How to "fix" your face

Summary

Today, Explained: How to "Fix" Your Face

Release Date: May 16, 2025
Hosts: Sean Rameswaram & Noel King
Produced by: Amanda Llewellyn
Network: Vox Media Podcast Network

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Introduction: The Allure of Advanced Skincare

The episode kicks off with Amanda Llewellyn sharing a personal experience that underscores the burgeoning interest in high-end skincare procedures. While vacationing in Portland, Oregon, Amanda encounters an aggressive skincare salesperson who convinces her to try a $1,300 treatment claiming it can eliminate the need for Botox for three years.

Amanda Llewellyn [00:00]:
"I have the beginnings of crow's feet, but I'm looking in the mirror and they're, they're gone."

This anecdote sets the stage for a deeper exploration into the pressures and trends surrounding facial aesthetics today.

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Unpacking Baby Botox: A Preventative Trend

Yasmin Tayag, a staff writer at The Atlantic and host of the podcast How to Age Up, delves into the phenomenon of "baby Botox." Initially secretive in the mid-2000s, Botox has become more mainstream, particularly among younger demographics aiming to prevent wrinkles before they form.

Yasmin Tayag [03:03]:
"Baby Botox is thought of as a preventative procedure. The idea is that if you begin using it before you start forming wrinkles, you will not develop those wrinkles as long as you keep up the Botox."

Baby Botox refers to the use of smaller, less noticeable doses of Botox, typically ranging from 10 to 20 units compared to the standard 20 to 40 units. This approach aims to maintain a youthful appearance without the overt "frozen" look often associated with traditional Botox treatments.

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The Cultural Shift: From Secretive to Open

Noel King and Yasmin discuss the transformation of Botox from a clandestine procedure to a widely accepted norm, influenced heavily by reality TV shows like Vanderpump Rules and The Real Housewives.

Noel King [04:16]:
"I'm a couple years older than you. My impression of Botox is that it is something we do in the shadows."

Yasmin Tayag [05:35]:
"The openness just sort of bled out into the wider culture, leading us to a place where people aren't really embarrassed anymore."

This normalization is further propelled by social media platforms where individuals constantly scrutinize and compare their appearances, exacerbating the desire for cosmetic enhancements.

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Social Media’s Impact on Self-Perception

The incessant use of smartphones and platforms like TikTok has intensified self-examination, making users hyper-aware of their facial features and imperfections.

Yasmin Tayag [06:10]:
"You're looking at your face constantly. I think broadly, our culture has just become so visual."

The advent of tools like ring lights, which are designed to enhance on-camera appearances but also highlight every minute detail of one's face, contributes to this heightened self-awareness.

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Economic Considerations: Is It Affordable?

A critical discussion emerges around the affordability of baby Botox, especially for younger individuals grappling with economic pressures like inflation and rent.

Yasmin Tayag [08:38]:
"Even baby Botox, which uses fewer units than normal Botox, is still expensive. It can run up to between like $200 and $400 per session."

Despite the costs, many perceive it as a part of their regular skincare routine, often comparing it to other beauty treatments that also require consistent financial outlay.

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Long-Term Risks and Ethical Concerns

Dr. Michelle Huri, a dermatologist, provides a professional perspective on the long-term implications and ethical dilemmas posed by the increasing trend of cosmetic procedures among younger populations.

Dr. Michelle Huri [10:10]:
"We don't really know that much about the long-term effects of regular Botox use."

She highlights potential physiological consequences, such as muscle dependency and the emergence of new wrinkles due to imbalanced facial muscle activity. Additionally, Dr. Huri emphasizes the psychological risks, including the development of dependency on cosmetic procedures for self-esteem.

Dr. Michelle Huri [23:05]:
"At what point is it kind of be not enough? Right. So you're gonna do more and more and more, and then you're not gonna look like yourself."

