When Should You NOT Have Botox?

One of the slightly odd things about aesthetics is that people are sometimes genuinely surprised when I tell them no.

You've booked Botox. You want Botox. You're perfectly happy to pay for Botox. Surely the next logical step is for me to give you Botox?

Not necessarily.

There are plenty of reasons I might decide not to treat someone. Sometimes there's a medical reason we need to postpone treatment or avoid it altogether. Sometimes it's because of your anatomy. Sometimes you've already had enough. And sometimes the answer is simply that Botox isn't going to fix the thing you're asking me to fix!

A consultation isn't there so I can work out how many units to sell you. It's there so I can work out whether I should be treating you in the first place.

Who Should Not Have Botox?

Let's get the obvious one out of the way first.

Botox is a prescription-only medicine in the UK, and there are medical reasons why somebody may not be suitable for treatment. Your medical history, current medications, previous reactions and what's happening with your health at the time all matter.

For example, the prescribing information for BOTOX lists a known hypersensitivity to botulinum toxin type A or its ingredients and an infection at the proposed injection site as contraindications. There are also other medical conditions and circumstances that need to be discussed with your prescriber before treatment.

This is why I ask you medical questions before sticking needles in your face.

I'm not just being nosy.

And if something comes up during your consultation that means treatment needs to wait, then it waits.

I Might Say No Because Botox Isn't Actually What You Need

This is probably one of the most common reasons I talk somebody out of the treatment they thought they wanted.

You might come in asking for Botox because your face feels heavier.

But when I actually look at you, the thing you're noticing might be volume loss. Or skin laxity. Or a change in the support through your mid-face. Or skin quality.

Botox works by reducing the activity of specific muscles. It can't restore volume that has been lost or tighten loose skin simply because we'd quite like it to.

This is where treating faces as a list of individual problems rather than as a whole gets us into trouble.

If you tell me that you hate your jowls, I'm not automatically reaching for whichever syringe has "jowls" written on it.

I'm looking at your whole face and working out why they're there.

Sometimes Botox will form part of that answer. Sometimes it won't.

I Might Say No to Forehead Botox

This is one people don't always expect.

You've got forehead lines. Botox treats forehead lines. What's the problem?

Your frontalis - the muscle creating those horizontal forehead lines - is also the muscle responsible for lifting your eyebrows. Some people naturally rely on it more than others, particularly if there's already heaviness around the brows or upper eyelids.

Relaxing it too much can therefore affect brow position and potentially make that heaviness more noticeable. This is exactly why forehead Botox needs to be tailored to the person rather than injected using the same pattern on everybody. Published expert guidance specifically recommends assessing things such as muscle activity, brow position and whether somebody is compensating for existing brow heaviness before treating the forehead.

So yes, I can see the lines. No, that doesn't necessarily mean I'm going to obliterate them.

I'd quite like to know what the rest of your forehead is doing first.

I Might Say No Because You've Already Had Enough

This is another one.

Botox gradually wears off and movement gradually returns. That is supposed to happen.

A tiny bit of movement coming back doesn't necessarily mean something has gone terribly wrong and we need to immediately throw more Botox at it.

There are recommended doses and treatment intervals for botulinum toxin products, and repeatedly adding more simply because you've spotted an eyebrow moving isn't how I approach treatment. Product guidance specifically warns against exceeding recommended doses and treatment frequencies.

I want to know when you were last treated, what you had treated, what was used and how your muscles are behaving now.

Sometimes you'll need treatment. Sometimes you'll need to wait.

Your forehead moving isn't an emergency.

I Might Say No If You're Chasing Absolutely Zero Movement

Some people love a very smooth Botox result. That's fine.

But there's a point where we're no longer talking about softening the thing that's bothering you and we're chasing every last flicker of movement across your face.

In my Aesthetic Clinic, that isn’t the goal.

Faces move. That's quite an important feature of them.

Good Botox is about understanding which muscles we want to relax, how much we want to relax them and what effect that's going to have elsewhere. Good botox is also meant to look human (in my opinion). 

So if you're asking me to keep adding more until your forehead has entered witness protection, I may well say no.

I Might Say No Because Botox Won't Give You the Result You Want

This is a big one.

Sometimes somebody is technically perfectly suitable for Botox but I still won't necessarily do it.

Because if what you're expecting isn't something Botox can realistically achieve, I'd rather tell you that before you spend your money.

Deep lines that are already visible while the face is completely at rest are a good example. Botox can reduce the muscular movement repeatedly folding the skin and those lines may soften, but an established static line isn't necessarily going to disappear simply because the muscle underneath it has relaxed. 

Deeper static lines related to loss of skin elasticity may not respond to botulinum toxin in the same way as dynamic wrinkles.

If you're expecting me to inject your forehead and erase a line that's been sitting there for fifteen years by Tuesday, we need to have a conversation first.

I'd much rather slightly disappoint you during a consultation than considerably disappoint you two weeks later.

I Might Say No Because I Don't Think You'll Look Better

And this is probably the simplest reason of all.

I don't need a dramatic medical contraindication to decide against a treatment.

If I think treating an area is going to throw off the balance of your face, make another concern more noticeable or simply isn't going to improve anything, I'll tell you.

The same goes if you've become focused on correcting something that I genuinely don't think needs correcting.

My job isn't to agree with absolutely everything you point at in the mirror.

Sometimes my job is to say, leave it alone.

There will always be another clinic willing to inject another area. That doesn't mean another area needs injecting.

Why a Good Botox Consultation Sometimes Ends With No Botox

I know it's not particularly exciting to book an aesthetics consultation and leave with exactly the same amount of Botox in your face as when you arrived.

But sometimes that's the right outcome.

I'd much rather lose the treatment fee than carry out something I don't think is right for you.

Because being good at aesthetics isn't just knowing where to inject. It's knowing when not to.

Considering Botox in Newbury?

If you're considering Botox near Newbury, my consultations at Aesthetically Refined aren't based around deciding how many areas I can treat.

We'll talk about what's bothering you, I'll watch how your face moves, look at how the different areas are working together and work out whether Botox is actually going to achieve what you want.

Sometimes I'll recommend Botox. Sometimes I'll suggest something completely different. And sometimes I'll tell you to keep your money.

Annoying for my bank account, but better for your face!