Is It Safe To Get Botox Again?

As the world begins to slowly (and as safely as possible) reopen amid the current COVID-19 pandemic, elective medical procedures are back on the table for many Americans. While a looming colonoscopy or the root canal that's been on hold for months might not be at the very top of your to-do list, a long-awaited appointment for Botox is a completely different story.

Umbareen Mahmood, MD, a board-certified plastic and reconstructive surgeon based in New York City, says that the demand for Botox has increased exponentially over the past few months. The reasoning, she explains, is likely two-fold: a combination of backlog and the natural stress response to the state of the world.

"Feelings of stress and anxiety cause facial muscles to tense up, resulting in wrinkles and furrows," Dr. Mahmood says. "Plus, with nonstop Zoom calls being the new normal, it's easier than ever for people to scrutinize their own reflection. For those who have had Botox before, they may realize it has worn off, and for others who never had it, this opportunity gives them time to research what it’s all about."

No matter which camp you fall into, the procedure will look a lot different for the foreseeable future, with additional safety precautions in place to protect both doctor and patient from contracting coronavirus. Ahead, we consulted surgeons, dermatologists, and public-health experts to break down what the safest possible facial-injection experience should look like during this time — when and if you chose to go.

Seeing as the number of COVID-19 cases varies city by city, public-health expert Karl Minges, PhD, says that you should always adhere to your own state's public-health guidelines before scheduling an elective procedure such as Botox. If your local dermatologist or outpatient clinic has been given the green light to reopen, call beforehand and inquire about the increased safety measures in place.

"In terms of safety precautions, I would contact the clinic prior to any visit and ask if the staff are routinely tested for COVID-19, and how the clinic is preventing the transmission of the virus among its patients," Dr. Minges says. "As dermatological procedures such as Botox injections often require the removal of a mask, patients should also ask how often the rooms are disinfected and the length of intervals between procedures in a given exam room."

As a general safeguard, every process that can be contactless should be. "All medical insurance forms, payment, and other paperwork should be done online prior to the appointment to minimize unnecessary hand or surface contact," says Hadley King, MD, a NYC-based dermatologist. Beyond just routine consent forms, Dr. Mahmood adds that patients should be provided with a timely and specific COVID-19 questionnaire ensuring they haven't left the state or exhibited symptoms, and are not at high risk for infection.

Even if you're feeling perfectly healthy the day of your appointment, your provider should still screen you for a fever at the door. "All patients should be temperature-screened for fever upon arrival," Dr. King says. "Anyone with a fever, even low grade, should be required to reschedule." Any and all cancellation fees will be waived at this time per CDC guidelines for all practicing medical facilities, so if you feel at all nervous or symptomatic in any way leading up to your Botox appointment (or any other appointment, for that matter), you can cancel without penalty.

As with other reopened personal-care services, like nail and hair salons, the lobby or waiting room (as it were) of your esthetician or dermatologist's office should be spotless — and completely empty. Neethi Masur, a registered nurse at NYC's SKINNEY Medspa, explains that staggered appointments allow for safe social distancing and provide time for exam-room sanitation. "In our office, each Botox patient will have buffer time before and after their procedure, which is typically inside of 30 minutes," she says. "About 15 minutes between patients ensures our office has adequate time to properly clean and sanitize the room with medical-grade disinfectant, and the time lapse also avoids all unnecessary contact between clients."

Considering that COVID-19 is a respiratory virus spread primarily through droplets in the air, the protocol on protective face coverings is arguably the most important. According to experts, all patients and staff must be wearing a mask at all times, and the provider should be wearing extra personal protective equipment (PPE), including a face shield, gown, and gloves.

Now, you might be wondering: Logistically, how can a doctor administer a Botox injection to a patient wearing a face mask? Bruce Moskowitz, MD, a NYC-based plastic surgeon, says that it takes a tiny bit of creativity. "It is slightly more difficult to inject around a properly-fitted mask, but it can be done safely," he says. "Injecting Botox into the forehead can be done easily, but the mid-face — the nose and mouth area — requires that the mask is maneuvered slightly. But with proper PPE, only the doctor is momentarily exposed to the patient's respiration, not the other way around."

Like most other decisions we're making in this strange new world, the choice to go under the syringe should not be taken lightly. "As with anything, there is a risk-reward ratio to consider when determining if you should undergo an elective procedure, even something quick, like Botox," Dr. Minges says. "Those who are older, have comorbid conditions, are immunocompromised, or are caring for a vulnerable person may want to weigh that risk-reward very carefully."