The rise of baby Botox

0:00Earlier this year, producer Amanda Llewell and RIP was in Portland, Oregon. on vacation. I'm hanging out, feeling really good about myself, and I walk past this store where a guy is offering free skincare samples. And I say, sure, I'll take one. Then he literally grabs me by the hand and pulls me into his store. And suddenly he's putting like this goop under my eyes. And I'm not a big skincare girly, but I dabble. And I'm telling you that this stuff was magic. Like, I have the beginnings of crow's feet, but I'm looking in the mirror and they're gone. And he tells me, This stuff costs$1 ,300, but it is so worth it because you won't need Botox for another three years.

0:45How old are you, Amanda? I'm 28 years old.

0:52Coming up on Today Explained. The pressure to fix your face.

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2:04It's Today Explained. I'm Noelle King. Yasmin Tayag is a staff writer at The Atlantic, where she also hosts a podcast called How to Age Up. This is a show about rethinking aging, which Yasmin recently found herself doing when she noticed that many of her friends have been looking suspiciously good. Well, as a woman in her late 30s, who is on Instagram all the time, I couldn't help but notice that some of my friends who are the same age as me look amazing. And I was like, wait, I know you're in your late 30s. Your face should not look that tight. What's going on here? So in person, I started to ask casually, like, what's your secret?

2:47And everyone I spoke to was very happy to tell me that they've been doing baby Botox since their mid-20s. What is baby Botox? You can interpret baby Botox in two ways. The main way is that you use baby doses of Botox. So typically, a normal Botox procedure might use 20 to 40 units of Botox. A baby Botox procedure uses only 10 to 20. But I think it can also be interpreted to mean that it keeps you looking kind of like a baby from the moment you start. So baby Botox is thought of as a preventative procedure. The idea is that if you begin using it before you start forming wrinkles, so freezing your face at, say, age 20, you will not develop those wrinkles as long as you keep up the Botox.

3:48Huh. Yeah, I was really surprised and they were very forthcoming about it. This is super interesting. I'm a couple years older than you. I'm in my absurdly early 40s, let's call it. And my impression of Botox, which I haven't tried but definitely would, is that it is something we do in the shadows. It is not something that we tell our friend who is a literal reporter for The Atlantic about. Yeah, you would think, right? And I'll tell you that I used to work in a Botox clinic when I was in college. Well, I was a medical assistant to a doctor who began moonlighting as an injectables doctor. And so I was exposed to a lot of the people who were coming in to get Botox.

4:28And this was in the mid to late 2000s. And at the time, it was very secretive. You know, people didn't want others to know that they were getting Botox. We would have women come in paying in cash because they didn't want their husbands or family members to know that they were paying for Botox. And I think a lot has changed since then. So when I was doing reporting for the story, something that came up a lot was the impact of reality TV. I have Botox up here, here. I've had filler in my cheekbones, filler in the chin, filler in the jaw. And my lips, so pretty much my whole face except my nose. Multiple women I spoke to mentioned Vanderpump Rules and The Real Housewives series.

5:18So I don't really watch these shows, but what my friends told me was that on these shows, the women are very open about their Botox use. I get Botox and I get filler. I've always done that. And I take care of my skin. Lots of water. And I lost some weight. And I think that openness just sort of bled out into the wider culture, leading us to a place where people aren't really embarrassed anymore. I am by no means against Botox. And any time I can get it free, I double up. There are some other things, of course, driving this baby Botox trend. I mean, the fact that so many people are on their phones all the time taking photos of themselves, streaming on TikTok.

6:01You know, you're looking at your face constantly. Hey guys, get ready with me. I'm 39 years old, I'm obsessed with skincare, and this is my nighttime routine for glass skin, including a new product. If you think you have a double chin, you actually probably don't. Probably just excess lymph fluid that's sitting in this part of your face. And the same goes for having been on Zoom for all of the pandemic. Where are we looking during our Zoom calls? Are you looking at yourself to make sure you're not doing anything weird? Because that's what I tend to do. I actually purposely move my viewfinder close to your face.

6:35So you think I'm looking at you, but I'm really not. I'm really not. When you're looking at your face all the time, you're spending more time with the wrinkles and the fine lines that are forming. I think broadly our culture has just become so visual. We're always looking at faces on social media. We're seeing our faces juxtaposed with those of celebrities who look incredible, possibly because they are doing so much baby Botox and other procedures.

7:10Can I tell you my theory based off of what you just said? Yeah. I think we are doing and seeing too much in daylight. Half of my life used to happen after dark. Too much is being done with good lighting. We need to return to the days of poor lighting, going out late at night, having drinks at dusk. Everything gets blurry anyway. Yes. I mean, also, like we have to mention the rise of the ring light, right? Oh, my God. I have mine on right now. And I'm furious about it. You know, it's supposed to make us look better on camera, but it also magnifies everything on your face. How many of the youths are treating this as it regularly?

