I Asked a Plastic Surgeon Every Question I Had About Getting Botox

When I turned 40, I started noticing changes to the creases taking shape on my face. Fine lines that either hadn’t existed before or simply hadn’t bothered me suddenly couldn’t be denied. I had considered myself lucky up to that point, partially because of genetics (I have my late mom to thank for that) and partially because of the melanin in my skin. I’ll even admit I used to privately scoff at people who seemed to care so much about wrinkles and “the Botox of it all,” but as I watched those lines stare back at me in the mirror each morning, I quickly became one of the people who cared.In the four years since, I’ve spent countless hours researching all types of places for Botox: a plastic surgeon’s office, a dermatology practice, a dedicated Botox studio, and even an aesthetic boutique, and I’ve learned firsthand how the consultations, prices, techniques, and results can vary.The most successful? Shwetambara Parakh, MD, a board-certified plastic surgeon in New Jersey trained at Cornell and Columbia whose stunning results on her Instagram speak for themselves.I recently paid Dr. Parakh a visit to get her perspective on how to find the right experience and to ask her the questions I wish I had known to ask during my search before I’d found her. From the qualifications that actually matter to the risks of choosing an injector based on price alone, here’s what she wants prospective patients to know.What are the most important things to look for in a Botox injector? You want someone with core medical and aesthetic training. That could be a board-certified plastic surgeon or a dermatologist, as these specialties train for years in facial anatomy and complication management, and they apply the artistry of balance. We like to say true expertise comes from understanding the face and all the dimensions.Does experience matter as much as a provider’s title and credentials? Both matter. Formal training is the foundation, and we build on top of that after studying the facial muscles, the nerves, and the skin for years. When I’m injecting, I’m not just going by landmarks from a product company; I’m using my knowledge of facial anatomy and tailoring the injections to the unique anatomy of each patient. Hands-on experience refines that skill, but it starts with the right training.It’s like an airline pilot: You want someone who has been properly trained as a pilot and has logged hundreds of hours of flight. It’s why during training, we get the education, but we also spend a year in a clinical setting where we actually apply our learnings.If someone goes to a bad injector or doesn’t like their results, can they be fixed? It depends. Sometimes, we can tweak the results with a few additional units placed. For example, if one eyebrow is going higher than the other, then I can relax it with a couple additional units. There are certain things that cannot be fixed though, like if someone gets an eye droop, which is a side effect of Botox being put in the wrong muscle. The good news is that time takes care of Botox, since it lasts about three months. Some things can be fixed immediately, but if it cannot be fixed, you have to wait it out.Dr. Shwetambara ParakhDr. ParakhHow do you decide which brand of neurotoxin to use on a patient? All approved brands are safe and effective, and so sometimes I decide based on how quickly a patient wants results since some brands might be a day faster than others. Sometimes, patients just want to use something consistently. It’s important to understand what the patient is looking for and then go from there.Has your approach to Botox changed over the years? When Botox came out and became widely used cosmetically, providers were still understanding how to best apply it. Now, it’s all about balance and keeping the face expressive for most patients today. The trend is to look more refreshed and not completely “done” for the most part, and so it’s less about freezing movement and more about applying techniques delicately.Add Cosmopolitan as a preferred source in your Google search results.Use your Google account to add this to your settings.What are the biggest misconceptions about Botox?One is that Botox fills wrinkles. It does not; it relaxes muscles, which is different than dermal fillers that add volume to an area of the face.Another one I get from patients is that Botox will also automatically make you look frozen. If done well, Botox can actually make you look expressive, and if your Botox doesn’t look natural, the issue is sometimes with the technique, not necessarily the Botox itself.How do you determine whether a patient is a good candidate? I look for wrinkles that are caused or intensified by muscle movement, including frown lines, forehead creases, crow’s-feet, and lines around the nose. I also look at the patient’s medical history, lifestyle, and skin quality. It’s important to properly manage expectations, and I counsel my patients honestly on what Botox treatments can achieve vs. what they can’t.How do you cater the treatment to different facial structures, skin types, and age groups? Every face is unique. I look at the patient’s muscle strength, facial structure, skin thickness, age, and desired result. For younger patients, I may only apply a very light preventive dose compared to somebody who is older and might require a higher dose, and I’m always transparent about the dosing and explain the injection points accordingly. Beauty ideals differ as well. Sometimes patients want more, but I always balance it with what will look best.When a patient asks for an unrealistic result, how do you handle it?It begins with listening. I ask patients to describe the outcome they want, and sometimes I have them show me photos or point to examples of looks they like or dislike.My job is to take their vision and translate it into something safe and balanced. With Botox, if someone tells me they want a no-movement look, there’s nothing wrong with that. I have plenty of patients in my practice who want exactly that, and I’m happy to do it. But at the same time, I’m looking at the whole face and I will guide them and offer suggestions.What Botox trends are you seeing right now?One of the biggest trends is that patients are starting younger and asking for smaller, more subtle doses (that’s “baby Botox”) to soften lines while preserving movement. We’re also seeing more men seek treatment because they want to look refreshed at work.Botox is still most popular in the upper face, including the forehead, frown lines, and crow’s-feet, but interest is growing in lower-face and neck treatments, such as lip flips, injections for chin dimpling, and treatments that soften prominent neck bands. Those areas can be more technically sensitive, especially around the mouth and smile, so I approach them cautiously.Where do you see the future of neurotoxins and similar treatments heading in the next 5 to 10 years?I think we’ll continue to see longer-lasting products, potentially allowing patients to schedule treatments less frequently. Technology may also help providers customize treatments more precisely. Right now, I evaluate how strongly a patient’s muscles move and adjust the dose based on their anatomy and desired result. In the future, AI or other imaging tools may potentially help analyze facial movement and guide more individualized dosing and placement.This interview has been edited for length and clarity.Ronak Patel is the GM of the Lifestyle Group at Hearst Magazines. She oversees audience and revenue growth for brands like Cosmopolitan, Good Housekeeping, Delish, The Pioneer Woman, HGTV and Food Network Magazines, Woman's Day, Prevention, and Seventeen. Before becoming a GM at Hearst, she served as a GM at Ziff Davis overseeing the consumer tech group of brands such as Mashable, PCMag, and Lifehacker. She has been in media for over 20 years, serving in roles such as VP of Marketing and Integrated Marketing Manager at companies including Meredith Corp, Time Inc, and NBC Universal.