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Empowerment mantras drive women to black-market Botox

Two-thirds of practitioners who administer Botox are not sufficiently qualified. Credit: Getty

April 24, 2024 - 11:50am

Health officials in New York are warning the public against Botox injections from non-medical providers, after three people suffered from botulism, a disease caused by toxins that induce muscle paralysis, difficulty breathing and even death.

The Botox industry is infamously under-regulated. A UK survey found that more than two-thirds of cosmetic practitioners who administer injections are not qualified medical doctors, but the truth is that just about anyone can inject filler: there are currently no national minimum standards for practitioner training or regulated qualifications. We do not know exactly how many people have Botox or fillers each year, nor do we have any age-specific data to reveal the magnitude of the trend amongst young people. In America it is estimated that the use of Botox among those aged 19-34 rose by 87% between 2013-2018.

Greater legislation and regulation in the injectables industry is undoubtedly needed, as well as more awareness of the potentially dangerous side-effects: pain, headaches, swelling, bruising, infection, face paralysis, permanent disfigurement. We can crack down on dodgy backstreet practitioners, but the truth is that if demand is there, then supply will follow. Therefore we need to ask ourselves what is driving women (and it is predominantly women) to seek out black-market Botox in the first place, in spite of the horror stories of drooping eyelids and half-frozen faces.

Botox is an expensive habit: the cost usually varies from around £100 to £350 per treatment, depending on the clinic and the area being treated. It’s also an addictive habit: Botox is cleared from the body in about three to six months, and so customers have to keep coming back to maintain their smoothed-over skin and flawless features.

Much is made of how Botox is a gateway drug, leading to more invasive, permanent, complicated procedures, but it’s virtually impossible to do in moderation. Once you start to tamper and tweak, it’s difficult to stop: if one part of your face is eerily smooth, this will draw attention to other bits which aren’t, and once muscles start to atrophy then other muscles work harder, causing more lines. So you have more and more, and soon you have an entirely new, entirely waxy face: not so much an act of defiance against ageing as an act of defeat.

In their pursuit of the beauty and glamour and the value that supposedly comes with youth, women either spend thousands on the real deal, sometimes even falling into debt to achieve a real-life filtered face, or they turn to cheaper, unregulated alternatives, sometimes even buying fake facial fillers online. The fact that women are willing to risk being potentially scarred for life to chase a beauty standard is not a public health crisis, but rather a mental health crisis. Social media may tell young girls that this is an act of self-love or self-care, but it’s an act of self-sabotage.

It might go against the “love yourself” mantra which Gen Z and millennials love to espouse, but we desperately need online counter-narratives to the “Botox isn’t that bad” brigade. For too many, the journey through “follow, filter, filler” is irresistible, and our obsession with appearance — magnified by constantly seeing ourselves and others via screen — means we have ended up in a situation where paralysing your facial muscles is no longer seen as drastic but desirable.


Kristina Murkett is a freelance writer and English teacher.

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Daniel Lee
Daniel Lee
24 days ago

“In America it is estimated that the use of Botox among those aged 19-34 rose by 87% between 2013-2018.”
In my 60s, it’s hard to keep a straight face listening to these near-literal children fretting about wrinkles.

Derek Smith
Derek Smith
24 days ago
Reply to  Daniel Lee

These kids will be keeping straight faces.

Robert Paul
Robert Paul
24 days ago

I am finding more and more women even in their 20’s, much less their 30’s and beyond, so filled and surfaced and symmetrical that their faces lose all individuality, are nearly unrecognizable, and even lose a quality of humanness, puffed and pursed like some sea creature reeled in from the depths, nearly ready to explode.

Andrew Dalton
Andrew Dalton
24 days ago
Reply to  Robert Paul

Oddly enough, it’s almost solving the problem of making robots that look more human.

RM Parker
RM Parker
24 days ago
Reply to  Andrew Dalton

Yes, there’s a pleasingly symmetrical irony in that.

William Shaw
William Shaw
24 days ago
Reply to  Robert Paul

True.
There’s been a huge increase in young women who’s faces have entered the uncanny valley.
Men have a hard enough time reading subtle facial expressions without having to decipher frozen faces.

RM Parker
RM Parker
24 days ago
Reply to  Robert Paul

Reminds me of the character in Terry Gilliam’s “Brazil”, who has a series of facelifts – with terminally catastrophic consequences.

Lindsay S
Lindsay S
24 days ago

ODF
. Own Dumb Fault

Alex Lekas
Alex Lekas
24 days ago

When that many people well below middle-age are getting cosmetic treatments, the issue is not one of insufficient regulation.

UnHerd Reader
UnHerd Reader
24 days ago

We seem to have lost all sense of what beauty is. I can spot botox instantly and have never seen anyone who looks more beautiful for it. Quite the opposite. Seems to be driven by unreflective conformity, like a lot of fashion.
I made my fair share of beauty mistakes though when young, like plucking my eyebrows too thin, bleaching my hair etc. I get more compliments at 46 than I did when young, despite my wrinkles, as I’m now more natural looking.

