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  • Alexa Wardwell

All you need to know about injectibles, explained

Updated: Apr 19, 2023

By Alexa Wardwell

Sharp jawlines, full lips, and zero wrinkles are not only achievable on the old Barbie ™

dolls in your closet.

Perfection can now be a reality, and it is sweeping women across the nation.

With the help of botox and dermal fillers, wrinkle creams and home remedies can get thrown in the trash.

The promise of the younger and fresher-looking version of yourself is just a few injections away.

People have taken a liking to this approach of self-care, with injectables becoming the No.1 non-invasive aesthetic procedure in the United States and the global market for botulinum toxin alone being assessed at $6.13 billion as of 2021, with projections climbing to $9.09 billion by 2029.

This booming market of consumers is 92% female, so how has this market - initially used to fix cross eyes - put a chokehold on so many American women?

The answer lies in an unintended consequence from testing on monkeys leading to a fix for a problem that women have been waiting on for a long time- no more wrinkles.

Origins of botox

Led in the 1970s by Opthalmologist Alan Scott, scientists began experimenting on monkeys with botulinum for the treatment of strabismus (cross eyes).

This was the beginning of Botulinum use for a variety of medical reasons, including the FDA approval of strabismus (1989), chronic migraines (2010), cervical dystonia (2000), hyperhidrosis (2004) and bladder dysfunction (2011).

Not only was this a great revelation for medical use, but scientists had also noticed its effectiveness in reducing wrinkles.

This discovery sparked interest in the exploration of botulinum for cosmetics, and in 1991, Scott sold the rights of botulinum to an American pharmaceutical company called Allergan for a mere $4.5 million.

Allergan had taken over cosmetic medicine and evolved it into a popularity beyond belief.

How does it work?

After botulinum is injected into the muscles of the requested area with a micro-needle, the toxin immediately begins "paralyzing" the muscle by inhibiting the release of acetylcholine.

Acetylcholine is a chemical that carries messages from the brain to the nerve cells, and without it, muscle activity stops.

This process acts as a paralyzing agent by relaxing muscles at the injection site, preventing them from constantly contracting.

Although minor side effects include swelling, bleeding, and bruising, according to the Clinical Cosmetic And Investigational Dermatology Journal, generally, there are no linked long-term side effects.

The procedure is non-invasive with zero downtime other than being unable to touch your face for four hours after injection.

Abbey Francis, injectables manager of Totality Medical Spa in Daniel Island, South Carolina, believes starting preventative botox in your 20s will pay off later in life.

"If you keep up with it from a young age and get it done every three months, eventually the goal is that you have weakened your muscles so much over time that you can go longer without botox, and you don't have any of those static lines, which are lines that are there when you are not moving. So you just prevent that ever happening to you if you start young."

This prevention method has become increasingly popular for young women in the United States, with 21,105 13-19-year-olds and 151,441 20-29-year-olds getting botox or filler in 2020.

The changing demographic

According to the American Society of Plastic Surgeons, patients for these non-invasive treatments are satisfied with the results, with 77% becoming repeat customers.

And this has resulted in more than $7.8 million spent in 2020 alone in the United States on botox and filler.

Francis has seen a similar rise in popularity among young women, noting that in the past three years, her practice has grown from 3,000 to 10,000 patients, most of them getting botox injections.

Francis has noticed injections becoming the new normal for young women in their 20s, unlike older generations, where botox use was not normalized until an older age.

Currently, there are no age restrictions on cosmetic procedures, and the 22,000 teenagers who got botox in 2018 represented a three percent increase over the year before.

Social media plays a huge role in growth.

One of the primary reasons for the growing interest in botox treatments among younger adults and teens is the marketing on social media.

Francis, who also manages socials for Totality Medical Spa, said her social media posts, especially on TikTok, have shown a direct impact.

"I will say social media really increases business, like TikTok people, after a couple TikToks went viral about lip flips, we saw 20 college girls a week for lip flips, it grows and continues to grow rapidly."

Francis has clients who use her TikTok posts to determine what products to use and what injections to get.

