Let’s face it, we’re all talking about… And if you’re not talking about it, then you’re wondering about it. And if you’re not wondering about it, and you’re over the age of 35, then you’re just a very evolved human. Botox: Who’s getting it? Who’s gotten too much of it? And you, thinking you have crow’s feet and elevens and want to start getting it, let’s discuss…

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Alright, I’m probably not going to make any friends with this episode but let’s face it, we’re all talking about. And if you’re not talking about it, then you’re wondering about it. And if you’re not wondering about it, and you’re over the age of 35, then you’re just a very evolved human. Botox: Who’s getting it? Who’s gotten too much of it? And you, thinking you have crow’s feet and elevens and want to start getting it, let’s discuss…

So I meet with a bunch of women once a month for book club. Yes, the kind of book club where some of us read the book, but all of us show up to drink the wine. We’re all in our mid-to-late-30s and one of the women LOVES her MedSpa. There’s another woman, who goes to the same MedSpa, and so the topic of Botox and fillers comes up, well, not

I will say, just as an aside, I do appreciate the transparency of the Millennial generation who are just straight up owning their cosmetic beauty choices. I remember when there was a stigma around Botox and no one would actually admit to getting it. Those days are over – we Millennial women love talking about it, referring our injector, posting before and afters on Instagram and getting. that. referral. discount – amiright?

So, seven of us are sitting there at book club, and naturally, everyone starts going around and saying whether they’ve done botox before. Myself and three other women said they hadn’t, which left three who had. And this was actually shocking to me, because I just assume that I’m the only one still holding out.

I mean, the beauty industry is recommending that 20 year olds start doing botox preventatively – and I’m a lot older than that.

Anyway, that night I get home and I google the name of the MedSpa that was mentioned by these two friends. I knew way less about Botox then than I do now that I’ve researched this episode, and I was curious about the details – beyond just, ya know, a needle goes into your face a few times and then poof, you leave, and your wrinkles are gone.

So, you can imagine my surprise, when I get to the website of this MedSpa in San Diego (that I’ll keep anonymous) and I find their dedicated sales page to Botox and as I read paragraph after paragraph, they continue to refer to it as a neurotoxin. Not by the brand name, not even using the word neuromodulator, they’re using the word neurotoxin.

Now, I did know this much. I knew that Botox is, in fact, a neurotoxin. A neurotoxin is a natural or manmade toxic substance that alters normal activity of the nervous system. 

What I didn’t expect is for a MedSpa to outwardly, openly and publicly refer to Botox as a neurotoxin on the sales page of their own website. I was very confused. That’s like, going into a bar, looking at a cocktail menu and seeing a bourbon Old Fashioned described as, “A classic cocktail with simple syrup, bitters and poison – served on the rocks.”

But anyway… I see this on the website, I immediately send the link to my friend who works in the clean beauty industry and I ask her why they would refer to Botox in this way. Surely, they could stick to “neuromodulator,” which would still be accurate but maybe, like, sound a little bit less scary…

She couldn’t come up with an answer either. So, we just concluded that, I don’t know, we didn’t have a conclusion… maybe they pride themselves on their transparency and moral high ground? Orrrr their website must’ve been hacked? I dunno.

This is all just a long winded introduction into telling you that Botox is the trade name (or brand name) for Botulinum (baa·chuh·lai·nuhm) Toxin Type A, a neurotoxin known for causing botulism, an illness that paralyzes muscles and can be fatal. Botulism may sound familiar to anyone who has raised a kid and was terrified of your baby accidentally eating honey for, like, your entire first year of parenthood.

According to the National Institute of Health, Botulinum (baa·chuh·lai·nuhm) toxins are the most toxic naturally-occurring substances known to man.

Yeah. And we’re paying hundreds of dollars to willingly inject it into our faces. 

But let’s back up a little bit – in 1989, Botox first got FDA approval to treat medical ailments such as muscle spasms, excessive underarm sweating and eyelid tics. It wasn’t until 2002 that the FDA approved the drug to be used cosmetically to minimize facial wrinkles.

