“Microdosing” Is The New Botox Trend Spiking In New York & L.A.

Illustrated by Vero Romero.
Microdosing had a big year. From Silicon Valley execs to A-list comedians, it seems that everyone had an opinion on the supposedly life-altering benefits of extreme moderation in 2019. But it’s not just tiny doses of THC or psychedelics making headlines: The just-a-little-bit approach is trending in beauty, too.
"Micro-Botox" is an injectable technique in which itty-bitty amounts of a neuromodulator (like Botox Cosmetic, Dysport, or Xeomin) are used to tighten pores and tame oil and sweat production, in addition to providing more natural-looking line reduction. According to top dermatologists in Los Angeles and New York, the procedure is a rising star in doctors' offices everywhere, where it's also nicknamed baby Botox, microtox, mesobotox, or skin Botox.
Of course, there are nuances to the burgeoning trend — and, as with any injectable, there are still risks, so studying up is the best jumping-off point. So, what does it really mean to microdose Botox, and what do you need to know before you book an appointment? We checked in with the experts to answer all our burning questions, below.

What is micro-Botox?

“Micro-Botox refers to the injection of multiple small doses of Botox into the skin,” says Chaneve Jeanniton, MD, board-certified oculofacial plastic surgeon and founder of Brooklyn Face & Eye in New York. ”It’s injected superficially and therefore only targets the skin, where oil production, facial flushing, and acne occur. But it differs from conventional Botox as it does not iron out wrinkles caused by muscle contractions.” That’s right: Botox injected at the top layer of the skin works to control oil and redness while making pores appear smaller, which could mean fewer breakouts, but won't stamp out wrinkles.
Perhaps the biggest caveat is that, because this treatment goes by many names, it can mean different things for different injectors. Where one doctor might stick to subdermal injections just at the surface level of the skin for a patient who wants to reduce sweat (similar to an armpit injection) or oil, another might go a little deeper to also lightly paralyze the muscle for added fine-line reduction. Like all parts of dermatology, it’s not an exact science, so it’s very important to ask questions, do your research, and ultimately make sure you and your injector are on the same page about your goals. 
For Karyn Grossman, MD, a board-certified L.A. cosmetic dermatologist with a celebrity following, micro-Botox means just barely entering the muscle to soften, but not paralyze, the patient’s expression. “You can inject neuromodulator in different amounts in similar places [to a traditional Botox injection], but place it higher in the skin,” she says of her technique. Her main objective is to avoid the "frozen" look at all costs, which is where micro-Botox often comes in handy. “Frozen is not youthful,” she adds.
Illustrated by Vero Romero.
Vanessa Lee, RN, founder and in-demand injector at L.A.’s The Things We Do, falls somewhere in the middle. She says that she likes to “just barely kiss” the muscle with the Botox for a slight smoothing effect. “It doesn't take away fine lines by any means, but it is a significant change in the skin,” she says, noting that the softened look results in a “did she or didn’t she?” effect that’s very natural-looking — fresh, not frozen.

How long does it last? 

Just like Botox applied in the traditional way (injected into the muscle), micro-Botox lasts up to three or four months; however, there are some potential long-term benefits when mixed with H.A. filler. 

Should you mix micro-Botox with other injectables?

Cocktailing or layering Botox with hyaluronic acid dermal filler isn’t just common — our experts say that the technique is actually more valuable than the sum of its parts. “You get a synergistic effect when you decrease muscle contraction and put a little stretch [on the skin] with fillers,” Dr. Grossman says, noting that this is believed to be one way to prompt your body to make more collagen, a building block of youthful skin that tapers off as we age.

“My favorite cocktail for this treatment is Botox, hyaluronic acid filler, and vitamin C,” Dr. Jeanniton says. “It results in smooth, plump, glowing skin. I will often also add PRP to the mixture for a truly sublime result.”

What should I look for in an injector?

Necessary qualifications vary by state, but Dr. Grossman says that finding a skilled injector is very important, on top of checking out their qualifications. “Intradermal injecting is a more difficult skill to learn than the subdermal,” she says. “It’s a precision thing.” Pick someone who lacks skill, she says, and you could put yourself at risk.

So, what are the risks?

“After treatment, minor swelling and redness and the possibility of slight bruising are expected, similar to regular Botox injections,” says Dr. Jeanniton. Adding in H.A. filler? Uneven texture is also a possibility, says Dr Grossman, who adds that while occlusions — which is what happens if an injector accidentally enters a vein — are rare, they can occur whenever injecting into vascular areas, even the skin. "There's never no risk," Dr. Grossman says.
Illustrated by Vero Romero.
Then, there are longterm risks. “One risk is weakening of muscles on the face, which can interfere with facial expressions,” says Joshua Zeichner, MD, board-certified dermatologist and director of cosmetic and clinical research in dermatology at New York’s Mount Sinai Hospital. Dr. Grossman agrees, noting that muscles of the face can eventually atrophy, which means that restraint is important if this is something you plan on maintaining.

Who's a good candidate?

Essentially, anyone who is looking for any of the aforementioned benefits is a candidate, but Lee says those with dry skin should avoid the treatment or risk making skin drier due to decreased oil and sweat. 

Is micro-Botox more popular than regular Botox?

Our experts say that, while it hasn’t usurped traditional Botox injection techniques, the trend shows no signs of slowing. “As issues like excess oil production are a relatively unmet need, I do think that micro-Botox will continue to gain popularity,” says Dr. Zeichner.
Different iterations of the treatment are also taking off. At Lee’s L.A. practice, injectors administer Botox mixed with H.A. filler via a microinfusion punch, which is basically a microneedling device that lightly punches the concoction into the skin using gold-plated .6mm needles. She says patients love it for both the immediate results and the longterm microneedling benefits

How much does it cost? 

It depends on where you live and the experience of your injector, but expect to pay in the ballpark of $500.

Does it hurt?

Dr. Grossman notes that, the closer the injection is to the surface of the skin, the more painful it is. Plus, since the product needs to be properly diffused, many injections are necessary. “It may be uncomfortable, as many pinches are given to the skin,” Dr. Zeichner says. Dr. Jeanniton adds that “a needle could be inserted anywhere from 50 to 100 times over the face compared to 5 to 20 times for traditional Botox injections,” so numbing cream is commonly applied before the treatment.

More from Skin Care

R29 Original Series