7:53How common is this? So it's become really popular. I saw this statistic that said between 2019 and 2022, the number of people in their 20s who got Botox rose 71%. It's a lot. It's a lot. And these are people who in the early 2000s you wouldn't really think of as people who would get Botox. How are younger women doing this when there's also rent to pay and inflation running around the grocery store? Like, where's the money coming from? Great question. I mean, you're right. Even baby Botox, which uses fewer units than normal Botox, is still expensive. It can run up to between like$200 and$400 per session.

8:44And if you were to keep it up, you'd probably have to do it at least twice a year because Botox tends to wear off between three and six months. Okay, so a couple hundred bucks twice a year. I guess something you can budget for, but not nothing. Not nothing. But the way that my friends framed it, if you take it in the context of other procedures or other cosmetics that people are using to try to stay young, such as, you know, all the fancy anti-aging creams or facials, massages, all of these things that a lot of people do pretty regularly, those can cost easily up to$100. You know, in New York City, at least, mani-pedi can go for$100 easily.

9:33Yeah. I paid$87 the other day. Without tip. It's too much. Yes, with the tip. It's crazy. And so I think when you view it as just a part of your normal skincare routine, you know,$200 isn't that big a leap. especially if you consider it as potentially reducing your reliance on other types of cosmetics or anti-aging procedures. Is there any danger to starting Botox when you're in your 20s? I think something that should really give people pause is that we don't really know that much about the long-term effects of Botox, of regular Botox use. So the baby Botox trend began somewhere in the aughts.

10:16And we just don't really know what happens because there just hasn't been enough time to see what the long-term effects can be. But some of the dermatologists I spoke to for this article told me that broadly, one issue with Botox is that if you paralyze the muscles in one part of your face, the other muscle, like it still wants to move. Your face still wants to move. And so other muscles can try to compensate. And so, you know, you'll start seeing wrinkles in those areas and potentially need to get Botox there. So I think one potential consequence of regular Botox use from a very young age is that you become dependent on it.

11:04Yeah. You're like chasing the aging all around your face. That's actually super interesting to think about. If your forehead doesn't wrinkle, something else somewhere on that face is going to move. And then, you know, a couple of years from now, you might be chasing that with the injectable. Let me ask you, you host a podcast about aging. You try to be optimistic. You also know, I would imagine, that there's a lot of pressure to look younger than you actually are. If baby Botoxing becomes a bigger trend, could it become kind of an arms race where you've got a whole generation of 50-year-olds who look 30 and then everyone has to change and double down in order to look good for their age?

11:50You know, it's interesting. One of the women I spoke to actually brought this up. She felt like she was in competition with women to look youthful. And her concern was that all of these younger women started baby Botox earlier than she did. And so she's like, they've got a head start. You know, I only started in my late 20s. These women have seven years on me. And if we're going to end up continuing to do this procedure, I'm not going to ever catch up to where they are. and it's funny because intellectually I can understand yes we're supposed to be celebrating aging and feeling good about the wrinkles and the gray hairs and all of the wisdom and experience that come with it but at the same time I'm still looking at myself in the mirror trying to pull out my white hairs and it comes from this immense cultural pressure especially on women to look good for their age, but I wonder if looking good for your age isn't even going to be good enough if this trend keeps up.

12:58You don't want to just look good for 30 or 40, you want to look 20. One thing that has come up for me a lot as I think about this baby Botox trend is that if you manage to stay looking 20 for the next 30 years of your life, what do you miss out on? You know, as I got older I found that people treated me differently often in a positive way I was taken more seriously I was told I had more gravitas and if you never look that way what happens to you?

13:47Yasmin Tayag of The Atlantic. Her podcast is called How to Age Up. Coming up next, a physician who has been chasing young women out of her office.

14:18you're listening to today explained so my name is michelle heary i'm a physician i do dermatology and dermatopathology which is looking under the microscope for you know skin biopsies and whatnot and so i'm seeing patients medical patients, cosmetic patients, and occasionally surgery. And I have my own office. So I started my practice at the end of 2015 and really got into the swing of things in 2016. And I really didn't start seeing that uptick of younger cosmetic patients until the pandemic. Everyone was basically chronically online. They were on Zoom. They were looking at themselves. And there was the rise of TikTok and the filters.

15:16And people were really, you know, seeing these flaws, these perceived flaws that either aren't there or are so minimal and just normal anatomy. and they have really, you know, made it front and center where it affects them. It affects their daily life. And, you know, I really feel that it has become more of a pathological thing. I did have this patient very recently who was on the younger side. She was mid-20s and really, you know, beautiful girl. I don't see a lot of signs of aging on her face, but she was coming in for neurotoxin, Botox, dysport, that sort of thing. You know, I really had to kind of search for movement on her face already.

16:06So there wasn't a lot for me to treat. So I told her, you know, okay, no problem. I will do a little bit. I mean, I see maybe it helps with your 11 lines in the middle. You know, maybe if you're looking angry, that's fine. No problem. We'll do a little bit. And at the end of the session, she was asking me, so what do you think about my nasolabial folds? Basically, it's the fold that goes from the corner of your nose, your nostril, to the corner of your mouth. And it is kind of the barrier between the kind of upper lip and your cheek. And when you smile, it kind of folds like that. Of course, the more you age, the more of a line will be left behind when you're not smiling.

