I got Botox and now I'm a Bitch

how Botox helps my headaches and gives me freedom to stop people-pleasing.

I never thought plastic surgery was on the table for me. When I was in middle school, I had some insecurities about my nose and lips. I considered what it would look like if my bridge was smoothed down, or my lips plumped with filler. But ultimately, I thought that even if I got the money to change those things, there will be more important things to do.

I grew into my face, and I like my lips and nose now. I don't even have the hang-up over aging that my mom almost passed down to me. I like my skincare routine because I like how it feels, not because I want to look young. When I notice a gray hair, I keep it on my head. I think salt and pepper looks sexy, and I'll be fine as hell in 30 years. My crow's feet, and the lines around my jowls, will be evidence of my decades spent smiling and laughing.

Why would I get Botox then?

I have chronic head pain. It started in 2022. It's been diagnosed as different things - tension headache, chronic migraine without aura, status migrainosus. I've talked to 4 different neurologists now who have described it in different ways. The most helpful ones have been honest with me, that medicine still can't explain a lot of things and diagnoses have a limited scope on what they are able to accurately describe and treat. It's been frustrating nonetheless.

I lost track of the number of medications I've tried - somewhere between 15 and 2 dozen. It felt like running a constant gauntlet. That pill didn't work? Try this one. That didn't work either? Try this one. I was constantly monitoring my symptoms while dealing with new and confusing side effects. Sometimes I was pressured into trying medication that I already knew would make me feel worse. It's been a tough journey.

I started thinking Botox could help me about a year before I was approved to get it. I was living in a camper in South Carolina. I had been constantly stressed for weeks, with my headache growing in severity, and I felt it concentrated around my forehead. I looked in the mirror and realized my face had been stuck in a fear position - eyebrows raised, eyes wide, jaw tight - and that I was defaulting to this face during the day, even at rest.

I spent the next week consciously relaxing my face and correcting myself when I noticed I was stuck. Sometimes it was helpful to do opposite expressions to unlock the tight muscles. Within a few days of practicing this, I found relief. Not total relief, it was only a fraction, but it was clear to me that this fear expression was at least making my symptoms worse. I needed to remind myself to relax.

It was a lot easier to control my face at that time when I was unemployed and didn't need to speak to people on a regular basis. It's harder to control during and after conversation, when your face is naturally reacting to people and responding to the emotions that socialization brings up. I think most people have experienced a time when they couldn't stop smiling even though it was hurting their cheeks. You might have even needed to massage your face to make it stop. I was experiencing stuck expressions like that every day, and it was causing me chronic pain.

This felt like a really stupid explanation to give a doctor. It felt like I was working backwards from a solution to describe the problem in terms that would get me the treatment I wanted. Even if I was right, it wouldn’t matter. I'd had enough doctors treat me as pill-seeking and speak to me like I was incompetent. I didn't want to risk sounding as stupid as I was already made to feel. So I held my tongue on asking about Botox and continued to take what doctors offered me, in hope that I would eventually get approved for something that effective.

I finally regained hope for treatment when I tried muscle relaxers. The first one worked fantastically - my pain went from a 10 to a 2 in 3 weeks. I was overjoyed, but I had to stop when I developed an allergic reaction. Those 3 weeks though, that relief was so unbelievable that it gave me the motivation I needed to keep trying until I found something that helped. And I did!

I've been taking a different muscle relaxer consistently for over a year now. It isn't as magical as that first one I tried, but it's given me consistent relief, and raised my baseline for how well I feel on a regular basis. It's the major reason I was able to work again. But the relief from that plateaued to a point where I still need help, so I kept going.

After a few more tries, including a medication I injected into my leg using an EpiPen-like device, my health insurance approved me for Botox. All the numbers nurses told me sounded great - 50% of people see this much improvement after their first session! This many people are migraine-free after 12 months! Compared to the people in the studies, I knew my case was severe, so I did try to manage my hope so I wouldn't be let down if it didn't work.

For migraines, there are 31 injection points located across the forehead, along the sides of the head, down the neck, and into the shoulders.

The theory with using Botox for me, is that since muscle relaxers have helped, forcing those muscles to stay relaxed with the neurotoxin will be even better. If Botox is effective enough, I might be able to take less pills and be alright.

After my first two sessions (spaced 3 months apart), I had what they called a "needling effect", which I experienced as an increased and concentrated pain around the places it was injected. It lasted 2-4 weeks. They assured me that most people just need to get used to it, but that there's a small percent of people whose bodies simply reject it. I held that possibility and waited for improvement, using more cannabis medicine in the meantime to mitigate the side effects.

My 3rd session was the game changer. I did not have an adjustment period. Within that 7th month I saw a 30% decrease in my pain. The headache was still every day, but less severe. When I came in for my 4th session I was told this is great news, and I will continue to see improvement.

That's where I'm at now. I'm really good with needles at this point. The trick is to focus on your breathing, and exhale during the insertion.

I don't expect this to be a perfect solution. I don't expect it to make my headache go away, but it's definitely better than before. I'm less exhausted on a daily basis, so I'm glad I get to continue with it.

However, I really underestimated how Botox would affect me socially. I didn't even think about it, really. I thought the long-term implications of having less wrinkles in my forehead was a cool side effect, but I didn't consider how it'd affect me on a daily basis. I have a semi-permanent poker face now.