And to be fair to Botox, the Botox brand name is just one brand of the neurotoxin – you may have also heard of Dysport or Juvederm – there are a bunch of others, just like there are different brands of, let’s say, ibuprofen. Botox is the most well known brand so that’s the one I’m going to refer to for the purposes of this episode, but just know that there are others out there. 

Just one more quick note here: Botox is also used for medical and therapeutic purposes, specifically for children who have cerebral palsy, and this episode is not a critique on that. Today I’m speaking solely of its cosmetic uses.

So again, as someone who was pretty naive to Botox, and for anyone else who hasn’t gone down this road yet either, the way Botox works is not by eliminating wrinkles. When the Botox wears off, which it does about every 3-4 months, then you’ll start to see your wrinkles again. That’s because Botox is not filling in the wrinkle, or plumping up your skin to minimize wrinkles – no, the neurotoxin is injected into the muscle below your skin and paralyzes it. 

Think about it: it’s the muscles under your skin that make your face move and create lines (the ones on the corners of your eyes, around your mouth when you smile, on your forehead when you’re surprised) and when those muscles can’t move they can’t make lines in your skin. When your skin can’t crease, then your skin can’t wrinkle as easily.

And this is the reason that people in their 20s are getting Botox, despite still having natural, smooth and youthful skin. They are preventatively stopping their facial muscles from moving so that they don’t make creases in their skin. They’re counting on less creasing over time to mean less wrinkles when they’re older.

So, the question is: Is there a problem with any of that? Because if you’d ask most dermatologists, they’d say no.

In fact, when I started researching this episode, it was very hard to find anything that spoke negatively about Botox – all of the safety studies focused on how rare side effects or complications are and highlighted the lack of deaths. So much so that I almost abandoned this episode entirely, thinking there wasn’t really anything to sound the alarm on.

But with Botox coming in as the top minimally-invasive cosmetic procedure of the last year, according to the American Society of Plastic Surgeons’ 2020 Plastic Surgery Statistics Report, I thought to myself, “If it’s that popular, if it’s that requested by patients (and doctors and scientists are saying it’s safe) then who would speak out against it?” 

And then my brain kept circling back to Dopesick, that TV series on Hulu, that my husband and I just finished watching – how many doctors promised their patients that OxyContin was safe? Over and over and over again. To the point that we now have an opioid epidemic in the United States.

Am I comparing Botox’s safety to that of opioids? No, definitely not. It’s just to say, I can think back to a myriad of widely-accepted products on the market that were labeled and recommended as safe and then turned out not to be. Heroin was sold by Bayer as a cough medicine. Smoking cigarettes was prescribed to pregnant women who had anxiety. Sugar was marketed as a health food and Trans fats were once considered healthier than Natural fats – remember margarine and I Can’t Believe It’s Not Butter?

With this in mind, it prompted me to channel my inner Erin Brockovich and start digging deeper. And what I found out is that the FDA issued a black box label for the cosmetic use of Botox in 2009. According to The New York Times, the requirement was issued just 15 months after the FDA received a petition from a public advocacy group, claiming that the FDA had received reports of 180 serious health problems and 16 deaths connected to Botox injections. The FDA responded to the petition by saying it had identified even more reports of complications, including 225 reports of problems caused by the drug spreading from the injection site to distant parts of the body. In other words, there’s evidence (and even studies that have been conducted since 2009) concluding that Botox doesn’t necessarily stay in the same place it’s injected. So I ask again, can a dermatologist confidently tell you it’s safe if they can’t say that it won’t travel from your forehead to let’s say, your brain? Just spitballing here.

So what did the FDA do? The solution they came up with was to put a black box label on the packaging of Botox – a package with a warning label that a patient will likely never see.

Requiring a drug to be packaged with a black box warning label is one of the strongest safety actions the FDA can take. Black boxes are typically reserved for medications known to have serious or life-threatening risks.

I later found lawsuits and Facebook support groups for people who are still living with debilitating side effects of Botox injections. But it’s suspected that most side effects go largely unreported. So yeah, being wrinkle-free for 3-4 months – or many, many years – does not come without risk.

Despite all of that, though, it’s not actually the black box or the short-term side effects that give me pause. What concerns me, and keeps me from going under the needle myself, is the lack of long-term studies. It’s the lack of long-term studies on a product that essentially requires long-term use. 

