Can We *Really* Call Botox & Filler 'Self-Care'?

by Jessica L. Yarbrough

This story first appeared on Fashionista.com.

GoodSkin Clinic/Fashionista.com

GoodSkin Clinic/Fashionista.com

Ah, self-care. The concept defies definition. As the name implies, it is entirely dependent on the self, meaning there could be as many as 7.53 billion variations on self-care being practiced in the world at this very second. For many, it starts and stops with the basics: food, sleep, sex. For some, self-care means meditating or sinking into a warm bubble bath at night. Still others may keep a daily journal or schedule a weekly therapy appointment or inject a quarterly syringe of Botulinum Toxin Type A into their forehead.

Botulinum Toxin Type A, the purified neurotoxin responsible for the rare, muscle-paralyzing, life-threatening condition of botulism, is, of course, more colloquially known as Botox. And along with other injectables — like fellow face-freezing neuromodulators Dysport and Jeuveau, plumping hyaluronic acid fillers Juvéderm and Restylane and fat-destroying Kybella — it has officially entered the so-called self-care space.

"Aesthetics treatments are becoming a greater part of the overall wellness and self-care conversation," Dr. Steven Dayan, a Chicago-based plastic surgeon, recently told Allergan, the makers of Botox Cosmetic and Juvéderm, as part of the company's 360° Aesthetics Report. The report's data supports this (for instance, 64% of "aesthetically conscious consumers" surveyed said looking "on trend" directly impacts their confidence), and anecdotal evidence abounds. Los Angeles's Aura Spa, a holistic wellness center, is built around the natural elements of air, energy, water… and injectables. New York City "injectable bar" Plump lists Botox just above something called Skin Therapy on its treatment menu. LA-based GoodSkin Clinic says it exists to provide its patients with the best "wellness services."

Even Well + Good, an editorial platform that urges readers to "Wellness-ify Your Entire Life" with content typically centered around healthy eats and natural beauty, recently proclaimed: "It's time to broaden our wellness boundaries beyond salt scrubs and sweat sessions to include anything that we do that makes us feel better about ourselves — including injectable appointments." Is that perhaps a tad broad and even a bit, er, irresponsible? Not everything that makes a person feel good about themselves in the moment counts as an act of wellness. Like cyberbullying. Or bingeing and purging. Or glossing over deep-seated, societally-imposed insecurities with a temporary fix.

Is this what injectables are? A short-term solution for issues that run deeper than the length of a 32-gauge needle? Well, no… and also, yes. It really depends on the person, says Dr. Anthony Youn, "America's Holistic Beauty Doc" and host of "The Holistic Plastic Surgery Show" podcast. "Self-care can refer to anything a person does for himself or herself to improve their lives and/or enhance their health," he tells Fashionista, citing mindfulness, meditation, exercise, skin care and, yes, getting injectable treatments as examples.

"However, today there is an epidemic of beautiful, young women (and men) who are profoundly unhappy with their appearance and believe that injectables are the key to high self image and self-esteem," Dr. Youn continues. "This is not what I consider self-care, but more self-destruction."

Daniel O'Connell, LCSW, a counselor who specializes in mental health, agrees. "We must wonder what condition comes before cosmetic treatment, the same as with reconstructive treatment," he says. "If we attend to a burn victim we blame the fire, but if we attend to dysmorphia, we must look to the social and psychological [factors] that tell a person they are unsatisfactory as they are." O'Connell puts it like this: The term "self-care" is best reserved for actions that attend to the actual self, and not the outer "shell."

His take is rooted in ancient philosophy. In Alcibiades I, a text that dates back to 390 BCE and documents a dialogue between Alcibiades and Socrates, the former introduces the concept of "care of the self," which he defines as care of the soul (or mind, or inner self or true you — insert your preferred non-spiritual word here).

From this angle, the philosophical act of self-care would be examining the feeling that precipitates the injectable (societal pressure to stay forever young-looking, outer appearance informing your sense of self-worth, curiosity about looking just a little bit different) and addressing said feeling through inner work (cultivating self-acceptance, finding worth outside of appearance or detaching from it altogether).

But here's where that point of view falls out of focus: There's evidence to suggest that some injectables actually do have a positive impact on the mind. Botox is now a potential treatment for depression, according to this 2017 study, since it inhibits an individual's ability to scowl, frown or otherwise appear downtrodden — and apparently, looking happier translates to feeling happier.

