I Got Rejected For Botox & It Was A Hard Pill To Swallow

"I wouldn't inject you," aesthetic doctor, Dr Harris, said matter-of-factly as he sat across from me. I had hoped to get a Botox top up. "Come back in a few years and we can talk about it," he added.

I'm 34 and, in four years of getting injected with Botox once or twice a year "preventatively" by different doctors, this was the first time an expert had turned me away for the procedure. 

Botulinum toxin, more commonly known as Botox, is a neurotoxic protein produced by the bacterium Clostridium botulinum. It inhibits the release of the neurotransmitter acetylcholine and causes paralysis which, when injected, relaxes the muscles in your face temporarily smoothing the appearance of lines and wrinkles. 

For that reason, no longer the preserve of celebrities in LA or New York, it has become a high street "anti-ageing" treatment. It sits somewhere between applying creams and serums and getting a surgical facelift on the scale of beauty extremes. On that day, I wanted a 'top up', like getting extra data for my mobile phone. 

Just two decades ago, altering the appearance of your face generally involved undergoing invasive and risky surgery. Botox changed all that. First approved by America's Food and Drug Administration (FDA) in 1989 for rare eye muscle disorders (and then as a cosmetic treatment for wrinkles in 2002) it is now ubiquitous, along with hyaluronic acid-based fillers.

Today, getting Botox is framed as banal as applying an over-priced moisturiser. You can get it in nail and hair salons. You can buy it now and pay for it later. You can have it injected and go straight to the pub. But the effects of Botox are not permanent. Usually, it lasts around three or four months, and it doesn't come cheap.

Having your face injected with a toxin so strong that it can paralyse the muscles to prevent normal facial expression and diminish the lines left by a life well-lived has been normalised to the extent that getting it is barely remarked upon. In fact, certain women's lifestyle publications will even happily offer advice about the "best age to start". That's 25 if you want to "prevent" ageing, according to one article I read in an established glossy magazine from a few years ago while researching this piece.

The notion of "preventative Botox" — Botox administered to prevent wrinkles from forming — has taken hold in recent years, too, and, honestly, I think I had taken it on via osmosis. For some reason, though, I never thought to properly interrogate it. A quick sweep of Google reveals articles which state that Botox will stop new wrinkles forming as fact. 

But when I asked Dr Harris as to why he wouldn't recommend Botox for me he dropped a bombshell: there is no clear evidence that preventative Botox works. "There are no large-scale studies to show that Botox has a preventative role," Dr Harris revealed to me. "These studies wouldn't be easy to conduct but they would be possible to do," added Dr Harris, "and right now, there aren't any to that effect."

Then came another bombshell, and this time, it was personal to me. "If you do come back in a few years," continued Dr Harris, "we'll need to be very careful with injections because of the position of your low brow." In fact, Dr Harris told me that I could be vulnerable to a brow droop, which is where the brow falls after injection. Not exactly what you want having booked in to smooth and lift your features.

That was the first time an aesthetic doctor had ever flagged this feature of the way my face is shaped. Since I met with Dr Harris, the only other person to flag this has been Dr Uliana Gout who is currently the President of the British College of Aesthetic Medicine. Shockingly, it has taken several years and visits to two of the world's most renowned aesthetic practitioners (who I only have access to because I am a journalist) for me to be told that, a) the evidence on preventative Botox is shaky, and b) that having it could actually cause problems because of my face structure. 

Dr Harris of The Harris Clinic has 146k followers on Instagram. He is an award-winning aesthetic doctor known for his frank approach to myth-busting cosmetic treatments, as well as for being a champion of natural-looking results amid what he calls an epidemic of "alienisation". This, as he describes it, is the trend for using fillers to create distorted features such as over-filled lips, cheekbones and jaw lines. 

His perspective is needed now more than ever. The normalisation of Botox has gone almost unremarked upon. Perhaps this is because anti-ageing skincare has historically been marketed and publicised using the language of secrecy. "What’s her secret weapon?" voices in adverts ask. "The secret to looking 25 when you're 37?". Maybe she's born with it, maybe it's Botox.

I know plenty of women in their early thirties who get Botox surreptitiously and plenty of younger women who are spending money they don't have on it. But last year the surge in teenagers seeking such cosmetic enhancements due to what has been dubbed the "Love Island effect" caused so much concern that former UK health minister Nadine Dorries announced a person's age will need to be verified before treatment can be carried out. Practitioners face prosecution if they fail to do so. In Australia, Botox injections are just one of the cosmetic procedures under the microscope, thanks to an ongoing crackdown by AHPRA (The Australian Health Practitioner Regulation Agency).

We must stop to question why and how this has happened. 

Firstly, beauty standards are not innate. They are created by a society which is heavily influenced by corporations that want to sell people things. Anti-ageing creams and serums have long-been big business. One which thrives on telling people, specifically women, that being beautiful and, often, youthful, is the most powerful thing that a person can be. 

