Chances are, you know a guy who's had Botox. Since 2000, the number of men undergoing the procedure has surged by more than 200 percent, with some 385,000 procedures in 2013, according to the American Society for Aesthetic Plastic Surgery. (That's still a far cry from the 5.9 million procedures on women, of course.) These aren't necessarily the stereotypical model and newscaster types, either. "Middle-aged, health-conscious, white-collar guys come in wanting to look fresher, younger," says Todd Schlifstein, a New York City physician and owner of Fountain Medical Group, who says 10 percent of his Botox patients are now male. "They just like to keep it quiet."
Maybe that's why there's a lot of misunderstanding about what "brotox" can and can't do.
The common assumption is that Botox freezes the face in place. Not really. Injections of botulinum toxin paralyze muscles, causing them to weaken and ease their grip on wrinkles, explains Dr. Anthony Youn, a plastic surgeon in Detroit. "Botox acts like a cast on the face — it causes muscles to atrophy and get thinner." The wrinkle-reducing effect generally lasts three to four months, but, says Youn, "even when it wears off, the wrinkles that come back aren't nearly as deep."
That's where the procedure's cosmetic benefits end. It won't fix flaws like dark circles, hollowed cheeks, or a saggy face. To address those, explains Dr. Paul Jarrod Frank, a New York City cosmetic dermatologist — about a quarter of whose Botox patients are men — you need dermal fillers like Juvéderm. "I tell patients, 'Fillers fill holes, and Botox flattens mountains,' " says Frank.
Which isn't to say that Botox cannot go seriously awry: Think about all those male celebrities with deer-in-the-headlights expressions. That frozen look isn't so much from an excess of Botox as from poor execution. To avoid it, be careful who does the injecting. Everyone from hairdressers to dentists now offers the treatment, and while many may be perfectly competent, there's an artistry to the procedure; you want someone who specializes in the musculature of the face — a doctor, dermatologist, or plastic surgeon — and understands how Botox affects it. Injections, for example, shouldn't be plugged into an obvious frown line, but into the opposing muscles that create it. Whoever's wielding the needle should use words like natural and subtle. "Women tend to want lines completely erased," says Frank. "But I lessen lines in men by only half."
The effect may be less, but expect to pay more than your wife. Men's facial muscles are larger than women's, so doctors must use a third more of the neurotoxin, pushing the bill, on average, 20 percent higher. "Men want to get rid of the scowling, unhappy look," says Dr. Michael Olding, a plastic surgeon in Washington, D.C., who treats a growing number of businessmen and politicians. That means injecting "the 11 lines," those vertical creases between the brow, the jawline, and the smile lines that run in symmetrical arches from nose to mouth. Protocol calls for three to six needle pricks per area (it's relatively painless), and treatments run $600 to $900 per appointment. The result isn't a dramatic new face — it's still you. Just more like you circa 2007. "Men have embraced Botox simply because they can have it done quickly and go right back to work," says Olding. "Nobody has to know they had anything 'done.' "
Three Other Uses for Botox
The benefits go beyond zapping wrinkles.
"Injections can lessen their frequency and intensity by blocking pain neurotransmitters," explains Jack Schim, an assistant clinical professor in the neuroscience department at the University of California, San Diego.
Paralyzing sweat glands can help keep normally clammy skin dry. "I often treat just the right hand of businessmen — the one they shake with," says Olding. An injection in the palm and fingertips lasts six months.
Dentists recommend Botox for patients who clench their jaws and grind their teeth while sleeping. "Injecting the corner of the jaw relaxes the chewing muscles, so you can't grind as intensely," explains Frank.