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The "Perception Drift" Phenomenon

A term introduced by Dr. Huri, "perception drift," describes the gradual shift in an individual's appearance due to continuous cosmetic interventions, potentially leading to a loss of one's natural look.

Dr. Michelle Huri [24:00]:
"At some point, you will do these little, little incremental treatments. Until the end, you are entirely a different person."

This concept questions the sustainability of altering one's appearance to align with ever-evolving beauty standards and the possible identity crisis that may follow.

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Economic Sustainability of Cosmetic Procedures

The conversation also touches upon the financial burden of maintaining such beauty standards over time.

Yasmin Tayag [09:40]:
"If you view it as just a part of your normal skincare routine, 200 bucks isn't that big a leap."

However, as procedures like baby Botox require regular touch-ups, the cumulative costs can become substantial, posing challenges for long-term affordability.

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Professional Integrity vs. Market Demands

Dr. Huri discusses the ethical tension between medical professionals' duty to prioritize patient well-being and the commercial pressures to maximize procedural offerings.

Dr. Michelle Huri [21:37]:
"I had to start my own office and be on my own. That goes against everything that I believe in, my oath."

Her experience reflects a broader conflict within the cosmetic industry, where economic incentives often overshadow medical ethics, leading to potentially harmful practices.

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Conclusion: Balancing Beauty with Health and Authenticity

The episode wraps up by pondering the societal implications of cosmetic enhancements. While advancements in skincare and cosmetic procedures offer individuals the means to maintain their desired appearance, they also raise questions about authenticity, psychological health, and the true cost of adhering to rigid beauty standards.

Yasmin Tayag [13:54]:
"If you manage to stay looking 20 for the next 30 years of your life, what do you miss out on?"

This reflective query invites listeners to consider the broader impact of beauty trends on personal identity and societal values.

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Key Takeaways:

• Baby Botox is a preventive cosmetic procedure gaining popularity among younger demographics to stave off wrinkles.
• Social Media Influence: Platforms like TikTok and tools like ring lights amplify self-scrutiny, driving the desire for cosmetic enhancements.
• Economic Factors: While perceived as part of a regular skincare routine, the cumulative costs of procedures like baby Botox can be significant.
• Health Risks: Long-term and psychological risks of continuous cosmetic interventions remain under-researched and potentially harmful.
• Ethical Dilemmas: Medical professionals face conflicts between patient well-being and commercial pressures in the cosmetic industry.
• Cultural Reflection: The pursuit of maintaining a youthful appearance raises questions about authenticity and the societal value placed on aging.

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This episode of Today, Explained offers a comprehensive examination of the pressures to maintain youthful appearances, the rise of preventative cosmetic procedures, and the complex interplay between social media, economic factors, and ethical considerations in the beauty industry.

Transcript

[Amanda Llewellyn]

Okay, so the other day I was in Portland, Oregon on vacation. I'm hanging out, feeling really good about myself, and I walk past this store where a guy is offering free skin care samples and I say, sure, I'll take one. Then he literally grabs me by the hand and pulls me into his store and suddenly he's putting like this goop under my eyes. And I'm not a big skincare girly, but I dabble. And I'm telling you that this stuff was magic. Like, I have the beginnings of crow's feet, but I'm looking in the mirror and they're, they're go. And he tells me this stuff costs $1,300, but it is so worth it because you won't need Botox for another three years.

[Noel King]

How old are you? Amanda?

[Amanda Llewellyn]

I'm 28 years old.

[Noel King]

Coming up on Today explained the pressure.

[Amanda Llewellyn]

To fix your face.

[N/A]

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[Noel King]

It's Today Explained. I'm Noel King. Yasmin Tayag is a staff writer at the Atlantic, where she also hosts a podcast called how to Age Up. This is a show about rethinking aging, which Yasmin recently found herself doing when she noticed that many of her friends have been looking suspiciously good.

