surgical. We make that distinction at the consultation, because not every sag on the eyelid is ptosis. In some patients the problem is only excess skin, and that's solved with a different procedure.
5. "I should wait until my wrinkles have fully set"
No, we don't wait. We do the opposite.
I generally like after the age of 25. Here's why: botox given before the wrinkles have fully set genuinely slows down how your face ages.
If you wait too long and the wrinkles settle in completely, botox has a limited effect even when it's done well. At that stage we may not be able to open the line all the way.
So the logic is this: prevent the wrinkle before it forms, rather than trying to correct it afterward. I go through the starting age and the criteria behind it in What Age Should You Start Botox? .
6. "I'm pregnant or breastfeeding, I can still have botox"
I have to give you an honest answer here, because this question has no clear scientific answer.
There's no study showing botox is harmful in pregnancy. That doesn't make it safe. To run that study you would have to give botox to a hundred pregnant women, withhold it from another hundred, and compare the children's health afterward. Because children's health is involved, that study can't be done.
So we don't have enough data.
In my own practice I wait until pregnancy and breastfeeding are completely over. I don't perform this treatment during that period. When the data isn't there, I'd rather stand on the cautious side.
Frequently Asked Questions
When does botox start working?
You won't see it right away. It starts within a few days, and you need about two weeks to see the full result. Don't look in the mirror on day three and decide it didn't work.
Will botox freeze my expressions?
Not when it's done properly. The aim isn't to paralyze the muscles, it's to reduce their working strength in a controlled way. A frozen look usually comes from too high a dose or the wrong choice of area.
Are botox and filler the same thing?
They're not. Botox reduces muscle movement, filler adds volume. Botox works on lines caused by muscle movement, filler works on hollows caused by volume loss. In some patients we use both.
What should I watch out for after botox?
For the first few hours we ask you not to massage the treated area, not to bend forward and not to lie down. We go over the advice specific to you separately.
Is botox different in men?
We plan it differently. Men's facial muscles are usually stronger and the aesthetic expectation is different. The aim isn't to change the angle of the brow, it's to keep the expression.
What age to start botox and what masseter botox actually does are worth reading too.
Dr. Alper Eskalen weighs all of these details when he assesses patients who come to him with questions about botox myths.