 To keep up with the desired results of starting Botox in the first place, you have to inject it every 3-6 months. And the thing is, we don’t have studies on the effects of injecting a neurotoxin, the most lethal neurotoxin that exists on the planet, 2-4 times per year for the next 25 to 40 years. Because Botox has only been used cosmetically for the last 20 years.

 What the safety studies will tell us is that it’s all about the dose – that it’s such a minuscule amount of neurotoxin that’s actually being injected. But if you’ve been a listener for a while, you know that my focus when it comes to chemicals, parabens, phthalates, etc., for me, is the toxic load. It’s about the burden of repeated and lasting exposure. Is doing Botox twice in your 30s going to cause Alzheimer’s in your 80s? Probably not more than anything else. But could the repeated exposure 2-3 times per year for the next 10-30 years be harmful in the long term? Maybe. That’s the uncertain part — we don’t have the long term studies or research. So any dermatologist who tells you “Oh, yeah, Botox is totally safe” is irresponsible and quite frankly, not telling the truth. Because we don’t have the data.

 My goal is not to shame anyone or make you feel bad if you love your Botox, I get it. It’s the same reason why so many of us keep drinking alcohol socially even though we know it isn’t good for us either. But if you were kind of teetering on the fence of thinking you should start Botox and you’re starting to worry that you’re going to look 20 years older than everyone else pretty soon, then I want to bring up some other things to consider.

  First, back to the black box label – for the several years that Botox was available cosmetically, we were told that the neurotoxin doesn’t leave the injection site. If you put it in your forehead, then it stays in your forehead. We now know, however, that’s not true. Which as I mentioned before, led to Botox getting a black box label by the FDA.

 Something else to consider is that when a muscle is kept under constant paralysis, it leads to muscle atrophy. Weakening of the facial muscles & thinning of skin, both caused by long-term Botox use, can – in an ironic plot twist – make you look older. So, if you do too much Botox on your laugh lines for example over many, many years, the muscles will get weaker and flatter and the skin will appear thinner and looser. To top it all off, as your muscles become weaker, they can start to recruit the surrounding muscles in your face when you make facial expressions.

In other words, if you stop using your forehead muscles, you may start squinting using your nose and have wrinkles along the side of their nose. So, then what happens? You need even more Botox for those newly recruited muscles. You can see where a Botox addiction might spiral…

 The third thing is something called Botox resistance: After extended use, you can develop antibodies to protect your body against this foreign toxin. So the next time you go to get injected, those neutralizing antibodies recognize the toxin and they try to stop it, which requires more of the toxin being injected to see the same results.

 And the fourth thing to consider relates back to what I said a few minutes ago: How long did it take for the medical industry or the FDA to tell us cigarettes were bad? Or opioids? Or baby powder? Or lead paint? Think of all of the FDA-approved products on the market that were widely accepted only for us to be told that after long-term research, they’re actually detrimental to our health, or addictive or cause chronic illness.

 Again, there are plenty of things we all do that we know “aren’t good for us” – we write them off as our guilty pleasures or vices or small joys of life. If Botox is that for you, then who am I to stop you? I simply wanted to do this episode to bring the conversation up. Because I think that we’re too often told how safe injectables are when the reality is, we don’t have enough long-term data to know for certain. 

But selfishly, I would just love it if we could all collectively agree to save our money, save our time, and be at peace with our naturally aging faces. [candid] I was actually thinking about the teaser episode I did a few weeks ago, talking about the wellness burden and democratizing clean living. I wasn’t thinking of Botox when I recorded that, but it’s relevant. Cosmetic treatments are a privilege, they’re class-related and only financially available for a certain demographic of people. So just by saying no to Botox, it’s one small way to stand up in society, as a citizen, and fight the ever-widening gap between the so-called upper and lower classes. That’s a whole other topic for debate, but something to think about in considering our fellow human beings.

Thanks so much for listening to this episode of The Clean Living Podcast — I’m your host Shannon Lohr. Did you know that you can suggest topics for future podcast episodes? We have a very quick form that you can fill out on The Clean Living Podcast website – I’ll put the link in the description of this episode ( While you’re over there, you can also subscribe to my email list so you don’t miss future episodes or product recs. See you back here next week!