[Yasmin Tayag]

Well, as a woman in her late 30s who is on Instagram all the time, I couldn't help but notice that some of my friends who are the same age as me look amazing. And I was like, wait, I know you're in your late 30s. Your face should not look that tight? What's going on here? So in person, I started to ask casually, like, what's your secret? And everyone I spoke to was very happy to tell me that they've been doing baby Botox since their mid-20s.

[Noel King]

What is baby Botox?

[Yasmin Tayag]

You can interpret baby Botox in two ways. The main way is that you use baby doses of Botox. So typically, a normal Botox procedure might use 20 to 40 units of Botox. A baby Botox procedure uses only 10 to 20. But I think it can also be interpreted to mean that it keeps you looking kind of like a baby from the moment you start. So baby Botox is thought of as a preventative procedure. The idea is that if you begin using it before you start forming wrinkles, so freezing your face at, say, age 20, you will not develop those wrinkles as long as you keep up the Botox, huh? Yeah. I was really surprised, and they were very forthcoming about it.

[Noel King]

This is super interesting. I'm a couple years older than you. I'm in my absurdly early 40s, let's call it. And I. My impression of Botox, which I haven't tried, but definitely would, is that it is something we do in the shadows. It is not something that we tell our friend, who is a literal reporter for the Atlantic about.

[Yasmin Tayag]

Yeah, you would think, right. And I'll tell you that I used to work in a Botox clinic when I was in college. Well, I was a medical assistant to a doctor who began moonlighting as an injectables doctor. And so I was exposed to a lot of the people who were coming in to get Botox. And this was in the mid to late 2000s. And at the time, it was very secretive. You know, people didn't want others to know that they were getting Botox. We would have women come in paying in cash because they didn't want their husbands or family members to know that they were paying for Botox. And I think a lot has changed since then. So when I was doing reporting for the story, something that came up a lot was the impact of reality tv.

[Amanda Llewellyn]

I have Botox up here. Here. I've had filler in my cheekbones, filler in the chin, filler in the jaw and my lips. So pretty much my whole face except my nose.

[Yasmin Tayag]

Multiple women I spoke to mentioned Vanderpump Rules and the Real Housewives series. So I don't really watch these shows. But what my friends told me was that on these shows, the women are very open about their Botox use. I'd get Botox, and I Get filler. I've always done that.

[Dr. Michelle Huri]

Okay.

[Yasmin Tayag]

And I take care of my skin. Lots of water.

[Dr. Michelle Huri]

Okay.

[Yasmin Tayag]

And I lost some weight. And I think that openness just sort of bled out into the wider culture, leading us to a place where people aren't really embarrassed anymore.

[Dr. Michelle Huri]

I am by no means against Botox, and anytime I can get it free, I double up.

[Yasmin Tayag]

There are some other things, of course, driving this baby Botox trend. I mean, the fact that so many people are on their phones all the time taking photos of themselves streaming on TikTok. You know, you're looking at your face constantly.

[Dr. Michelle Huri]

Hey, guys, get ready with me.

[Yasmin Tayag]

I'm 39 years old. I'm obsessed with skincare, and this is my nighttime routine for glass skin, including a new product.

[Dr. Michelle Huri]

If you think you have a double chin, you actually probably don't.

[Amanda Llewellyn]

Probably just excess lymph fluid that's sitting.

[Yasmin Tayag]

In this part of your face. And the same goes for having been on Zoom for all of the pandemic. Where are we looking during our zoom calls?

[Dr. Michelle Huri]

Are you looking at yourself to make.

[Yasmin Tayag]

Sure you're not doing anything weird?

[Dr. Michelle Huri]

Because that's what I tend to do.

[N/A]

I actually purposely move my viewfinder close.

[Yasmin Tayag]

To your face so you think I'm looking at you, but I'm really not. I'm really not. When you're looking at your face all the time, you're spending more time with the wrinkles and the fine lines that are forming. I think broadly, our culture has just become so visual. We're always looking at faces on social media. We're seeing our faces juxtaposed with those of celebrities who look incredible, possibly because they are doing so much baby Botox and other procedures.