16:52And she was just, you know, she's pointing to her cheek as if there was something there, but there was nothing there.

17:00And so I had to tell her, like, well, I don't see that. You're perfect. It's a phantom nasolabial fold. It didn't exist. So I had to bring a mirror out and show her. There's nothing here. Right? And so that sort of mentality where someone really is perceiving a flaw that is absolutely not there, providers need to say no. Unfortunately, they're incentivized not to, especially if you have a cosmetic office, if you're a med spa, if you're a cosmetic derm or plastic surgery office. Of course, you're incentivized to do what the patient wants. Well, I'm not going to do that. That's not what I do. So you said no to this young woman and sent her on her way.

17:45Yes. Which means you may get paid for seeing her in that visit, but you're not getting paid for putting filler in her face. Of course. I think what I hear you saying is other doctors would have done that. Absolutely. Oh. 100%. Wow. And I know this for a fact because many times those patients will come to my office to get that filler dissolved because they don't like it. In the larger practices or practices that are private equity owned, which is a huge problem in medicine, you are absolutely meant to sell as many products, as many procedures as possible. Oftentimes, I was told to sell as much filler as possible, right?

18:26Because every syringe is several hundred dollars. And then if they're there, talk them into a laser. Talk them into this. Talk them into that. Then you become a salesman. I mean, I was even told for my skin check patients, you know, I'm looking for skin cancer. I'm, you know, counseling them on how to take care of their skin. I was told don't talk to them about using sunscreen. No. Because we want them to get skin cancer and come back. I was pulled out of a room. I was pulled out of the room by my boss and reprimanded for explaining why it's so important to use sunscreen. And so this is why I couldn't do it anymore.

19:05I had to start my own office and be on my own. I can't do that. That goes against everything that I believe in my oath. Because there is harm, potential harm, on many different levels for cosmetic procedures. What are the risks here to giving someone a cosmetic procedure that you know they don't really need? Well, I mean, there are just issues with cosmetic procedures in general, whether they need it or they don't. You think about this is a medical procedure. There is always risk for any type of intervention, right? So what gets me is like Nordstrom is talking about having, you know, injections in their stores.

19:47Like this is some sideshow thing. This is ridiculous. This is a medical procedure. You can get infection. You can get vascular occlusion that can lead to death of the tissue overlying where you inject. It can lead to blindness. This is like a big deal. Of course, it's fairly safe if you know what you're doing, but not everyone knows what they're doing and knows how to handle the problems, the complications that can come about. So beyond that, you have financial issues. If someone does baby Botox in their 20s and they want to do it for a long time, you think about how much cost that is. If you're spending$500,$600 every three or four months, that's a lot of money.

20:29especially today. And then honestly, I feel like the psychological aspect of it is a big problem, right? So at some point you become dependent almost on these procedures to either feel happy or feel good about yourself. At what point is it kind of be not enough, right? So you're going to do more and more and more, and then you're not going to look like yourself. And it's going to be at a point where you look in the mirror and it's not you. One of my colleagues actually coined this term. It's called perception drift. At some point, you will do these little, little, you know, incremental treatments until the end, you are entirely different person.

21:12You look like a different person. And you might look very abnormal. Yeah. Right. So even if someone comes to me for something that is legitimate, it's still, once you start, it's going to be hard for you to stop. So if you're barely able to scrimp together enough to pay for that one thing and you have it done, great. What about all the rest of your life that you're going to want to do something? Are you going to be able to manage it? I wonder how all of this makes you think about your profession. I mean, most people get into medicine has always been my assumption to help people, to be helpful.

21:51And you've laid out a world in which procedures are being done that are not only not helpful, they could be dangerous, and you don't seem to like it very much. Yeah. And this is why it is a smaller and smaller and smaller percentage of what I do in my office. I love cosmetics to an extent, right? So I love to augment, make people love how they look. But when you start using cosmetics as a tool to make them feel better about themselves in a major way, and that they need these sort of things to, you know, validate themselves, it's a slippery slope. It should be more of a targeted thing, not making you look like an entirely different person because, you know, society has told you, you can't age, that, you know, women just can't age, which is just, you know, it's really disturbing to me.

23:01That was Dr. Michelle Hurie. Amanda Llewellyn produced today's show. Amina El-Sadi edited, Andrea Kristen's daughter, and Patrick Boyd engineered. Today's episode was a rerun. We'll be back with new shows on Monday. The rest of our team includes Abishai Artsy, Hadi Mwagdi, Miles Bryan, Peter Balanon-Rosen, Patrick Boyd, Danielle Hewitt, Kelly Wessinger, Ariana Espudo, David Tadishore, Dustin DeSoto, Estet Herndon, and Sean Ramos-Firm. Jolie Myers is our deputy EP. Our executive producer is Miranda Kennedy. We use music by Breakmaster Cylinder. I'm Noelle King. Today Explained is distributed by WNYC and the show is a part of the Vox Media Podcast Network, podcast.voxmedia.com.

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24:03Thank you.