Must be botox on the brain. At least, that’s what some of you have been wondering about in our inbox. To get those questions answered, we chatted with Dr. Komal Khiani (she/her), board certified cosmetic physician who also shares helpful beauty tips on TikTok.

“I grew up with horrible acne and was very insecure about it,” she says. “I started going to dermatologists to learn more about skin, and even made homemade skincare recipes. Still, I was left with acne scarring in my 20s, which led me to save money for lasers to help diminish them. I had bad experiences which left me with brown peeling skin, as well as lumpy and bumpy lips from filler. Then, I got botox for the first time, and my brows dropped. With my mixed results, I realized this field had plenty of room for improvement.

When I left my job in primary care, I was already passionate about the aesthetics field and I decided this was my chance. I worked my way up by shadowing injectors and training with a plastic surgeon. Now, here I am today with my own aesthetics and wellness practice.”

So, let’s (bo)tox about it.

What exactly is botox?
Botox Cosmetic is a prescription drug derived from the bacteria Clostridium botulinum. It blocks nerve signals to specific muscles where it was injected. Without this signal, the muscle cannot contract, resulting in diminished facial wrinkles. We tend to call everything Botox, however, the broader category is Neuromodulators. Botox is a brand. It was the first one on the market and is the most popular. Other brands include Xeomin, Dysport, Jeuveau, and the latest one, Daxxify. They all pretty much do the same thing however they are formulated differently by different companies.

What are the pros and cons of botox?
The pro is the ability to decrease fine lines and wrinkles. (And trust me, there is no skincare on the market that will get you those results.) They also have the ability to do other things that can build one’s confidence like flipping the upper lip, slimming the jawline, softening the marionette area, etc. The cons could be if you received injections by someone inexperienced, the inhibition of unintended muscles can alter your face. A few examples of this are heavy/dropped eyebrows and eyelids, uneven smile, or under eye swelling. Every injector is trained a bit differently, hence why botox looks slightly different at different practices.

What’s the difference between botox and filler?
When you think of botox, you should think of muscles. Fillers on the other hand are used for adding volume to a certain facial area. There are hyaluronic acid fillers and non-hyaluronic acid fillers. We have naturally occurring hyaluronic acid in our faces and as we age, hyaluronic acid decreases along with a decrease in fat pads and bone loss. Adding hyaluronic acid fillers strategically leads to a more youthful appearance. I only use hyaluronic acid fillers in my practice since they can be reversible. In very rare cases, filler can block a blood vessel in the face, leading to detrimental consequences such as tissue death. If caught early, all hyaluronic acid fillers can be dissolved, though.

On a side note, I want to mention a different category I use in my practice called biostimulators. A biostimulator product called Sculptra when injected stimulates your own collagen, whereas filler doesn’t do this.

How long does botox typically last?
Most neuromodulators typically last 3-4 months. Touch ups should be done 2-3 weeks after the initial treatments. In general, most of the neuromodulators peak at 30 days and then slowly decrease over the next 3-4 months.

Now that there’s research out there on it, what are the health risks of botox?
When we are talking about cosmetic botox, I would say almost none. When I think of health, I am thinking of more systemic problems. The most common, yet rare, side effects reported have been dysphagia aka difficulty swallowing, allergic reactions, and muscle weakness. There are no long-term or life-threatening adverse effects from the cosmetic use of botox. However, botox is also used for medical purposes. The dosage used is much higher and hence increased frequency of more serious possible systemic side effects.

What are your thoughts on Daxxify as being a botox alternative?
Daxxify is the newest neuromodulator and the longer lasting version. It seems to set in quicker and is being called the “6 month” botox. There is a 2:1 ratio, meaning, you need 20 units of botox then you would need 40 units of Daxxify. It’s still unclear if it really lasts longer for most people, though. There is also a higher chance of ptosis with it which I don’t like. Plus, I try not to use new products in the first year. Once there’s more credible data, then I can decide if it’s a good fit for my practice.

What should we look for in a cosmetics professional to do our botox?
Check out the practice’s website and read about the owner. Do you like their story? Then, check their social media platforms. Can you sense what the practice is about? Any before and after pictures? Do you like what you see? Then, when you call the practice, how do they answer the phone? Does the staff seem nice and personable? When you go into the office and meet the injector, do they take the time to get to know you and what you’re looking for? Do they guide you and educate you? If all the answers to the above questions meet your expectations, you’ve found a winner.