I'm a quiet person. I don't like to talk much. I use a lot of body language so that I can still communicate what I don't feel like speaking. This doesn't work as well with Botox. The upper part of my face is frozen, so I have to make more effort to be understood.

Something as basic as raising your eyebrows, creating those forehead lines, that's a way that our face communicates interest. You don't realize how much an impact that makes on communication until that piece is gone. I am now finding conversations ending early, and people shying away from me more often, because it looks like I don't give a fuck. I'm speaking kindly, I’m smiling, my tone is right, my actions are right, but my eyebrows aren't interested, and that's enough for the rest of it to look wrong.

I'm probably noticing this more acutely than some people with Botox would, since I work customer service. I feel that my effectiveness at work is determined by how nice and helpful I can present myself, even if my actions themselves are the same. Helping someone with a smile versus a frown makes a big difference in my book. But a third of my face doesn't show the smile now!

Some ways I've noticed Botox impacting me socially:

• I come off as less friendly.

• I look like I don't mean what I say.

• I can't pretend to be interested.

• I don't look annoyed when I really am.

• I am called "chill" and "spacey" more.

• My emotions in general do not look as strong as I feel them.

My face doesn't even scrunch up the same way when sunlight is hitting my eyes. I simply close my eyelids without involuntarily straining my face. It's strange. I look serene when I am uncomfortable.

I'm finding this to be a huge advantage when it comes to assholes. Sometimes customers take out their frustrations on me, or they play around with me just because I'm paid to be there and they can get away with it. It's mostly men trying to get a reaction out of me. (Male entitlement is something I want to write about in the future) When my face doesn't react as they expected, some of them do push harder, but most just give up because I'm not giving them the satisfaction they want.

I feel that in these instances that if my forehead had moved, it would have given them reason to continue trying at me. Even if they just got one eyebrow raised, that's an eyebrow raised. That's interest. That's engagement. But they don't get it. I physically can't give it to them, and now, I don't want to!

I have to make the rest of my language match this tone to be effective at deflecting assholes though, and I think I'm getting better at that with practice. I'm really impressed with how well I'm handling conflict now and recovering afterward. My face refusing to get stuck in an upset expression has been a part of that recovery.

It might not be that I have the freedom to stop people-pleasing, but rather that Botox has actually taken away my freedom to be as people-pleasing as I used to be. I won't sugarcoat it, I have acted like a doormat for most of my life, one way or another. A fucking doormat. I was disgusting myself and still doing it. It was for survival mostly, a learned fawn response: "if I make sure people like me, I'll be safe." But that doesn't really apply anymore, and that mindset has ended me up in situations I never want to be in again.

It is not true that you are safe as long as you are liked. People can like you and still hurt you. Some people like you BECAUSE they can get away with hurting you. You are more likely to be hurt by people you know than by strangers. You need to protect yourself first and foremost instead of other people's egos.

My face isn't free to move in the ways I have willed it to, but why was I willing it to begin with anyway? (For reasons that don't exist anymore.) I think it is better now. My poker face is forcing me to interact with the world in a different way, and it feels more authentic. I have to embrace my flat affect, rather than masking it to prove myself to others. I used to think a lack of reaction in my face is a bad thing. It's not. It's neutral.

Another thing I've learned is that Botox is more common than I thought. A few weeks ago, my physical therapist noticed in my chart that we see the same doctor for Botox injections. Until then I hadn't even realized her forehead wasn't moving. It both makes me feel less alone and is reassuring that I don't look as strange as I feel. I look at foreheads a lot now and I'm noticing Botox more often, in celebrities and in common folk, and it gives me a kind of satisfaction. I feel like I'm part of a world I didn't notice before. It's a barely-visible secret, with some strong opinions over it.

If I someday can't get the injections or find that I don't need them anymore, I do wonder what will happen with my face. How long will it take for full movement to return? Will the muscles in my face be permanently weakened? Atrophied? (Unlikely.) Would that even be a health concern, or would my face just look a little weird? A life-long uncanny valley face wouldn't be the worst thing in the world.

I'm not anti-plastic surgery. If something can improve your self-esteem, it could improve your quality of life. But I think it's important to first analyze why you think something needs to be changed, and whether you would really be changing it for yourself or for other people. If you're changing to fit someone else's standards, or society's, you'll find that those standards eventually change and you may be unhappy with yourself again. Don't base your worth on external validation, because it's inconsistent!

If you want Botox for yourself and can access it, I think it's worth a try! You might try it once and decide it's not for you. I know I thought I looked alien at first, and I’m still getting used to how my face moves now. It also took 7 months for me to see an improvement in my headache, so it may not be worth it for some people to wait that long. Some people don't feel results until their 5th session, after a year. It's definitely a time investment.

Overall Botox was a great decision for me, and I'll continue to get it every 3 months as long as it stays working for my pain. It's gonna be interesting to keep noticing how my physical appearance affects communication, and how I feel myself in relation to the world. Plus, if my forehead stays snatched along the way, that's a bonus!

I don't see many people talking openly about how Botox impacts their nonverbal communication, so I wanted to share what I've noticed. Here’s a related video about plastic surgery by an esthetician on YouTube, Cassandra Banks, that helped push my thoughts in this direction. Talk about Botox starts at 12:48.

Who is going to tell them this doesn’t look good? (youtube.com)

Have you considered Botox? Did you know that it’s used for a variety of medical issues, and that it started out as a treatment for crossed eyes? If you've got any thoughts to share, leave a comment <3

I hope this was an interesting read, and that you have a great rest of your week!