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What Is A “Botox Facial” — & Is It Safe For Skin?

"Skin Botox” is officially a thing , and it’s exactly what it sounds like: a shallow injection of botulinum toxin straight to the face. Also known as MesoBotox or most commonly the “Botox facial,” the treatment utilizes very micro microneedles to deliver a dose of muscle-freezing neuromodulators (like Botox) to the upper layers of the skin. “It’s like airbrushing,” Dr. Anna Guanche, M.D., a board-certified dermatologist who works with Olivia Culpo, explained to a small group of journalists at a recent event; an IRL version of an Instagram filter, an in-person Facetune-up — but there are still a number of concerns that patients should keep in mind before they make an appointment.

“We have known for years that Botox can also make the skin appear smoother and overall brighter, and make pores tighter,” Lisa Goodman, PA-C, the founder and owner of GoodSkin Clinics, tells The Zoe Report. She offers a version of the service — the AquaGold Botox + Filler Facial — at her treatment centers. "This is technically not microneedling; this is using an AquaGold stamping tool that delivers the Botox to the dermal and epidermal layers of the skin,” she says. (AquaGold features needles thinner than a human hair, and is pressed onto the skin rather than rolled. The effect is similar to microneedling: It stimulates collagen production and delivers product deep into pores.) “By using Botox to primarily treat the skin, the muscles are not affected, so full movement remains," Goodman says. Just like regular Botox, you see the results of skin Botox in about two weeks, and it lasts for two to four months.

Here's where skin Botox gets a little sketchy, though: Goodman notes the "mechanism of action is unknown" — meaning science doesn’t yet understand how or why microdosed Botox has these exact skin-smoothing effects. The reason science doesn’t yet understand? Because the Food and Drug Administration has not conducted studies or clinical trials on this particular technique, making it an off-label use of Botox not explicitly approved by the FDA.

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Dr. Guanche, who offers skin Botox via the BellaMicrogold treatment in her Calabasas, CA office, has a few ideas about how the technique works. “Neuromodulators have receptors they bind to on your oil glands and sweat glands to make them not secrete as much oil,” she recently explained in a video series on her Instagram Stories. “Your tiny, tiny muscles get affected just partially by the neuromodulator — not enough to change your facial expression, but just enough to make those fine lines not as apparent.” According to Dr. Guanche, the Botox-laced needles reach the sebaceous glands and sweat glands, which sit right in the middle of your pores. Combined with the pore-tightening effect, this keeps you from secreting sebum and sweat; while at the same time, needling stimulates collagen. “On one hand you’re less sweaty, but on the other you’re more dewy,” she said.

When I ask Goodman about the potential risks associated with the treatment, she notes “none” — which kind of seems strange, given that no one really knows the full extent of how Botox affects the skin at this level. (If the mechanism is “unknown,” the risks are “unknown," right?) And sure, Botox is largely considered safe — but new research from the University of Wisconsin presents “clear evidence that [botulinum] toxin is moving between neurons in a lab dish.” This is concerning, since the FDA’s approval of Botox in 2002 was based on “the idea that ... they stay where they are injected, and you don’t have to worry about toxin going to the central nervous system and causing weird effects,” Edwin Chapman, an investigator at the Howard Hughes Medical Institute and professor of neuroscience at the University of Wisconsin–Madison, says in the study. ("Weird effects" being, quite literally, botulism — the deadly infection that made botulinum toxins famous in the first place.) The findings have prompted research into a “safer drug.”

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Botulinum toxin risks aside, there are other reasons skin Botox might not be the best idea. For one, it physically tightens your pores, per Dr. Guanche — and pores are important. They pretty much exist to release sweat and oil. “Without them, our skin would be congested and have no way of releasing toxins or protecting itself from dehydration and overheating," Dr. Caroline Robinson, M.D., a board-certified dermatologist, previously told The Zoe Report for an unrelated article on how pores function. "Once we understand this, we understand how it might make sense to keep our pores the way they are.” So yes, skin Botox may make you look airbrushed... but it also may inadvertently create buildup, clog pores, and mess with the skin’s built-in detoxification function.

Speaking of which: “Sweating or perspiring is our natural way of staying cool — it helps us detoxify,” Ron Robinson, a cosmetic chemist and the founder of BeautyStat, tells TZR. “We are meant to sweat.” Especially when it comes to skincare, sweating serves a purpose: It opens pores and flushes them out, and sweat even has antibacterial properties to keep pores clean and clear. Basically, if healthy skin is what you’re after, decreasing your sweat and squeezing your pores shut is decidedly not the way to go.

That being said, this is all hypothetical: Like Goodman notes, skin Botox hasn’t been studied and isn’t fully understood… not even by the doctors who administer it. Airbrush at your own risk.