Secondly, there is money to be made by peddling this message. TIn 2022, the Australian facial injectable industry was valued at $3.5 billion USD (at current rates, $5.4 billion AUD) in 2022.

Doctors who practice outside of the public health system are operating in a commercial market. Consider an article in the UK that was aimed at doctors and titled "Top 4 Reasons to Supplement Your NHS Income with Aesthetic Practice", which is listed on a website that provides training for those looking to take on extra work in aesthetics. 

"Working as an [public] NHS doctor is often challenging, particularly with the current understaffing and intense pressure levels throughout the system," it reads, before extolling the financial and work/life balance benefits of making a career switch to aesthetic medicine. Profitable though it may be, ageing has been cast so firmly as a negative process to be solved, cured or prevented, and it needs interrogation. 

As Dr Harris bluntly but carefully turned me away, something unexpected happened. I felt relief. Relief that he wouldn't freeze my expressions. Relief that he didn’t think the signs of ageing showing on my face were severe enough to warrant Botox. Relief that someone had given me permission to stop. 

I realise now that I was seeking that dispensation to leave behind an expensive habit I had picked up, if I am honest. I turned thirty when my long-term relationship began to fall apart because my then-partner cheated on me with someone younger for the first (but not the last) time. It was a living cliché but hindsight, as they say, is a wonderful thing. I was at a low ebb. My confidence had been knocked. A magical poison, which promised to give me a more youthful appearance when my age had been highlighted, was appealing. 

Years later, it was no coincidence that I had made the journey to a modest clinic on a tree-lined suburban road to see Dr Harris — a vocal critic of doctors overdoing aesthetic treatments — instead of visiting a fancy Harley Street practice in central London where, I know, fewer questions would have been asked. For his part, Dr Harris has given his role as a respected aesthetic doctor who does administer Botox where appropriate (for instance once visible and significant signs of ageing are apparent) a lot of thought. 

"There is this pressure, especially from social media, to start addressing these [lines and wrinkles] of issue earlier on I think," Dr Harris explained over the phone when we caught up after our first meeting. "I've definitely noticed a change over the years," he said. "And so, for those reasons, people are seeking treatments earlier and earlier." Dr Harris wants to understand the motives for treatment. "Does someone actually need [Botox] or is their desire coming from an external pressure to have absolutely no lines or signs of ageing?"

"Botox," Dr Harris adds, "is a drug, and it can come with side effects and complications so it has to be taken seriously." The drooping of the brow which I am at risk of is just one of the more serious of these. Others can include muscle weakness and vision problems if injections are not done properly. 

Another, less medically concerning (but hardly to be taken lightly) issue is that Botox does stop you from expressing yourself. When I have had it in the past, it is harder for me to raise my eyebrows. My exclamations are less pronounced and my smiles lessened because they don't take place across my whole face. Friends have told me that I look permanently "unimpressed" after fresh Botox.

This is more serious than it sounds. US studies have found that freezing our facial expression actually dampens our experience of emotions and that that people are slower to understand emotionally charged sentences after receiving Botox injections because their ability to read the emotion on other people's faces is impaired.

Botox might smooth the skin but to live is to feel and express those feelings. As you get older, you gain experience. Not all of it is pleasant, of course, but every smile, frown and grimace will leave its mark over time forming a retrospective roadmap of the life you have lived. 

Was I, I wonder, able to properly express my anger at what had occurred in my relationship after I started getting Botox? Did rage and disappointment show completely on my face or were they masked? Or did I diminish that, too? Dampening my reactions to an urgent and painful personal situation not only stunted me, it prevented those around me from experiencing the consequences of their actions. Crucially, it's not just ageing that Botox veils — it's feeling. And feeling isn't always attractive or palatable, but it is part of a human life.

Even when he does inject, Dr Harris says he does not advocate "extreme treatments". He adds, "We need expression in order to communicate. It's a very basic sort of human function to be able to read each other and have a decent conversation," he concludes, "and if you're completely frozen, then that's going to interfere with that, whether it be with friends or family. Too much Botox can cause problems in terms of basic communication."

Dr Harris hits home that if a patient comes in and they don't have any lines but want something like preventative Botox, he wouldn't be able to justify that scientifically. "Or ethically, for that matter," he tells me.

On reflection, I originally sought Botox ought for the wrong reasons. I wish I had been forced to have a more robust conversation about my motivations at the time.

With that in mind, however, it would be disingenuous to say that I'll never get Botox again. I'm still not sure that the principle is any different to those behind the over-priced face creams I apply or the laser facials I love. But just as 30-year-old me did not know how I would feel at 34, I can't be sure what my relationship with ageing will be at 40 or 50. Though I hope it will be peaceful. 

This much I know: Botox made me feel, momentarily, like I was taking control at a time when I felt had little command over a situation in my personal life. Long-term, Botox did not hold my relationship together. It did not stop me growing in experience. It certainly did not stop the inevitable march of time. And, it did not erase the pain of infidelity or stop me feeling it. Though it may have stopped me expressing it to the full.