Love it or hate it, everyone and their (almond) mother is getting work done. Botox, filler, threads, lip flips… the full à la carte face. It’s not taboo, it’s Tuesday.
And let’s be honest: everyone thinks they know the best injector. A friend of a friend has a “hidden gem” in Tribeca. Your facialist swears by a woman who once assisted someone famous in London. There’s always a name whispered over matcha — the one who only books via DM, posts cryptic before and afters and claims to be subtle but has never met a cheekbone she didn’t want to overfill.
The truth? Most of these people have no idea what they’re doing. Which is exactly why we tapped someone who actually does.
Enter Betsy Tanenbaum, board-certified family nurse practitioner, needle whisperer and the woman behind By Betsy. With a background in both traditional medicine and aesthetics (read: she can treat your sinus infection and your smile lines), Betsy is the real deal. No gatekeeping, no fluff, just smart straightforward advice on what you actually need to know before letting anyone near your face with a syringe.
From “when can I expect results?” to “are off-label treatments FDA approved?” consider this your pre-injectables cheat sheet straight from someone who’s seen it all, fixed it all and will 100% tell you when less is more.
What is Botox and how does it work?
Botox is a brand name for botulinum toxin type A, a neurotoxin made by the bacteria Clostridium botulinum. Under every wrinkle are muscles that move and contract. Botox blocks the nerve signals telling those muscles to contract, which relaxes both muscle and wrinkle. In the U.S., Botox isn’t the only option — there’s also Dysport, Xeomin, Jeuveau and Daxxify. They all differ a bit in how they work, how fast they kick in, how long they last and the price.
What is filler and how does it work?
Dermal fillers are injectable gels that restore volume, smooth lines and enhance your face’s contours. Most fillers are made of hyaluronic acid, a natural skin substance that holds moisture and adds volume. Fillers physically fill in wrinkles or hollow areas. In the U.S., popular fillers include Juvéderm, Restylane, Radiesse, Sculptra and Bellafill. They vary in composition, feel, longevity and where they work best.
What affects neurotoxin duration?
Neurotoxin usually lasts 3 to 4 months but it varies based on the person, the procedure and the product used. People with faster metabolisms may break it down quicker. Frequent or exaggerated facial movements can shorten how long it lasts, and lots of exercise or sun exposure can also decrease its duration.
What dictates botulinum toxin dosage?
Stronger or more active muscles — like a man’s frontalis compared to a woman’s, or the masseter muscle — usually need more units. Underdosing can make results wear off faster (more units means longer-lasting results, but also a more “frozen” look and higher cost). Placement and injection depth matter too — poor technique can cause the product to spread too quickly or not work as well. Over time, repeated treatments can actually make effects last longer by training muscles to relax and causing some muscle atrophy.
Why is having a skilled injector so important?
I can’t overstate how important expertise is with neurotoxin and dermal fillers. A skilled injector knows where muscles, blood vessels and nerves are, how to avoid or handle complications, and how to pick the right product for each person. Experienced injectors customize treatments to your unique face, muscle strength and goals. Choosing a qualified injector—ideally a licensed medical professional trained in aesthetics—means safer treatments and better results.
On-label vs. Off-label: What’s the difference?
You might be surprised to learn that some of the most popular anti-wrinkle treatments are technically off-label. On-label uses are FDA-approved for things like treating frown lines, forehead wrinkles and crow’s feet, plus medical conditions like migraines, overactive bladder, muscle spasms and excessive sweating. Off-label uses aren’t FDA-approved but are safe and commonly done by licensed providers based on experience and research. In fact, many of the most popular cosmetic neurotoxin treatments are technically off-label.
What should I do before my neurotoxin treatment?
It’s important to plan ahead. Try to avoid alcohol and blood thinners like ibuprofen or aspirin for 24 hours before your treatment to lower your risk of bruising. If you can’t avoid them, you can still get treated, but bruising risk goes up. Pregnancy and breastfeeding are no-go’s for this kind of treatment. Be sure to talk through all contraindications with your provider before booking.
What should I do after my neurotoxin treatment?
Right after your appointment, you might notice some mild redness or tiny bugbite-like red dots that should fade within an hour. Arnica cream can help with any bruising. Follow the 4-24-7 rule after neurotoxin injections to keep complications at bay:
4: Stay upright for at least 4 hours and skip makeup during that time.
24: Avoid vigorous exercise, sweating or saunas for 24 hours—take the day off. Also steer clear of alcohol and ibuprofen to lower bruising risk.
7: No facials, lasers, massages, waxing, gua sha or peels for 7 days.
Always follow your injector’s instructions for the best results.
When can I expect results?
Botox: You’ll start to see less muscle movement within a few days, with full results showing up by about two weeks. Depending on where you get treated, you might notice smoother, more radiant skin, better facial symmetry, enhanced features like your lips or eyes, and an overall glow-up in skin texture. Results usually last 3 to 4 months, with movement gradually coming back. Most people schedule appointments every three months.
Filler: Results are immediate after treatment, though you might have some swelling that settles over the next few weeks. Fillers can last anywhere from six months to over two years depending on the type, amount, and area treated. You might need touch-ups with smaller amounts to keep things fresh.
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