Even those who don't specifically get Botox to deal with depression notice a mood shift. "Perhaps it's placebo, but I do believe I experience — and certainly broadcast — far less stress and angst with 'fresh' Botox than when I'm able to furrow my brow as deeply as I normally would," Marley, a Botox user who cites injectables as part of her own holistic self-care routine (she also dry brushes, eats mindfully and uses clean beauty products), tells Fashionista. "The specific crease I treated with Botox was a reminder of a stressful period in my life. Addressing it was, in part, a way to move past that."

There are medical reasons to call on neuromodulators and fillers, too. Lisa Goodman, founder of GoodSkin, tells me about a patient she treats who recently went through chemo and credits injectables with helping her look and feel healthier; another, who was born without sufficient fat pads under his eyes, relies on fillers to present as well-rested for professional purposes. Goodman, for one, enthusiastically lists injectables under the heading of self-care.

"A reason [to get Botox] may be an overactive platysma, which will cause increased jowling and a loose neck, and can lead to cervical compression over time due to poor posture," Goodman tells Fashionista. "And if placed properly, fillers can slow down bone loss and create new collagen." To this end, she takes a diagnostic approach with her patients and considers a host of factors — genetics, bone structure, muscle tone — before deciding on a course of treatment.

"Instead of looking at things as 'there's a problem,' we look at things as a whole," Goodman explains. "It's more, 'Here's what's really important — your bone structure and your mid-face is really low.'" (A matter of semantics, perhaps: Does knowing why a person looks a certain way justify implying that looking a different way is objectively better?)

Compelling as they may be, these examples make a flimsy foundation for the aesthetics-as-wellness argument, for the simple fact that they don't represent why the majority of people get Botox or hyaluronic acid fillers. Consumers, for the most part, aren't hoping to remedy future bone loss as much as they are hoping to mask the fact that they perceive signs of aging or thin lips.

"I was at lunch with my mom 10 years ago, and I could tell she wasn't listening to whatever I was saying, and I remember being shocked when she interrupted me and said, 'Do you want to go see Dr. F? I'll pay for it,'" a regular Botox user who wished to remain anonymous tells Fashionista. "I guess the line in the middle of my eyebrows was so expressive that I just looked mad all the time. I was all for it." She took her mom up on the offer, and has since branched out into fillers, too — both of which she considers integral to her self-care regimen.

"I plump [my lips] up a bit now and feel like a 10-year-old again, kind of," she says. "I admit, it is a slippery slope — I totally see myself being that old lady with pulled-tight skin and puffy lips." She adds, "God willing!"

Her statement is one that sticks with me long after our conversation is over. There's nothing particularly out of the ordinary about it — I've heard similar musings from my own friends and family — but her juxtaposition of the pull of youth and the fear of aging perfectly sums up the far-reaching ripple effect of aesthetic treatments. Looking like a pre-teen is "preferable" to looking like a real, live, middle-aged woman; looking unnaturally altered in old age is more "acceptable" than looking like you haven't at least attempted to stop nature in its tracks.

"What prompted my initial decision to get Botox was feeling deeply insecure about the wrinkles around my eyes," former Botox user Melanie tells Fashionista. "I was 30 when I first did it, and it was definitely something I went back and forth on, as someone who's worked really hard on my self-confidence and self-acceptance." She did end up getting the injections, but ultimately decided not to keep up with them.

"I think it was a combination of wanting to 'walk my talk' about self-acceptance, hearing female comedians speaking up about the importance of their lines and also having my 23-year-old sister come to me and say that she's now starting to get insecure about her wrinkles because I have talked so much about mine," Melanie elaborates. "I think I wanted to be an example for her and for others to just embrace a natural process. "Does she still think her stint with Botox was a form of self-care? "I do believe self-care means different things for different people, but for me, I want to be someone who values self-acceptance and self-love more than satisfying an insecurity," she says.

Evidence suggests a shot of hyaluronic acid to the tear troughs does little to actually"satisfy an insecurity," anyway. It typically just files the feeling away to be dealt with at a later date (usually around the four- to six-month mark for Botox and Juvéderm recipients — at which point, results begin to fade and it's time to re-up). Many of the sources Fashionista spoke to for this story said their first adventures in injectables made them hyper-aware of other "fixable flaws," and led to more treatments down the road.