[Noel King]

Can I tell you my theory based off of what you just said?

[Yasmin Tayag]

Yeah.

[Noel King]

I think we are doing and seeing too much in daylight. Half of my life used to happen after dark. Too much is being done with good lighting. We need to return to the days of poor lighting. Going out late at night, having drinks at dusk. Everything gets blurry anyway.

[Yasmin Tayag]

Yes. I mean, also, like, we have to mention the rise of the ring light, right?

[Noel King]

Oh, my God. I have mine on right now, and I'm furious about it.

[Yasmin Tayag]

You know, it's supposed to make us look better on camera, but it also magnifies everything on your face.

[Noel King]

How many of the youths are treating this? How common is this?

[Yasmin Tayag]

So it's become really popular. I saw this statistic that said between 2019 and 2022, the number of people in their 20s who got Botox rose 71%. It's a lot. It's a lot. And these are people who, in the early 2000s, you wouldn't really think of as people who would get Botox.

[Noel King]

How are younger women doing this when there's also rent to pay and inflation running around the grocery store? Like, where's the money coming from?

[Yasmin Tayag]

Great question. I mean, you're right. Even baby Botox, which uses fewer units than normal Botox, is still expensive. It can run up to between like $200 and $400 per session. And if you were to keep it up, you'd probably, probably have to do it at least twice a year because Botox tends to wear off between three and six months.

[Noel King]

Okay, so a couple hundred bucks twice a year, I guess something you can budget for. But not nothing.

[Yasmin Tayag]

Not nothing. But the way that my friends framed it. If you take it in the context of other procedures or other cosmetics that people are using to try to stay young, such as, you know, all the fancy anti aging creams or facials, massages, all of these things that a lot of people do pretty regularly, those can cost easily up to 100 bucks. You know, in New York City, at least a mani pedi can go for $100 easily.

[Noel King]

Yeah, I paid 87 the other day.

[Yasmin Tayag]

Without tiff, it's too much. Yes. With the tiff, it's crazy. And so I think when you view it as just a part of your normal skincare routine, you know, 200 bucks isn't that big a leap, especially if you consider it as potentially reducing your reliance on other types of cosmetics or anti aging procedures.

[Noel King]

Is there any danger to starting Botox when you're in your 20s?

[Yasmin Tayag]

I think something that should really give people pause is that we don't really know that much about the long term effects of Botox of regular Botox use. So the baby Botox trend began somewhere in the aughts and we just don't really know what happens because there just hasn't been enough time to see what the long term effects can be. But some of the dermatologists I spoke to for this article told me that broadly one issue with Botox is that if you paralyze the muscles in one part of your face, the other muscle, like it still wants to move, your face still wants to move, and so other muscles can try to compensate. And so, you know, you'll start seeing wrinkles in those areas and potentially need to get Botox there. So I think one potential consequence of regular Botox use from a very young age is that you become dependent on it.

[Noel King]

Yeah, you're like chasing the aging all around your face. Yeah, that's actually super interesting to think about. If your forehead doesn't wrinkle, something else somewhere on that face is gonna move. And then, you know, a couple years from now, you might be chasing that with the injectable. Let me ask you, you host a podcast about aging, you try to be optimistic. You also know, I would imagine that there's a lot of pressure to look younger than you actually are. If baby Botoxing becomes a bigger trend, could it become kind of an arms race where you've got a whole generation of 50 year olds who look 30 and then everyone has to change and double down in order to look good for their age?

[Yasmin Tayag]

You know, it's interesting, one of the women I spoke to actually brought this up. She felt like she was in competition with women to look youthful. And her concern was that all of these younger women started baby Botox earlier than she did.

[Noel King]

Oh.

