When a Friend Gets Too Much Botox

Photo-Illustration: by The Cut; Photo: Getty Images

Swellness” is a monthlong series exploring the health and wellness stuff no one talks about.

I met a friend for dinner recently and was alarmed to find that when she laughed, the top half of her face did not participate. Instead, her forehead remained frozen, her eyebrows quivering like a weight lifter pinned under a barbell. I tried to ignore it, but then she brought it up herself: “I tried Botox. Can you tell?” I panicked and babbled something about how she always looks great.

Afterwards, I felt guilty. As her friend, I had a responsibility to answer her honestly, but I had chosen my own comfort and lied. Even worse, this wasn’t the first time. A colleague once asked me if she looked any different after getting “some derm-y stuff” done, and I balked. She did look different, and not in a good way. But what could I say?

I’m not against Botox or filler or any dermatological procedure you want to try (it’s none of my business, really). I’ve dabbled in a few myself. But I’m much more scared of looking unnatural than I am of wrinkles,  and for that reason, if I ever did look “done,” I’d want someone to tell me the truth.

A while ago, that actually happened. One of my oldest friends was visiting for a weekend and peered at me over breakfast. “Did you get Botox?” she asked. I admitted that yes, I had recently tried it for the first time, and immediately felt self-conscious. Vanity is embarrassing! Was it obvious? She assured me that she could only tell because she’d known me so long, but my forehead wasn’t moving the same way when I smiled. That was all I needed to hear, and I was grateful for it. I switched dermatologists and swore off Botox for the foreseeable future.

“There’s no one better to say something than a friend you value,” says Dr. Azadeh Shirazi, a board-certified dermatologist based in San Diego. Plus, a friend can offer a perspective that you may have lost. “When people consistently undergo cosmetic procedures, they start to forget how they originally looked,” she explains. “Their perception becomes distorted, and they keep coming back for more even as they drift farther away from their original appearance and aesthetic goals.”

That distortion is exacerbated by seeing ourselves on screens so much, adds Vanessa Coppola, a nurse practitioner who specializes in cosmetic dermatology. “It’s a form of body dysmorphia that we’re seeing a lot in the industry now,” she says. “Working on Zoom and viewing our faces in a two-dimensional format all the time has led people to seek very unnatural results that look strange in real life.”

But how exactly do you say something without hurting that person’s feelings or making them upset? When I polled friends, most of them were in my camp — they’d white-lied their way out of giving genuine feedback in the past and felt bad about it. We all agreed that if questioned, it’s better to be gently truthful.

Coppola suggests starting with a positive comment. “You could say something like, ‘Your skin always looks great,’” she says. Then follow it with something constructive and nonjudgmental: “‘Now that you bring it up, you do look a little different to me. Maybe take a break for a little while and see how you feel?’”

The “take a break” advice also has clinical upsides; Dr. Shirazi recommends that many of her patients take time off from Botox every few years to give their muscles time to recover. (With repeated Botox use over time, muscles start to degenerate — which, ironically, makes you look older.) Mentioning this more generally — “I’ve heard it’s healthy to stop every once and a while!” — is a nice way to encourage someone to cut back without saying outright that their face looks like a wax sculpture.

On the other hand, if you’re too uncomfortable or worried that a friend will be offended by even the most tactful comment (it’s their face, after all), you’re not obligated to step up. Instead, Coppola recommends that you redirect the question back to the practitioner who’s trained to deal with it. “Have you talked to your dermatologist?” or “Do you like your dermatologist?” are easy ways to segue the conversation.

Remember, the point isn’t to make your friend feel bad, but rather to help them see what you do — that they look best when they look like themselves. Which is always a good line to fall back on, if you need to.

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