"We don't treat those clients, because it falls under Body Dysmorphic [Disorder],'" Goodman says (a condition where sufferers "can't stop thinking about one or more perceived defects or flaws," according to the Mayo Clinic). "The healthy ones know they have it, and I always joke with them. I'm like, 'If you didn't have me to tell you no, you would look really sorry! Left to your own devices, you do not see yourself like normal.'" Goodman says her practice, which focuses on creating results that appear "healthy" rather than ones that keep up with trends, is "a value-add to those people."

Certainly, having a trained professional tell you "no" when you've gone too far is invaluable; at the same time, putting other patients out into the world with professionally fine-tuned faces perpetuates the beauty standards that can lead to appearance anxiety and, potentially, BDD.

Goodman doesn't necessarily see it that way; after all, her trademark — literally — is The Untouched Look™ and her website proclaims, "We Believe in Botox That Only You Can Detect." The goal is to provide subtle treatments that make the patient feel better about their face, but don’t necessarily register to the rest of the world.

Goodman has tapped into something interesting here. "This experience contributed way more to the way that I feel than the way that I look," the writer of Well + Good's injectables-as-wellness treatise said after getting Botox and cheek fillers. "A poll of about 20 of my closest friends and colleagues revealed no one could tell I'd had a treatment done."

Jillian, a 32-year-old public relations professional who recently had her first injectable appointment at Alchemy 43, takes this sentiment a step further. "As soon as I got in my car, I instantly took a look at myself in my rear view mirror and already felt better about myself, even though my lips were swollen and forehead was starting to bruise," she tells Fashionista.

While this idea of feeling-good-despite-not-looking-any-different (or, in Jillian's case, looking worse) is often used to justify injectables' inclusion in the self-care conversation, there's a flip side to that coin: If it's about how you feel — especially in a way that's imperceptible to the outside world — why are expensive injectables the vehicle of choice? If what you're after is a sense of inner confidence, and not an outward aesthetic, why opt for something that comes with a significant host of side effects and risks?

The answer is simple: Inner work requires more time and effort and, well, work, than "having a little work done." It's easier to entrust your self-esteem to someone else, who can fix you up in an hour or less, than to embark on the (sometimes) years-long journey to self-acceptance through therapy or self-reflection.

"If I'm honest, I did feel better about myself when I tried Botox," Melanie admits. "However, underlying all of it was feeling hypocritical." She compares her decision to stop getting injectables to "being the change I wish to see in the world" — an act of self-care, to be sure, but also an act of care for others.

How? Well, it could be said that her attitude is similar to that of the body positive movement. We have concluded that all bodies are good bodies. We push for "realness" in the media, and believe it's important to represent all shapes and sizes. We reject unnatural tweaks to models, like filters or Photoshop, so that future generations can see this and feel normal and beautiful, no matter what their body looks like — cellulite, stretch marks and all. We've agreed that weight is not an indicator of health or beauty.

So why are we so stuck on the idea that a perfectly smooth face and youthfully-plump lips are?

Where is the wrinkle positivity? The thin lip positivity? The aging positivity? Why are our faces the last frontier of self-acceptance?

Before we deem "anything that we do that makes us feel better about ourselves" an act of self-care, perhaps we should consider the after-effects of said act — just like with bullying (making someone else feel bad), or bingeing and purging (damaging the body) or even sheet masking (landfills are full of them). If the commodification of wellness expands to include injectables for the sake of aesthetics, will future generations crumble under the pressure of unnatural beauty standards? Will it perpetuate the pretty privilege and the age bias that permeate society? Will it do more harm than good, collectively? Will it actually make anyone well?

Selfishly, I don't want to include injectables in the self-care conversation. I don't want to it to be A-OK to spend $300 to $600 every four months to iron out the slight lines in my forehead with a neurotoxin that may blur my vision or cause muscle weakness so long as it assuages an insecurity. I want to push toward a future where "care of self" — the deep, messy stuff that, sure, is sometimes accompanied by bubble baths and face masks and candles — is celebrated more than taut forehead skin; a future where destigmatizing aging is more important than destigmatizing dermal fillers.

But, ah, self-care. The only part of that hyphenated word that truly matters is "self." However you, yourself, define it.