In 2010, as an assistant at my first magazine job, my boss pulled me into her cubicle and lowered her voice. “I got Botox during lunch,” she said, gripping my arm. How daring. How glamorous. How slightly shameful! I thought. This memory feels like a hundred years ago. In 2024, getting Botox is as controversial as brushing our teeth.
Now in my late thirties, I feel like an outlier for having abstained for this long. My reasons for opting out matter as much as anyone else’s reasons for opting in (as in, they don’t). But though I may be without Botox, I am not without vanity. I care massively about how my face looks as it moves through time. Fortunately for me, “Notox” treatments, or alternatives to neurotoxins, are gaining popularity thanks to social media and the desire for a more long-term, holistic approach to aging. If you’re forgoing injections or simply curious about your options, alternatives range from the traditional to the spiritual abound.
Traditional Chinese Medicine (TCM) is the original “Notox,” offering natural body and face treatments for millennia. “I see a lot of interest in using facial cosmetic acupuncture and gua sha as an alternative to Botox,” says Sandra Lanshin Chiu, a licensed acupuncturist and TCM practitioner based in Brooklyn. She often uses a combination of acupuncture, gua sha, and face cupping that yields impressive skin-tightening results, but she thinks it’s important for people to level their expectations about what these techniques can do. “Botox will deliver a more complete line erasure for those who want that,” she says.
Perhaps the most distinct philosophical difference among the practitioners offering Botox alternatives is that they want our face muscles to move, and they reject the idea that freezing a muscle helps reverse signs of aging. Chiu agrees. “When you paralyze a muscle, you are turning off its function. You’re completely restricting it from carrying out what it was designed and built to do,” she says. “As a TCM practitioner, I’m thinking about how that affects your Qi, or your life force energy. Every cell, every fiber in our body, is alive because of the energy that flows through it. When you straight-up paralyze a muscle, it’s kind of like turning off the spigot of energy, and that would be absolutely sacrilege in TCM.”
I made an appointment to try facial acupuncture with Dr. Alexa Woods at Four Moons Spa in Encinitas, CA. She placed needles around my mouth to stimulate collagen and bring blood flow to fine lines that have started to appear around my smile. After our session, my skin looked bouncy, and my lines were less pronounced, but it’s not a one-and-done approach. “People want the results right away, and acupuncture is more of a long game. The results happen over time,” Woods explains.
One benefit to using a modality like facial acupuncture is that the practice is safe for pregnant and breastfeeding women and people with autoimmune issues, while botulinum toxin is not. Beyond safety, there are more profound reasons why Dr. Woods champions using alternatives. She thinks that neurotoxins might have a larger implication on social connections. “When you freeze the muscles of your face, it prevents an expression,” says Dr. Woods. “That creates unconscious mistrust because you can’t read someone, and you can’t see how they’re really feeling. A barrier is unconsciously put up. We’re social creatures. Emoting is a way that we feel safe and able to connect on a deeper level with someone.” Studies on facial mimicry support this theory.
Anastasia of the popular Anastasia Beauty Fascia account believes in a hands-on approach to reversing signs of aging by manually manipulating the fascia on the face, neck, and scalp. Fascia is the continuous matrix of tissue that connects our organs, muscles, and bones—essentially, it holds everything in our body together. Healthy fascia is flexible and supports better blood flow, body symmetry, and posture, all of which contribute to looking younger. Anastasia says wrinkles are not the most significant measure of how we perceive aging. “Screw the wrinkles,” she says. “You don’t see wrinkles from afar. You see how old someone is because you look at the posture, you look at the length of the neck, you look at the jawline.”
Anastasia theorizes that freezing and tightening the face can actually make one appear older. “The way a woman moves will tell you how old she is,” Anastasia says. “Plastic surgeons and cosmetologists show the before-and-after pictures. But show me how she talks. Show me how she moves. Show me how she laughs when I tell a joke.” She’s not anti-Botox, however. “It’s a great drug for people who need it. I think we need to give women opportunities, and we have to stop saying: ‘This is the only solution.’”
As a follower of Anastasia’s video tutorials (she has an audience of over two million on Instagram), I find it empowering to take matters of aging into my own hands, literally, and appreciate that I can do so at home, without products or practitioners. Her goal is to give people a methodology that doesn’t require relying on outside help.
But sometimes, it’s nice for someone else to touch your face. Spas are responding to the “Notox” trend by offering treatments that improve the contours of the face, not just the surface of the skin. Facials like The Method at the Conrad Spa in Los Angeles—one of the best I’ve had—combined firm facial massage with LED light therapy to stimulate collagen.
There can be a heavy emotional component to our aging journeys, even if we refer to our chosen treatments as “self-care.” Allie Ninfo, an intuitive energetic healer, offers an even more alternative alternative to neurotoxins that first involves addressing how we feel about ourselves. She believes that wrinkles on the face correlate to specific emotional stresses. “If I have forehead wrinkles, that’s a physical manifestation of worry about how people perceive me,” she says. “I’d do the inner work around that – reprogramming the subconscious mind to fall in unconditional love with myself. The only reason we’re worried about how other people perceive us is because we’re judging ourselves. We don’t think we’re good enough.”
Ninfo believes that she can reverse signs of aging on her clients by helping them increase their sense of positive self-perception. “Self-image healing involves working on how we perceive ourselves and how we believe that other people perceive us. Before we change anything, we’ve got to fall in love with it first. The problem doesn’t go away because it’s not a physical problem. It’s an emotional wound.”
Whatever our level of comfort (and open-mindedness) is when it comes to cosmetic intervention, we have options. The rise in “Notox” and Botox usage tells us that our desire to chase youth isn’t changing – we’re just seeking alternative routes. And whatever your approach, may it make you feel daring, glamorous, and not the least bit shameful.
