Why Botox Has a Bad Reputation


Although Botox treatments are now more popular than ever before, they are continuously portrayed in a negative light, particularly within the media

As Botox (onabotulinumtoxinA) is often considered a solution to aging, it is one of the most popular cosmetic treatments available on the market.

No plastic surgeon should be surprised by the procedure’s popularity. After all, it is relatively inexpensive and does not require a lengthy recovery time. In fact, many of my patients receive Botox injections during their lunch break and then head right back to the office.

But while Botox treatments are now more popular than ever before, they are continuously portrayed in a negative light, particularly within the media, which I attribute to the following factors:

The “Ice Queen”

Everyone has seen those expressionless celebrity photos with taglines such as “too much Botox.” The goal of Botox treatment is to smooth out wrinkles and help a patient look refreshed, not emotionless.

As healthcare professionals, we immediately think the “Ice Queen” look is the result of too much Botox being administered too frequently, but does the public realize this? I believe many people not. As a result, many of my prospective patients who are interested in receiving a Botox treatment voice concerns about what they will look like following the procedure.

“Poisonous” Toxin

Botox continues to have a bad reputation because it is sometimes referred to as a poisonous toxin. But while onabotulinumtoxinA is a neurotoxin, it is certainly not poisonous.

In an effort to correct this misconception, I always speak with my prospective patients about what the drug is and how it works. Botox is a neurotoxin that targets the facial muscles commonly associated with wrinkles and fine lines. The injections “relax” these muscles, leaving patients looking younger and more relaxed. I have found that sharing this information with my patients not only puts them at ease, but also enables them to better anticipate their results.

I also let my patients know that Botox is a temporary solution, so the results of a single injection will only generally last from 6 months to one year. However, the facial muscles targeted by Botox can develop atrophy or weaken over time, which means future treatments require less of the drug to achieve the same desired effect.


As healthcare professionals, we need to educate our patients about what Botox is and how it works. In doing so, we will be able to dispel much of the skepticism surrounding the popular cosmetic treatment.

Robert T. Grant, MD, MSc, FACS, is Chief of the combined Divisions of Plastic Surgery at New York-Presbyterian Hospital-Columbia University Medical Center and New York-Presbyterian Hospital-Weill Cornell Medical Center. He is also Associate Clinical Professor of Surgery in the College of Physicians and Surgeons at Columbia University and Adjunct Associate Professor of Clinical Surgery at Weill Cornell Medical College. For more information about Dr. Grant or to contact him, visit his website at www.robertgrantmd.com.

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