'Baby Botox' and the psychology of cosmetic procedures
is the co-host and editorial director of. Before joining Vox, she was a host of NPR's flagship radio showand the popular news podcast, and in 2020 she received the Radio Hall of Fame's One to Watch award.
Botox injections used to be a secret for (largely) women in their 40s and 50s. But growing numbers of (largely) women in their 20s and 30s are turning to 'baby Botox,' or smaller doses that are intended to prevent aging rather than combat it.
Baby Botox is just one intervention that doctors say younger people now frequently seek, and some view the trend with concern. Dr. Michelle Hure, a physician specializing in dermatology and dermatopathology, says younger patients aren't considering the cost of procedures that require lifetime maintenance, and are expressing dissatisfaction with their looks to a degree that borders on the absurd.
Hure traces the demand for 'baby Botox' and other procedures to the start of the pandemic.
'Everyone was basically chronically online,' she told Vox. 'They were on Zoom, they were looking at themselves, and there was the rise of of TikTok and the filters and people were really seeing these perceived flaws that either aren't there or are so minimal and just normal anatomy. And they have really made it front and center where it affects them. It affects their daily life and I really feel that it has become more of a pathological thing.'
Hure spoke to Today, Explained co-host Noel King about the rise of 'baby Botox' and her concerns with the cosmetic dermatology industry. An excerpt of their conversation, edited for length and clarity, is below. There's much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts and Spotify.
You told us about a patient that you saw yesterday, and you said you probably wouldn't keep her on because her mentality really worried you. Would you tell me about that young woman?
I had this patient who was mid-20s, and really a beautiful girl. I [didn't] see a lot of signs of aging on her face, but she was coming in for Botox.
There wasn't a lot for me to treat. And at the end of the session she was asking me, 'So what do you think about my nasolabial folds?'
Basically, it's the fold that goes from the corner of your nose down to the corner of your mouth. It's the barrier between the upper lip and your cheek, and when you smile it kind of folds. Of course, the more you age, the more of the line will be left behind when you're not smiling. And she was pointing to her cheek as if there was something there, but there was nothing there. And so I had to tell her, 'Well, I don't see that, you're perfect.' It's a phantom nasolabial fold. It didn't exist.
That sort of mentality where someone is perceiving a flaw that is absolutely not there — providers need to say no. Unfortunately, they're incentivized not to. Especially if you have a cosmetic office, if you're a med spa, if you have a cosmetic derm or plastic surgery office, of course you're incentivized to do what the patient wants. Well, I'm not going to do that. That's not what I do.
That means you may get paid for seeing her in that visit, but you're not getting paid for putting filler in her face. I think what I hear you saying is other doctors would have done that.
Absolutely. One hundred percent. I know this for a fact because many times those patients will come to my office to get that filler dissolved because they don't like it. In the larger practices or practices that are private equity-owned, which is a huge problem in medicine, you are absolutely meant to sell as many products, as many procedures as possible. Oftentimes I was told to sell as much filler as possible, because every syringe is several hundred dollars. And then if they're there, talk them into a laser. Talk them into this, talk them into that. Then you become a salesman.
For my skin check patients, I'm looking for skin cancer. I'm counseling them on how to take care of their skin. I was told, 'Don't talk to them about using sunscreen, because we want them to get skin cancer and come back.'
I was pulled out of the room by my boss and reprimanded for explaining why it's so important to use sunscreen. And so this is why I couldn't do it anymore. I had to start my own office and be on my own. I can't do that. That goes against everything that I believe in, in my oath. Because there is potential harm on many different levels for cosmetic procedures.
What are the risks to giving someone a cosmetic procedure that they don't really need?
This is a medical procedure. There is always risk for any type of intervention, right? What gets me is, like, Nordstrom is talking about having injections in their stores. This is ridiculous! This is a medical procedure. You can get infection, you can get vascular occlusion that can lead to death of the tissue overlying where you inject. It can lead to blindness. This is a big deal. It's fairly safe if you know what you're doing. But not everyone knows what they're doing and knows how to handle the complications that can come about.
Honestly, I feel like the psychological aspect of it is a big problem. At some point you become dependent, almost, on these procedures to either feel happy or feel good about yourself. And at what point is it not going to be enough?
One of my colleagues actually coined this term. It's called perception drift. At some point, you will do these little, little, incremental tweaks until you look like a different person. And you might look very abnormal. So even if someone comes to me for something that is legitimate, it's still: Once you start, it's going to be hard for you to stop. If you're barely able to scrimp together enough to pay for that one thing, and you have it done, great. What about all the rest of your life that you're going to want to do something? Are you going to be able to manage it?
I wonder how all of this makes you think about your profession. Most people get into medicine, it has always been my assumption, to be helpful. And you've laid out a world in which procedures are being done that are not only not helpful, they could be dangerous. And you don't seem to like it very much.
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