Is Botox Dangerous? Let's Walk Through The Fear Together
by Margaret Wheeler Johnson
A young lady with botox posing for a photo

My first fear around getting injectables in my face is obviously that Botox will disfigure me. I have watched daytime cable. I know about medical mistakes.

My second fear is apparently the most common, that I will look frozen and stretched and fake and desperate and ridiculous. The only thing this culture disdains more than a woman deemed past her sexual prime is one who won’t accept her expiration date.

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My third fear is of artistic differences. I notice the feline faces at the uptown lunch spots where no one eats the lunch. I see the aesthetic crimes committed by the better dermatologists of Manhattan. How does one avoid a similar fate? Should one see the fashion derm, the socialite derm, the corporate feminist derm, the “subtle” plastic surgeon who reportedly puts you out of commission for three months, so mangled that you can only be ministered to by a visually impaired, elderly housekeeper, but leaves you looking a refreshed 55? “But I’m 37!” I nearly tell the waiter at Fred’s.

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I text my friend Molly, who knows all. “Who is your derm?” I ask. “Need someone sane.”

"Go to Michele Green,” Molly writes back. “Expensive but normal.”

What can I say about Michele Green, besides that she’s a working mom who wears good jeans to the office, has soft, even, not-plastic skin, and gives it to you straight. I love her instantly, even when she comes in, peers at my forehead, and murmurs, “Ah, you have hooding,” thereby awakening a fourth fear I didn't have before but now do: It won’t work. I am beyond repair.

“What-ing?” I ask.

“Hooding.” Green explains: My eyelids are droopy. It happens to everyone eventually, but for the genetically unfortunate, onset is early. All it means is that she has to take care not to inject below a certain point on my forehead. Otherwise my eyelids will droop more, and an eyebrow or two could follow, creating that look that gives injectables a bad rep. "Sometimes [other practitioners] just try to freeze everything, and they don’t explain, 'Well, it’s going to make [your] eyes shut.’ And then the [patient] end[s] up hating Botox because of it.”

Overzealous injecting is responsible for most of the Botox injections that people are unhappy with, Green says, and advises finding a doctor who will practice restraint. "It shouldn’t look like you had something done. People should just say that you look a little bit better and not quite know what you did.”

That means your dermatologist needs to think strategically, and you need to be open to their direction. “People come in, and they have an idea about where they want you to inject. They’re not looking at the whole picture, so sometimes, you have to sort of show them. They’re worried about their nasal labia lines — their smile lines — but an injection there isn’t really going to fix them, and it may not look the best. What would be better is to inject their cheeks" with a filler like Juviderm.

“We don’t let you leave like that.”

Green gets to work injecting me, which is not painless, by the way. She numbs my forehead with a topical anesthetic — never a good sign — and begins to inject small amounts in the center of my forehead and the area between and above my eyebrows. The needle is necessarily tiny, but each time she goes in, there is a mysterious crackle, and my forehead zings with pain. It is definitely worse than as many flu shots.

When we're done, I have what feels like a sleep deprivation headache — faintly stinging and a bit chemical. My fifth fear is that I am poisoning myself. This feels real when Green says, “Botox is Botulism toxin — it’s really a toxin, and so it stops the nerves from contracting” but less real when I ask if this is going to give me cancer. “No,” she says, in the definitive way you want a physician to answer that question. According to a 2005 review in the Journal of the American Academy of Dermatology, between 1989, when it received FDA approval, and 2003, only 36 "serious adverse events" following cosmetic Botox injections use were reported, and no deaths. Good enough?

My sixth fear is bruising or lumping at the injection sites. "You have a little bit of swelling at the injection site for 10-15 minutes, that’s it,” Green says. “We don’t let you leave like that.” Still, there are ominous warnings not to tilt my head forward for 24 hours after I leave the office, lest the product move down, another scenario that can create the dreaded eyebrow droop. Also concerning is the instruction sheet Green gives me before I leave. It directs me not to use ibuprofen before or after my injections, as doing so can lower blood platelet counts, increasing your chances of bruising. What if, hypothetically, you have been taking Advil for a week since having some postpartum varicose veins ripped out (the glamour)? “I’m not so worried someone’s going to bruise,” Green tells me. So little worry!

Botox takes a week to show up on your face after you get injected, so there’s no instant reveal. For seven days I await a lopsided bulge above my eyes. It does not appear, and on the eighth day, the planned miracle occurs: Where are the stress creases I’ve worn since childhood? My forehead is a placid pool. Calm, inscrutable. I look like I don’t fret about anything, like someone who sleeps and delegates and does not ruminate on whether she embarrassed herself on Career Day in third grade. I look like someone who could pay someone else to fret for her.

"There’s a Botox cliff, Green tells me. One day, it just vanishes. 'You’re frozen frozen frozen frozen, and then all of a sudden: gone.'"

My seventh fear is of being judged if I tell anyone I’ve done this. Even in the era of skincare-as-pastime, some things, such as the shape of your features, are supposed to remain effortless and unedited. If we admit that many of the faces we consider beautiful are tweaked, that you, too, can alter your image and thereby game the criteria by which all women are judged, then on what basis can we be graded? There is always weight, of course, but that’s more variable. Since Helen of Troy, facial features have established a genetically determined hierarchy that cosmetics can’t alter. For much less money and temporarily, injectables disrupt that. Best, then, to shroud them in shame.

My eighth fear is that even though humans did best without any sort of Botulism until 1985, I can’t not have this. And yet I won’t, in three to four months. There’s a Botox cliff, Green tells me. One day, it just vanishes. “You’re frozen frozen frozen frozen, and then all of a sudden: gone." To get it back, you have to buy more. Combined with the cost of the appointment, that can set you back anywhere from $350 well past the $900 mark, depending on who you see, but is totally justified now that we know Botox is preventative. “They’ve found that if you do a little bit in your 20s and your 30s, it does prevent [wrinkles] from getting deep,” Green says. And if you get it often, individual injections can last longer — up to six months.


I spend weeks gazing at my smooth forehead, the forehead I could have had all this time. (Seriously — Green says she has 14-year-olds coming to her requesting Botox and fillers. She declines.) My friend Lindsay, who openly loves injectables and thinks we should have zero embarrassment about them, points out the lovely slight shininess a Botoxed forehead gets. The light hits its contoured shape differently.

The sheen is very nice, I concede. I start to fantasize about the clothes I will buy to match my supple dome, the workout and diet regimen I’ll kick off to smooth out the rest of me, the memories my children will have of their breathtakingly beautiful mother. I can see the person I’m about to become, whose clear, preventatively gleaming face gets her access to the happiness and self-ease reserved for those made of je ne sais quoi, cash, and neurotoxins.

My ninth fear around injectables is that they make me feel invincible, and things that do that always cost more than I can afford.