Why is there still a stigma around Botox?

Society’s attitudes are slowly changing

“I have a secret, one that I haven’t shared with any of my girlfriends. In fact, I worry my husband is going to find out. I have a standing appointment for Botox a couple of times a year. I love how it makes me look and I look forward to it. Why do we freely talk about sex toys now, but still not Botox?” —Signed, Smooth of Forehead

First of all, I believe that among people with the means to do so, more of them than you think are regularly indulging in a little subtle pick-me-up of Botox. This is just my hunch, and an eye trained by covering the goings on in the emerging injectables field. Plus, the fact that the global market for botulinum toxin used for cosmetic purposes is nearly $5 billion U.S.

Attitudes around getting a little work done are in transition right now: On the one hand, we have J.Lo who has sworn up, down and sideways that olive oil (a key ingredient in her own skin care line, J.Lo Beauty, launched late last year) is the “natural” secret to her age-defying complexion. On the other, we have fashion designer Marc Jacobs this summer sharing daily updates on his face lift on Instagram, from Day 1 swelling to his stints in a hyperbaric healing chamber, on through yellow bruising across his neck.

Here is my own experience with Botox. I tried it in the early days of injectables, circa 2000, when I was editing a fashion magazine; it was part of the cushy accoutrements of the job title, along with thrice-weekly hair appointments and a ritzy wardrobe for galas and events. These may as well be the memories of someone else (or of an alien) at this point, as my life now takes place exclusively in jeans and sneakers with my hair lumped atop my head in a messy bun. But anyway, back in the day, when doctors were just calibrating dosing and techniques, Botox could have a heavy, frozen effect. This look did not inspire me, so I did not do anything else intrusive to my face for a good decade and a half. Then I tried Botox again about a year ago, a conservative amount. Frankly, it was really great: The look was very subtle, my eyebrows slightly raised, the giant worry line between them soothed, eye crinkles softened. Twenty years later, doctors have amassed deft skills with needles; the art of Botox injection has come a long way, baby. The relative skill of a practitioner does matter: Do your research!

But the benefit was much more about how I felt. The act of self-care, especially after an expanse of pandemic neglect, gave me a palpable, lasting emotional lift. If I could afford it — or more accurately if I were to rearrange my budget priorities — I would definitely keep it up.

So why do people hide Botox still? Reflex, is my answer. I associated Botox with the whole plasticky exaggerated vibe of “Real Housewives” (great on my TV; jolting IRL). I also have a defiantly proud, working-class streak, and it felt a little indulgent to broadcast widely.

The perfect person to get the medical and emotional perspectives is Dr. Leah Smith, the founder and medical director of My Beauty Doctor, a female-physician-led practice in Yorkville. Smith started doing Botox herself when she finished medical school, aged 25 or 26. “Medical school aged me,” she says, laughing. Clearly a hard worker, she spoke with me by phone at 8 a.m. on a Sunday morning. As a client, she found a lot of holes in the market and attitudes that frustrated her: “I wanted somewhere physician-led, inclusive and not stuffy, not rushed or pushy. But I especially did not want to be told I needed a whole new face! There is a really toxic part of the industry.”

Smith says Botox is a luxury item, and it should feel like one. She is intent on countering “the culture of pointing out people’s flaws, and clinics that prey on insecurity.”

The MBD motto is “beautiful before, beautiful after.” The offerings are simple: medical grade facials, lighter to more intense medical grade skin care products, micro-needling, Botox and some hyaluronic acid fillers.

As to stigma, it is something Smith thinks a lot about. “Botox is going through its journey,” she says. “People are starting to talk about it on social media, moving toward being more authentic. Really, how is it different than covering up grey roots?”

She likens it to online dating and the changing attitudes toward that.

The openness that has transformed online dating, she says, is something she is starting to feel about Botox. “Our mission is to abolish Botox stigma.” Her clinic did a poll of its clients and the top fear was of being judged by others for Botox use. “Another thing that disturbed me was that people were afraid they weren’t naturally pretty enough, or that not aging perfectly was somehow a failure.” Social media’s filtered ideals contribute to these misconceptions, she says, as celebrities pretend “they just woke up like that.”

Smith sees patients of a wide variety of ages, and about 20 per cent of MBD clientele is male, usually referred by the women in their lives. “At any age Botox can have an effect.” Preventative is a big push these days, she says. See, in younger people (30s and under) you see dynamic lines, ones only visible when the face is in motion. As we age, those lines stick around at rest. “It depends on your goals,” she says of how much Botox she uses on a client. The costs range from about $300 to $1,000 a session, and the recommended time between appointments is three to four months.

Smith, who did her residency in family practice, is also trained for maternity care, and is on call once a week to deliver babies. She sees her various disciplines as complementary. “My passion in medicine is women’s health care,” she says. “I see self-care as an extension of that.” I have to say after speaking with her, I felt comfortable enough to talk here about the wee bit of botulinum I indulged in: It’s still a cost hurdle for me, but the emotional upside was quite uplifting. It’s worn off now, but I will not say never to going back for another round.