Will it be obvious if I get Botox?

Posted on April 2, 2023 | by Boston Plastic Surgery

Botox has been used for decades to soften wrinkles; the active ingredient (botulinum toxin type A) works by temporarily blocking nerve signals to treated muscles, relaxing expression lines. But, because the effects can be subtle or dramatic, it’s natural to worry about ending up with an unnatural result that is a dead giveaway of neurotoxin treatment.

If you’re considering Botox® or another injectable neurotoxin, you may wonder if you can get away with having the procedure without it being known to others. To help patients feel empowered about their decision, today we are sharing the signs of too much Botox, how many units are commonly used in a typical Botox treatment, and more tips on how you can achieve natural-looking results.

Can you automatically tell if someone has had Botox?

No. This is for a few reasons: first, an expert injector trained in the latest modalities for treatment will do a beautiful job keeping results natural, whichever brand of neurotoxin you choose (Dysport, Xeomin, Jeuveau, and Daxi are similar products). For patients who want to be particularly private about treatment, you can ask your injector to use a minimal amount of units to begin with and add more if needed.

A more subtle Botox treatment can soften lines instead of eliminating them, preserving a perfectly natural appearance.

One caveat: listen to your injector’s suggestions for your overall treatment plan versus giving them an artificial cap on how many units you are willing to try—this is because getting undetectable results may actually depend on having more units of Botox injected in nearby areas to balance out muscle movements.

Another reason that today’s Botox treatments often go undetected is that it has become so very common: with millions of patients having neurotoxin injections, it is less common for certain facial aging characteristics to be an expected part of our appearance as we age, i.e. not every 40 year old has deep frown lines. As such, people with reduced expression-based wrinkles are not likely to stick out among their peers.

How many units of Botox is best?

Your Botox treatment should be personalized to your unique anatomy and aesthetic goals, and the number of units each patient requires will depend on a few factors, such as their individual reaction to Botox, the age and condition of the skin and underlying musculature, and if they have previously received Botox in their desired treatment area.

Though dosage may vary from patient to patient, the manufacturer provides basic recommendations to treat various locations that injectors can modify to best meet the needs of their patients. Below is an approximation of how many Botox units you may need to achieve your anti-aging goals.

• Frown lines between the brows = 10-30 units
• Crows feet = 6-15 units per eye
• Forehead lines = 6-15 units

In addition to treating the areas listed above, Botox has been safely used “off-label” to treat fine lip lines, release dimples, slim the face, smooth the neck, and more. A knowledgeable provider will use their product experience and professional judgment to determine the right amount of Botox to achieve a smoother, natural-looking aesthetic.

Visible signs of too much Botox

When performed by an expert, Botox should be nearly undetectable. Poor injection skills, misunderstanding complex facial muscle interactions and anatomy, or imprecise dilution procedures can result in the following telltale signs of too much Botox.

• A frozen forehead. Botox should be conservatively injected to reduce muscle contractions just enough to soften or erase expression lines while still allowing some natural movement. A heavy-handed injector may inject too much Botox and leave you with an immobile forehead—a trademark of too much Botox!
• Eye appearance issues including over-arched eyebrows or eyelid ptosis. Perhaps this one doesn’t surprise you, but too much Botox or poor placement can make you appear surprised or sleepy until the effects start to wear off.
• The “bunny nose.” For some patients, diagonal lines (aka bunny lines) are formed on either side of the upper nose when they make certain expressions and the effect can be exaggerated when Botox is placed nearby. This happens when the underlying muscles in the area work harder to form expressions, compensating for reduced movement in treated areas. An extra unit or two can be injected on each side of the nose to soften or prevent the bunny lines effect.

Finding the right neurotoxin provider

The key to achieving satisfying results that still remain largely undetectable is choosing a highly experienced, medically licensed provider who specialize in injectables. Your face is made up of over 40 individual muscles, and each one serves a unique role when making facial expressions, thus a comprehensive knowledge of muscle function is absolutely essential to pleasing results with any neuromodulator.

Less experienced injectors, or those who treat patients without the benefit of a board-certified plastic surgeon to confer with, may be less knowledgeable about the intricacies of facial musculature and how muscles interact. There is no “fake it ’till you make it” strategy for injectors—a lack of experience and poor knowledge of facial anatomy is likely to produce undesirable or underwhelming results.

Choosing a medically licensed provider will also ensure that:

• Your treatment is administered in a clean, sanitary office where, if you prefer additional comfort during your injections, they will have topical aesthetics available.
• The risk of complications or poor results is minimized, and in the unlikely event you experience an adverse reaction, you will receive quick and professional medical guidance on the next steps.
• The product will be authentic and properly diluted.

At Boston Plastic Surgery, all injectables are administered by either our certified nurse practitioner Rachel Cohen, NP-C, certified physician’s assistant, Aliza Holstein PA-C, or our practice director, board-certified plastic surgeon Dr. Fouad Samaha.

An expert injector looks at the bigger picture

For discreet anti-aging results using Botox injections, an expert injector will not only ensure they understand your goals and concerns before administering treatment, they will also provide guidance on treating more than one area if needed to achieve a balanced, more natural-looking aesthetic. For example, if you address crow’s feet but not forehead lines, it may be more obvious that you’ve “had work done,” as each area will demonstrate different levels of aging. Treating both areas will achieve a cohesive aesthetic that will appear more natural overall. Treating multiple areas can also be important in reducing resulting overcompensation in muscles near targeted areas.

Your provider may also suggest complementary treatments to improve signs of aging that Botox cannot address, such as:

• Dermal fillers to add or restore lost volume to multiple areas of the face
• Sculptra injections to create a volumized, more youthful-looking appearance that lasts for years and boosts your natural collagen production to support healthier skin overall
• Vivace™ RF microneedling to stimulate collagen and elastic production, soften fine lines and wrinkles, improve mild skin laxity, and improve the appearance of scars
• Chemical peels to remove dull, damaged layers of skin, improve skin texture, and correct pigmentation irregularities
• Laser treatments to tighten loose skin, reduce static lines and wrinkles, and reduce other signs of aging
• Sofwave treatments to visibly lift the skin on the face, brow, neck, and jawline for a more youthful appearance

A professional injector will help you determine what additional treatments will support natural-looking Botox results. They may also suggest physician-only skin care products to treat signs of aging.

Natural-looking Botox at Boston Plastic Surgery

Whether you’re interested in preventative ‘baby’ Botox or want to reduce existing signs of aging, we invite you to visit our Skin Wellness Center in Boston. Our expert team of licensed medical professionals at Boston Plastic Surgery would be happy to meet with you and design a treatment plan to help you achieve safe, remarkably natural Botox results.

Under the direction of board-certified plastic surgeon Dr. Fouad Samaha, we are based in Quincy, MA, and we proudly serve the Boston metropolitan area. To schedule a consultation, please call our practice at (617) 786-7600 or contact us online today to get started!