"I have someone in here right now who actually relies on me and my posts to determine what they are going to buy and what they are going to do," she added. "So I do think Instagram is more appealing to the younger audience looking to do what is trending".

The big lip trend that celebrities such as Kylie Jenner and Madelyn Cline initially coined has now trickled down to normal college girls looking to fit in with the trends.

Sara Paetow, a 22-year-old student at the College of Charleston, has recently gotten lip injections and believes the social media marketing for these beauty trends are very influential.

She emphasizes the importance of influencers being transparent about when their look is natural and when it has been enhanced with anything from injections to plastic surgery.

"I think that it is important for people on social media especially to be transparent about what work they have gotten done," Paetow said, adding that it's particularly important if they have a major following where people look up to them and what they do.

"If they sit there and lie about what they've had done, and girls are doing natural things to try to become beautiful and it's just not achievable because in reality these influencers actually got work done, that is an unfair use of power.I think it is important to be transparent."

The Journal of Clinical and Aesthetic Dermatology reported on the Influence of Social Media on Cosmetic Procedure Interest, where researchers investigated the rise of searching online for cosmetic procedures through Google Trends.

According to the research, interest online has not only risen, but social media are actually propelling the popularity.

Demand for non-invasive procedures is increasing, and while increasing interest is likely due to a multitude of factors, social media appears to be an impressive driving force.

One study found that 95 percent of patients thinking about a cosmetic procedure consulted an online source, including looking on social media.

Part of the concern over the social media influence is the fear that images of perfect bodies only cause more anxiety among a group often already struggling to fit in.

Another study conducted by Nuffield Council on Bioethics found, in fact, that the rising levels of dissatisfaction with their body can easily be traced to the influence of social media.

Effects on self-esteem

Professionals taking an outside look into the aesthetics industry continue to wrangle with the pros and cons of procedures on women's mental health.

In general, young women are known to struggle with self-image, and with the rise of injectables comes the possibility of more insecurity.

Research on ethical concerns on cosmetic procedures by Nuffield Council on Bioethics concluded,

"The levels of anxiety arising in the context of pressures to conform to particular appearance ideals, and their impact on mental health, are a matter of public health concern. Moreover, the social expectations and ideals to which we are encouraged to conform and aspire are not necessarily ethically neutral or value free."

Paetow said the societal pressure for injections aligns well with Nuffield Council on Bioethics Research.

"I can definitely see why young women would feel pressured about getting these types of procedures done, because they see beautiful models on Instagram who have had all this work done. I did not feel pressured to do it myself I just always kind of liked the look of it but at the same time, if I never saw all these gorgeous girls getting lip injections on my social media, then it probably never would have crossed my mind."

Jeanne DiRe, a 50-year-old woman who uses botox, said she is glad she did not have to deal with this type of pressure growing up.

"I can't imagine being a young person at this time, with social media promoting so many new beauty hacks and standards. I feel lucky that I didn't even have the option to think about getting botox at the age of 20."

DiRe added that advertising for the injectables definitely seems to be hitting the younger crowd.

"I am not saying that it is bad or good because I think people should do what they want, but botox users seem to be shifting a lot from people my age looking to get rid of wrinkles to girls in their 20s getting injections that alter their appearance a little more."

The mayor of London demanded an amendment to companies advertising policy to refuse ads that "could reasonably be seen" as creating pressure to conform to an unrealistic or unhealthy body shape and creating issues with a person's body confidence.

This move by the mayor is in hopes to mitigate the pressure of conforming to an unrealistic beauty standard.

However, some women see the opposite results after getting botox, and feel better about themselves and their self-esteem.

"As a 50-year-old woman struggling with the realization that I am aging, botox has 100% boosted my confidence," DiRe says.

"I know that wrinkles and aging is a natural and beautiful part of life, but I do feel myself more confident and happier when I get botox and lessen the harsh look of my wrinkles. I have no regrets about doing it."

Francis added that she has definitely noticed a change for the better in a lot of her clients.

"I have seen so many patients of all ages come in feeling self-conscious about their lips or their forehead wrinkles and feel apprehensive about getting injections," Francis said, "but leave feeling fulfilled with confidence and feeling like a better version of themselves."


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