[Yasmin Tayag]

And so she's like, they've got a head start. You know, I only started in my late twenties. These women have seven years on me. And if we're going to end up continuing to do this procedure, I'm not going to ever catch up to where they are. And it's funny because intellectually I can understand, yes, we're supposed to be celebrating aging and feeling good about the wrinkles and the gray hairs and all of the wisdom and experience that come with it. But at the same time, I'm still looking at myself in the mirror, trying to pull out my white hairs. And it comes from this immense cultural pressure, especially on women, to look good for their age. But I wonder if looking good for your age isn't even going to be good enough if this trend keeps up. You don't want to just look good for 30 or 40. You want to look 20. One thing that has come up for me a lot as I think about this baby Botox trend is that if you manage to stay looking 20 for the next 30 years of your life, what do you miss out on? You know, as I got older, I found that people treated me differently, often in a positive way. I was taken more seriously. I was told I had more gravitas. And if you never look that way, what happens to you?

[Noel King]

Yasmin Tayag of the Atlantic. Her podcast is called how to Age Up. Coming up next, a physician who has been chasing young women out of her office.

[N/A]

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[Noel King]

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[N/A]

You're listening to today.

[Dr. Michelle Huri]

Explain. So my name is Michelle Huri. I'm a physician. I do dermatology and dermatopathology, which is looking under the microscope for, you know, skin biopsies and whatnot. And so I'm seeing patients, medical patients, cosmetic patients, and occasionally surgery. And I have my own office. So I started my practice at the end of 2015 and really got into the swing of things in 2016. And I really didn't start seeing that uptick of younger cosmetic patients until the pandemic. Everyone was basically chronically online. They were on zoom. They were looking at themselves. And there was the rise of TikTok and the filters. And people were really, you know, seeing these flaws, these perceived flaws that either aren't there or are so minimal in just normal anatomy. And they have really, you know, made it front and center where it affects them, it affects their daily life. And, you know, I really feel that it has become more of a pathological thing. I did have this patient very recently who was on the younger side. She was mid-20s and really, you know, beautiful girl. I don't see a lot of signs of aging on her face. But she was coming in for, for neurotoxin, botox, dysport, that sort of thing. You know, I really had to kind of search for movement on her face already. So there wasn't a lot, a lot for me to treat. So I told her, you know, okay, no problem. I will do a little bit. I mean, I see maybe it helps with your 11 lines in the middle. You know, maybe if you're looking angry, that's fine, no problem. We'll do a little bit. And at the end of the session, you know, she was asking me so what do you think about my nasal labial folds? Basically is the fold that goes from the corner of your nose, your nostril, to the corner of your mouth. And it is kind of the barrier between the kind of upper lip and your cheek. And when you smile, it kind of folds like that. Of course, the more you age, the more of a line will be left behind when you're not smiling. And she was just, you know, she's pointing to her cheek as if there was something there, but there was nothing there. And so I had to tell her, like, well, I. I don't see that you're perfect. It's a phantom nasal labial fold. It. It didn't exist. So I had to bring a mirror out and show her there's nothing here. Right. And so that sort of mentality where someone really is perceiving a flaw that is absolutely not there. Providers need to say no. Unfortunately, they're incentivized not to. Especially if you have a cosmetic, you know, office, if you're a med spa, if you're a cosmetic, derm or plastic surgery office, of course you're incentivized to do what the patient wants. Well, I'm not going to do that. That's not what I do.

[Noel King]

So you said no to this young woman and sent her on her way.

[Dr. Michelle Huri]

Yes.

[Noel King]

Which means you may get paid for seeing her in that visit, but you're not getting paid for putting filler in her face.

[Dr. Michelle Huri]

Of course.

[Noel King]

I think what I hear you saying is other doctors would done that.

