“Let me look at your neck. Hmmm…I’ve never seen something like that.”

Just the words I want to hear from a dermatologist.

Not long after I moved to Nashville, Dr. Melissa Langley and I met at an exercise class. One day, as we set up our mats and weights and balance balls, she continued to stare at my neck.

“Come see me at my office,” she said.

Besides treating skin, hair, and nail conditions and performing surgeries to remove moles and cysts, Dr. Langley specializes in cosmetic procedures. Melissa (or Lisa, as she’s known away from the office) administers Botox, the brand name of the first injectable toxin, to patients who wish to ward off unwanted facial lines and wrinkles.

Although Botox is used for other medical conditions—migraines, overactive bladders, eye issues (me!), excessive underarm sweating—people can be squeamish about a tiny needle aimed at their eye and forehead regions.

Some people worry about the “poisonous effects” of Botox. Yes, it’s botulinum, which is a toxin. “But it’s not a live version. It’s been around a long time, and I always reassure my patients it is safe,” she says. Her 85-year-old mom, and multiple family members, are regular clients.

Two types of wrinkles

According to Lisa, a double board-certified internist and dermatologist, we develop two kinds of lines on our faces. Dynamic wrinkles appear due to facial movements. If we furrow our brows when we work on a laptop or concentrate on a task, frown lines may develop. We smile and creases eventually form around our mouths and eyes.

We can see static wrinkles when our face is at rest. The little lines on our foreheads, neck, and radiating from our nose and mouth. Those wrinkles result from the disintegration of our skin as we age, but mostly from prolonged sun exposure.

Most people have both types of those pesky wrinkles. Together, they can make us look droopy and tired and, let’s face it, old. Although Botox primarily treats dynamic wrinkles, it “gives most people a bit of a lift.” They look like they are fresh from vacation, rested and relaxed.

With a quick sting, Lisa and her teeny needle inject Botox into those annoying lines caused by the dynamic wrinkles. The drug prevents our bodies from releasing a hormone which the muscles need to contract. Within about two weeks, the wrinkles relax and soften.

Less is more

“My philosophy? Less is more,” says Lisa. “I don’t want others to look at my patients and know they’ve had Botox. I want to maintain a natural look, not an overdone look.” After the office visit, Lisa invites her patients to return for a two-week checkup. “I’m conservative,” she says. “I’d rather not give enough and then add more if necessary.”

For optimum results, it’s best to keep those dynamic wrinkles at bay. As muscle action returns—after three or four months—the lines and wrinkles begin to reappear. The cost of treatments adds up. But, the good news? If used on a regular basis, smaller amounts of the drug are needed in the future.

Since the most common side effect is possible bruising, Lisa recommends no ibuprofen (Advil) for a week before the treatment. She also uses ice compresses to prevent bruises. Some patients may experience a slight headache.

“Not one person, in my 25 years of practice, has had a stronger reaction than a bruise or headache,” says Lisa.

Since heat destabilizes the toxins and makes Botox less effective, she asks patients not to exercise—and heat up—for 24 hours after their injections. “I also want patients to stay upright for 4-5 hours, so the drug doesn’t go where it’s not supposed to go,” says Lisa.

And avoid “manipulating your face” for five hours. When it’s time to take off makeup for the day, gently rub up, not down.

Does she give Botox to many men? Yes—plenty! Although her husband, Jim, isn’t interested! Many men do care about preserving their looks.

Of course, with access to products and information, a dermatologist is bound to have glowing, beautiful skin. But Lisa’s healthy habits contribute too. After meditation and coffee (her husband brings it to her each morning), Lisa and Jim hit the trails near their home. With headlamps or flashlights, they hike, talk about their two college-aged kids, and watch the sun come up. “During the pandemic, it’s become a wonderful routine,” she says.

After that morning coffee, she doesn’t eat again till mid-afternoon. A “loose intermittent faster,” she enjoys a small cheese and fruit plate at her desk.

The bottom line on Botox? “Get recommendations, do your research, and go to someone you trust,” says Lisa.

And that spot on my neck…After a couple of tests and sleepless nights, it turned out to be okay. But “wear your sunscreen,” Lisa warns.

PS—Ovarian cancer, Lyme disease, and ways to express sympathy to a friend

Photos courtesy of Dr. Melissa Langley, Nfocus, and Daniel Meigs