Today I had a patient come in concerned that she would be bruised from her BOTOX injection – “like Kim Kardashian”. It turns out this 29-year-old actress had BOTOX injections around her eyes while being filmed, and then afterwards had bruising and itching – all dramatically captured on video for prime time.

The next question was – “Why would anyone in their twenties get BOTOX, especially a beauty like Kim Kardashian?” The internet is full of comments. As a cosmetic surgeon I have a hard time understanding all the controversy.

Injections, whether they are flu shots or BOTOX injections, carry a risk of bruising. The crow’s feet area around the eyes (which it looks like Kim had treated) are particularly prone to bruising because of dense blood vessels in the area. In my practice less than 5% of patients bruise in this area, but it does happen. It also does not last very long and can be covered with make-up. Rarely has the bruising lasted more than a couple days, and patients seem to tolerate this minor bruising well.

BOTOX in your twenties is the other big question. BOTOX works by relaxing muscles of expression that form wrinkles and other “unwanted” creases – like frown lines between the eyes and crows’ feet around the eyes. Some of these expressions are actually developed in childhood, so it is not uncommon to have a person in their twenties with deep frown lines that they want relaxed. Why wait till you are 40 to look friendly?

If you live in a sunny climate (like Los Angeles), you are also at risk for developing crow’s feet lines around your eyes sooner, because of exposure to sun or because of squinting in bright sunlight. BOTOX relaxes these lines and can actually prevent the creases from forming.

BOTOX has been proven to be very safe with no known long term side-effects. An occasional minor bruise is the biggest risk. For a 29 year old actress competing for jobs in Los Angeles, BOTOX is probably right up there with hair dye as an employment prerequisite. If you have premature gray hairs or frown lines, why wouldn’t you improve them?