Secret Uses for Botox From the Number-One Injector in the Country

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“So all the tech bros are getting Botox, huh?” I laugh into the phone. I’m on the line with San Francisco dermatologist, Seth Matarasso, MD, who currently holds the title as the number-one user of Botox in the country.

“Everybody!” Dr. Matarasso quips back. “Not just tech bros! This morning I had an 85-year-old in my office. In fact, I’m more surprised when I hear of people not doing Botox. ”

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This breadth of clientele—old, young, male, female, black, Caucasian, Asian—all coming in for Botox Cosmetic injections is what makes Dr. Matarasso inject a self-estimated roughly 200,000 units of the toxin per year. But it’s also the breadth of uses for the product that keeps the doctor reaching for it day after day.

“Botox is FDA-approved for 11 lines, around the eyes and for excessive sweating,” says Dr. Matarasso. “But I’ve been using it off-label since it was approved. I use it for the forehead, around the mouth, on the neck, in the jaw, on the tip of the nose, around the bra line, and for a number of reconstructive uses. I use it both for therapeutic, as well as aesthetic indications—it’s the aspirin of this decade and we are only hitting the tip of the iceberg for all the ways it can be used.”

“What I find so amazing about Botox is that it’s extremely precise and has very few, if any, limitations,” continues the doctor. “The results kick in in a few days are cumulative. If I like the results, I’ll do it again and it builds up muscle memory. If I don’t like it, it wears off and goes back to baseline. It’s one of the safest things I can offer my patients.”

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The safety profile of the drug, along with its built-in wear-off date (most Botox Cosmetic injections last only three to six months in the body) is what allows doctors like Dr. Matarasso to get creative. “One of my favorite uses for the toxin is in the neck,” he says. “For men, when they button up a shirt, there’s excess skin that can drape over the collar. By using Botox, I can tighten up the neck muscles to get rid of that. But nothing is gender-specific—women also want the appearance of a sharper neckline.”

While most patients come into Dr. Matarasso’s office requesting Botox Cosmetic, there is one instance where the doctor administers it as a precautionary courtesy. “When I do Mohs surgery (removal of cancerous cells), I inject a bit of Botox near the wound to relax the muscle so there isn’t as much tension. When the muscle isn’t contracting, it really helps to minimize the resulting scar.”

What else goes into becoming the number-one injector of Botox Cosmetic in the country? Below, a recap by the numbers:

Number of patients who request Botox per year: 2,000–3,000 patients

Youngest age of patient: 19, using Botox for therapeutic reasons (sweaty hands)

Oldest age of patient: 90-something, for aesthetic reasons

Average number of visits per year: 3–4

Average appointment time: If just toxin, 5–10 minutes

Average number of months before someone needs to be reinjected: 3–4

Longest he’s ever seen Botox last in someone: 4.5 months

How many units of Botox he injects per year: 200,000 units/ 2,000 vials per year  

How many units of Botox he’s injected in his entire career: 2 million+

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