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The Daily Dish The Real Housewives of New York City

Everything You Need to Know Before Trying Botox for the First Time

Calling all curious Botox virgins: Here's every last detail you'd want to know before going in for your first injection. 

By Talia Ergas
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These days, no one raises an eyebrow when you mention Botox. On The Real Housewives, Botox injections are a practically routine beauty maintenance, just like applying moisturizer. You'd be hard-pressed to find a Housewife who hasn't tried the injectable muscle-freezing procedure, and many of the ladies re-up every few months. Still, it wasn’t until recently that I considered trying the treatment myself.

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I always thought Botox was for people who already had lots of wrinkles and were looking to smooth them out — but then I started seeing Bravo stars in their early 30s and even in their 20s going under the needle. Pretty much the entire cast of Vanderpump Rules swears by the injectables for keeping their skin looking its best, and the always-ageless Heather Dubrow recently shared that she's been getting Botox since age 27 at the direction of her plastic surgeon husband, Terry Dubrow. 

Preventative Botox — that is, preemptively using Botox to freeze your face muscles so you never even get wrinkles in the first place — has been gaining more and more prevalence in the beauty world, and suddenly I started to feel like at 29, I was already behind the ball and I desperately wanted in. So, I turned to one of the best of the best: Dr. Howard Sobel, NY Cosmetic Dermatologic Surgeon and Director of Sobel Skin.

Dr. Sobel is the go-to dermatologist and injector-in-chief for many of the Real Housewives, counting Bethenny Frankel, Ramona Singer, and Tinsley Mortimer as patients (in fact, he appeared on The Real Housewives of New York City last season to give Tinsley Botox to treat her TMJ).

As a Botox virgin, I had a zillion questions and concerns. Would this hurt? Would I look like I had been through a wind tunnel after my first round of injections? Is Botox even right for someone who barely has wrinkles yet? And how much was this all going to cost? Scroll down to get all the details on everything you need to know before getting your first spritz of Botox, from the expert Dr. Sobel and a newly inducted Botox addict (me!).

What happens when you go in for your first Botox treatment? 

When I walked in for my first treatment at Dr. Sobel’s office, I was immediately struck by how gorgeous his Manhattan office is. The lobby looked like the entrance to a boutique hotel with a chic gray color palette, a white-washed brick fireplace, and sparkling chandeliers. The aesthetic atmosphere really helped calm my nerves and not make me feel like I was about to go in for a medical procedure. 

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I had to fill out a few forms detailing my medical history, and then I was whisked into a patient room to get my forehead numbed. (You will get the option of using a numbing cream, which takes about 15 minutes to half an hour to start working. I highly recommend it, but more on that later.)

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When I got to meet Dr. Sobel, I could immediately see why he’s a favorite amongst the Real Housewives. Dr. Sobel was very attentive while listening to exactly the kind of results I wanted to get — as a first-timer, I was nervous, so he promised me he’d be very conservative with the needle. He asked me about each area of my face (my forehead, my crows feet, my smile lines) and whether or not I was interested in treating that particular area. We decided I’d start with my forehead and crows feet, and skip the smile lines. 

We took a series of “before” pictures, and then when the numbing cream had set in, it was time to inject my face. The whole injection process took less than a minute, and that was it!

How badly does it hurt?

Of course everyone’s experience is different, but for me, I was honestly shocked that it didn’t hurt at all. (Remember, I did accept the optional numbing cream — and told the nurse to slather all over — so I definitely recommend that.) The needles they use are teeny tiny, and they don’t go very deep. I barely felt anything as the needles were going in. (The next week I got a flu shot and that hurt way worse. If you can survive a flu shot, Botox is a cakewalk.)

Another reason for my lack of pain probably had a lot to do with Dr. Sobel himself. His publicist described him as “an artist” of the face, and she’s right: It really pays to stick with a board-certified doctor with lots of experience. 

How quickly do you see results?

After my procedure, the muscles in my forehead started to freeze up gradually over the next few days, and I saw full results in five days. 

I was really worried that may face would appear stiff and expressionless and that everyone would immediately be able to see that I had gotten Botox. This couldn’t be further from what happened. The end result was a very natural look. Dr. Sobel had promised he’d go conservative with my injections, and so my eyebrows still move freely with my expressions and I don’t look stiff at all. The only difference is, when I raise my eyebrows all the way up, my forehead looks completely smooth and flat where it used to wrinkle up into deep creases. 

Honestly, nobody noticed that I had anything done at all, which is what you want when you go in for a cosmetic procedure: You want to look like yourself, but better. (Although when I raised my post-treatment eyebrows while holding up my “before” photo of the same expression, people were stunned by what a huge difference the Botox made, while still looking incredibly natural.)

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How has the use and understanding of Botox changed since it first came on to the scene?

"Botox has continued to grow in popularity and remains one of the most popular non-surgical solutions for combating wrinkles. Nowadays, it’s also used for other conditions such as treating TMJ, excessive sweating, and migraines," Dr Sobel explained.
What is the benefit of “preventative” Botox? Why are people starting the process at earlier and earlier ages?

"Preventative Botox is most commonly done to prevent the formation of static lines which can become more apparent and turn into deeper, etched lines as you age. Rather than treating existing or fully developed wrinkles, preventative Botox stops them from forming in the first place by making the muscle not able to contract so you don’t create wrinkles.

"If you are considering preventative Botox, you should make the commitment to continue to get Botox throughout the year whenever it wears off. If you don’t, you will start seeing etched fine lines in the skin that will not go away even with Botox. Remember: Preventative means being consistent, and you won’t be saying, ‘How come I had Botox, but I still see fine lines?’" he said.

At what age should a person start considering preventative Botox, if they’re interested?

"The earlier you address a wrinkle, the better the outcome, so I always tell patients to consider doing it sooner rather than later. Depending on the person, it can be done in your early to mid-20s, while for others it may be in their 30s," Dr Sobel said.

What are some common misconceptions about Botox and what it can/can’t do?
"A common misconception that patients ask is if they will get that 'frozen,' expressionless face. That is not the case.  A licensed, certified doctor should be able to moderately and properly administer Botox for a more natural look... Another misconception is that Botox is permanent. Results last only a few months, typically three to six," he explained.
What makes someone a good or a poor candidate for Botox?

"Anyone with wrinkle lines is a good candidate for Botox, but people that have very heavy hanging brows are not good candidates for Botox injections above the eyes (forehead) because they can get a droop. All other areas can get Botox."
What’s the average cost per area?

"The cost varies with geographic area but also depends on how many areas of Botox you do. The range can be from $500-$1,500."

How long does it take for the Botox effects to wear off before people need to come back for more?

"Botox works by relaxing muscles under the skin and the results typically last anywhere from three to four months. However, if you start at an early age, where lines aren't deep or etched, Botox can easily smooth them away almost completely. For younger patients, you may only need to come in one or two times per year," Dr. Sobel explained.
With spas and beauty salons offering Botox treatments, is it best to rely on a medical professional?

"It’s best to trust a board-certified doctor that is trained and licensed to perform cosmetic procedures. You never want to go for the cheapest price, or risk having an inexperienced person perform any cosmetic treatment," he noted.


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