In 2014 the Real Academia de la Lengua incorporated the term ‘botox’ into the dictionary. It did so castilianized and with an accent, for the sake of being a plain word that does not end in n or s, and it was defined as “the graphic adaptation of the English word botox (acronym of bo[tulinum] tox[in], initially a brand name), which designates a preparation based on botulinum toxin used in various treatments, especially cosmetic.” Since then, ‘getting botox’ has become one of the most well-known and most administered cosmetic treatments.
The problem arises when, instead of calling it by that name, which remains the adaptation into our language of a commercial brand, professionals of aesthetic medicine refer to this drug by what it is, the botulinum toxin. The immediate response is: Won’t it be dangerous to inject a toxin into the skin? The doctors who use it in our daily practice (in accordance with Royal Decree 1277/2003, aesthetic medicine treatments may only be carried out by aesthetic physicians with a medical license or degree) always deliver the same reassuring message.
But the sound of the term ‘toxin’ lingers in the air, like a troubling burden. And every so often celebrities, influencers, or gurus emerge who suggest that we are ‘poisoning’ patients in order to eliminate wrinkles. They are prejudices about botulinum toxin that create uncertainty about a safe and well-regulated drug.FOTO:
The burden of being a toxin
There are words that weigh more than the facts. “Toxin” is one of them. Just pronouncing it makes many people imagine a poison, a risk, or something incompatible with health. However, few words generate such a stark contrast between perception and scientific evidence. It is true that the neuromodulators used in aesthetic medicine derive from the botulinum toxin type A, but it is also one of the most studied drugs in modern medicine. It has decades of clinical experience and millions of treatments performed worldwide, with an excellent safety profile when used correctly.
But of course, it is a toxin. Originally the same toxin that causes botulism, a dangerous foodborne illness that can occur, among other things, from eating improperly preserved foods. It only takes linking these points to unleash a fear-inducing message. One of those messages that works wonderfully on social networks.
The key is the dose
As early as the Renaissance, the physician Paracelsus made famous the concept that any substance, in large enough doses, can become a poison. It is the dose that differentiates a poison from a remedy. Centuries have passed, but that principle remains unmovable. In medicine, almost nothing is inherently good or bad. Everything depends on the dose, the indication, and who administers it. The same active ingredient can be beneficial or harmful depending on the context. Botulinum toxin is a perfect example of this.
While aesthetic medicine uses very small doses to modulate certain facial muscles, neurology or rehabilitation use markedly larger amounts to treat conditions such as chronic migraine or spasticity. And yet, we rarely hear that those treatments, which notably relieve the ailments of those patients, are met with the same rejection.
Removing wrinkles and bearing a stigma
Perhaps the real problem is not the toxin itself, but everything we project onto it. That vanity, superficiality, or triviality that is often attributed to someone who, fully capable and with means, decides to soften their wrinkles. With far too much frequency, the debate about aesthetic medicine abandons scientific evidence to settle in the realm of prejudice. There is talk of an obsession with youth, even social pressure, as if anyone who chooses to take care of their image is automatically renouncing their freedom.
The argument is those smooth faces we saw more than a decade ago and which now, thanks to greater consistency in toxin use, are hardly seen.
Today the vast majority of patients who come to consult do not want to look twenty years younger. They do not seek a different face either. They want to look rested. They want their expression to reflect how they really feel. They want to continue recognizing themselves when they look in the mirror.
And that difference is important. Responsible aesthetic medicine is not about manufacturing identical faces or pursuing impossible youth. It consists of accompanying aging, preserving facial identity, and offering tools so that each person can feel good about their own image without ceasing to be themselves.
The myth that we take care of ourselves for others
There is another issue that I find especially relevant: Do we take care of ourselves to please others or to feel good about ourselves? Probably both coexist to varying degrees. We are social beings and our image inevitably influences how we relate to the world. But we also know that the perception we have of our own appearance affects self-esteem, confidence, and emotional well-being.
It is not about pursuing perfect beauty, but about maintaining a healthy relationship with the image the mirror returns.
“It’s that you inject yourself because of social pressure”
I also hear and read frequently that those who turn to aesthetic medicine do so because they are subjected to social pressure that prevents them from deciding freely. I do not deny that such pressure exists. It would be absurd to deny it. Especially women have lived for decades with demanding and sometimes unattainable beauty standards. But recognizing the existence of that pressure does not mean denying the autonomy of those who decide.
If we consider that a woman can decide on her professional career, motherhood, wealth, or any other significant aspect of her life, we should also recognize her ability to decide whether she wants to treat a wrinkle, care for her skin, or simply look better. Thinking otherwise would imply assuming she loses her judgment precisely when she decides about her own image.
That said, freedom never exempts medical responsibility. Our obligation is not to treat always, but to know when to do so and when not to. If a patient presents unrealistic expectations, a distortion of their self-image, or seeks a treatment from suffering or obsession, the doctor’s role is to say no. Because good aesthetic medicine does not consist of satisfying any request, but in indicating only what can truly benefit the patient.
Relax without changing
Neuromodulators are a good example of that medicine practiced with discernment. And, yes, botox, botulinum toxin, is a neuromodulator. They do not erase facial expression or change who we are. Their function is to modulate certain muscle movements to soften dynamic wrinkles and to make the passage of time leave a gentler trace on the skin, always respecting the naturalness and identity of each patient.
Perhaps the moment has come to stop debating whether a person should care for their appearance and begin asking something more important: how to do it with discernment, with safety, and always respecting their identity.
The real risk has never lain in a word like “toxin.” What exists are prejudices about botulinum toxin or botox, with the blessings of the RAE, rooted in ideas that have little to do with the toxin itself. The real risk appears when we substitute scientific evidence with prejudices and forget that medicine, including aesthetic medicine, must always be at the service of the well-being of people.
Mar Mira
Licenciada en Medicina y una de las pioneras en la medicina estética en España, disciplina que lleva ejerciendo desde hace 25 años. Su técnica se articula sobre una lectura global del rostro de cada paciente y una escucha atenta de sus motivaciones y expectativas. Actualmente dirige la clínica que lleva su nombre en Madrid.