[Dr. Michelle Huri]

Absolutely. Oh, 100%. Wow. And I know this for a fact because many times those patients will come to my office to get that filler dissolved because they don't like it in the larger practices or practices that are private equity owned, which is a huge problem in medicine. You are absolutely meant to sell as many products, as many procedures as possible. Oftentimes, I was told to sell as much filler as possible. Right. Because every syringe is several hundred dollars, you know, and then if they're there, talk them into a laser, talk them into this, talk them into that. Then you become a salesman. I mean, I was even told for my skin check patients, you know, I'm looking for skin cancer. I'm, you know, counseling them on how to take care of their skin. I was told, don't talk to them about using sunscreen. No, because we want them to. We want them to get skin cancer and come back. I was pulled out of a room. I was pulled out of the room by my boss and, and reprimanded for explaining why it's so important to use sunscreen. And so this is why I couldn't do it anymore. I had to start my own office and be on my own. I can't do that. That goes against everything that I believe in, my oath. Because there is harm, potential harm on many different levels for cosmetic procedures.

[Noel King]

What are the risks here to giving someone a cosmetic procedure that, you know, they don't really need?

[Dr. Michelle Huri]

Well, I mean, there are just issues with cosmetic procedures in general, whether they need it or they don't. You think about, this is a medical procedure. There is always risk for any type of intervention, Right? So what gets me is like Nordstrom is talking about having, you know, injections in their. In their stores. Like this is some sideshow thing. This is ridiculous. This is a medical procedure. You can get infection, you can get vascular occlusion. That can lead to death of the tissue overlying where you inject it can lead to blindness. This is like a big deal. Of course, it's fairly safe if you know what you're doing, but not everyone knows what they're doing and knows how to handle the problems, the complications that can come about. So beyond that, you have financial issues. If someone does baby botox in their 20s and they want to do it for a long time, you think about how much cost that is. If you're spending five, six hundred dollars every three or four months, that's a lot of money, especially today. And then, honestly, I feel like the psychological aspect of it is a big problem, right? So at some point you become dependent almost on these procedures to either feel happy or feel good about yourself. At what point is it kind of be not enough? Right. So you're gonna do more and more and more, and then you're not gonna look like yourself. And it's going to be a point where you look in the mirror and it's not you. One of my colleagues actually coined this term. It's called perception drift. At some point you will do these little, little incremental treatments. Until the end, you are entirely different person. You look like a different person and you might look very abnormal. Yeah, right. So even if someone comes to me for something that is legitimate, it's still, once you start, it's going to be hard for you to stop. So if you're barely able to scrimp together enough to pay for that one thing and you have it done, great. What about all the rest of your life that you're going to want to do something? Are you going to be able to manage it.

[Noel King]

I wonder how all of this makes you think about your profession. I mean, most people get into medicine has always been my assumption to help people to be helpful. And you've laid out a world in which procedures are being done that are not only not helpful, they could be dangerous. And you don't seem to to like it very much.

[Dr. Michelle Huri]

Yeah. And this is why it is a smaller and smaller and smaller percentage of what I do in my office. I love cosmetics to an extent. Right. So I love to augment, make people love how they look. But when you start using cosmetics as a tool to make them feel better about themselves in a major way and that they need these sort of things to, you know, validate themselves, it's a slippery slope. It should be more of a targeted thing, not making you look like an entirely different person because, you know, society has told you you can't age, that, you know, women just can't age, which is just, you know, it's really disturbing to me. Foreign.

[Noel King]

That was Dr. Michelle Curie. Amanda Llewellyn produced today's show. That's her last one for us. Fair Winds and following Seas Gorley Aminah Elsadi edited, Andrea Christensdotter and Patrick Boyd engineered. The rest of our team includes Abishai Artsy Miles, Bryan Hadi Muagdi, Devin Schwartz, Denise Guerra, Gabrielle Burbay, Jolie Myers, Miranda Kennedy and Sean Ramasfirm. I'm Noel King. Today Explained is distributed by WNYC and the show is a part of vox. If you'd like to support our journalism, you can join our membership program today. Just go to Vox.commembers to sign up. And do recall we make a show on the weekends now, too. Check out Explain it to me in this feed every Sunday morning. Sam.