Frances An
Frances An
23 days ago
Reply to  UnHerd Reader

I agree that the standard for beauty has warped. I’m 26-years-old and am shocked to see girls younger than me undergoing invasive and frankly unnecessary procedures! It really speaks to the unrealistic, Instagram-filtered standard they are buying into. Frightening and quite bleak…

William Brand
William Brand
24 days ago

The female urge to fake youth is stupid.

UnHerd Reader
UnHerd Reader
24 days ago
Reply to  William Brand

Well it’s understandable, but rarely successful.

Bernard Hill
Bernard Hill
21 days ago
Reply to  William Brand

…but not nearly as bad as the female urge to perpetuate the infantile.

Benedict Waterson
Benedict Waterson
24 days ago

The future female face is a sheet of paper

David Morley
David Morley
23 days ago

Pretty much covered by Dr Who.

RM Parker
RM Parker
24 days ago

Oh dear. Quite agree that injecting crud into your face (and elsewhere) is a ludicrously bad idea. That it’s been framed as an act of feminist defiance shows how jejune our public sphere has become.
I have no time for hand wringing on this issue – if you’re easily led, you’ll end up in trouble but it won’t be anyone else’s fault. Ditto the fads of enlisting nutritionists and trainers, and undertaking unvalidated and expensive testing of blood and stool by opportunistic companies – it’s all unnecessary and a drain on finances and happiness.
As I’ve grown older I’ve come to realise there are far worse fates than growing old gracefully. Or, more enjoyably, disgracefully.

David Morley
David Morley
23 days ago
Reply to  RM Parker

That it’s been framed as an act of feminist defiance shows how jejune our public sphere has become.

Is it framed in this way? I think it’s more that an original message: women should not be shamed for their appearance; has been interpreted as putting women beyond all judgement and social control. Any messages about responsibility, accountability or just good sense are unpopular, so they’ve been dropped. There was lots wrong with second wave feminists – but it certainly wasn’t their intention that women turn into entitled, self obsessed bimbos.

J Hop
J Hop
23 days ago
Reply to  RM Parker

“Oh dear. Quite agree that injecting crud into your face (and elsewhere) is a ludicrously bad idea. That it’s been framed as an act of feminist defiance shows how jejune our public sphere has become.”
True, I remember when Madonna, ever the narccisist, struck back at criticism over her overdone face with how empowered and brave she was to define beauty on her own terms or some such crud. I think I must have LOL’d over that. She’s obviously TERRIFIED of aging!

UnHerd Reader
UnHerd Reader
22 days ago
Reply to  J Hop

It’s those women in the public eye resisting botox and fillers that are brave and empowered in my view.. Wrinkles are not ugly, a dehumanised face is.

p3rfunct0ry 4p4th3t1c
p3rfunct0ry 4p4th3t1c
24 days ago

If a few (or a lot) need to die from botulism to learn of the associated risks, let them die.

David Morley
David Morley
23 days ago

That’s a bit hard, but you can’t help wondering what will happen if all risks and downsides are removed.

David Morley
David Morley
23 days ago

Once upon a time any article like this by a woman would have found some way to blame men or the patriarchy for this. It’s refreshing to get to the end of the article without this having happened.

David Morley
David Morley
23 days ago

Can we not develop a tax system based on the seven deadly sins? The worse the sin, the higher the tax. So Botox and the rest would be hit by a vanity tax. I’m half serious. We do need some sort of clear social message that although allowed, this sort of stuff is not approved of.

J Hop
J Hop
23 days ago
Reply to  David Morley

Interesting concept. Would you tax makeup? Would high heels cost more than sneakers? Would a beard trimmer get a tax? What about body lotion. Functional yes, but also makes your skin youthful and dewy.

William Brand
William Brand
23 days ago

Botox is a stupid fad in which women try to fool men about the age of the eggs in their ovaries. Men are given the ability by evolution to see through female deception of their fertility. Rich men will want to trade in an older wife for a new model anyway. Make it clear to hubby that it is cheaper to keep her. Pick out a third world young concubine for him who will respect senior wife. An older woman should first check for Cancer genes and if present remove dangerous organs in order to be able to keep her vagina usable with hormones.

Bernard Hill
Bernard Hill
21 days ago
Reply to  William Brand

…its never about fooling the men dear boy. It’s all about position on the henpecking hierarchy.

Bernard Hill
Bernard Hill
23 days ago

…NO, NO and NO several more no’s…..greater legislation and regulation of the injectables industry is NOT undoubtedly needed. Credentialling everything people do, and removing risks from personal choice, are major factors in the decline of productivity as well as the general social chaos we are enduring.