NEW YORK, United States — Among the endless stream of women cuddling their babies in Mother’s Day tributes on Instagram earlier this month, one parent’s post had an unusual message in the caption.
“Talk to your doctor about Botox Cosmetic and whether it’s right for you.”
In addition to several posts about the joys of new motherhood, Cosmopolitan’s Beauty Director Carly Cardellino advised her followers about her “go-to” self-care treatment: Botox, the temporary but irreversible injections that smooth wrinkles. The post was marked as a #ad and accompanied by a lengthy medical disclosure of the sort typically found in magazine advertisements and television commercials. “It is not known if Botox Cosmetic passes into breast milk,” it read in part.
Cardellino is in good company with her endorsement. In February, Heather Muir Maffei, beauty director of Real Simple and Health, posted a similar ad for Botox on Instagram underneath an image of her on a hike. April Franzino, beauty director at Good Housekeeping, Woman's Day, and Prevention magazines, also published a sponsored Botox post, since deleted, showing the editor at a brunch. A person with knowledge of the matter said the payment Botox offered these editors was well above the going rate for sponsored posts for influencers with followings of their size.
Cardellino declined to comment through a representative. Muir and Franzino did not respond to requests for comment. Allergan, the maker of Botox, also declined to comment.
Botox is waging a campaign to maintain its edge in the fast-growing injectables market. The product makes up 70 percent of a more than $1 billion US market, according to Bloomberg, bringing in $907 million for Allergan last year in the facial aesthetics category. The number of wrinkle-reducing procedures in the US increased by 3 percent in 2018, totalling 7.4 million, according to the American Society of Plastic Surgeons. The injections cost patients an average of $397 per session.
But for the first time in 10 years, Botox has a direct competitor in Evolus Inc.’s Jeuveau, which was approved by regulators earlier this year and became available to the public last week.
Instagram, the social media platform of choice for women in their 20s and 30s, who make up one of the fastest growing markets for injectable treatments, is the battleground of choice for both brands.
In January, Allergan launched its #OwnYourLook campaign, hiring influencers like Lo Bosworth (891,000 followers) and Lauren Bushnell (1.2 million followers) to post about Botox. Beauty editors are another front in Allergan’s marketing effort as they carry authority with readers and attract audiences eager to see life behind the scenes at glossy titles.
Evolus is wooing doctors, earlier this month flying plastic surgeons and cosmetic dermatologists to the Ritz Carlton in Cancun for an extravagant celebration that they documented on social media with the hashtag #newtox. One doctor described it as “everything Fyre Fest was supposed to be,” according to the New York Times.
Advertising medical treatments on social media is riskier than pitching lipsticks or handbags. Aside from the usual concerns about influencers including required #ad disclaimers, Botox and Jeuveau require a prescription and aren’t safe for all consumers.
That’s why posts by Cardellino and other editors and influencers must come with lengthy warnings of Botox’s risks. They also include a link to an Allergan Instagram account with full product information, including the federally mandated warning and medication guide.
The doctors traveling for Jeuveau as part of its advisory board were not required to include those warnings because they were not directed or paid to post from Mexico on social media, but rather were compensated for advice about how to launch Jeuveau, said Crystal Muilenburg, Evolus’ vice president of corporate communications and public relations. The company is planning a broader social media and digital marketing strategy this year, as well as a loyalty programme for consumers. (Botox currently has a loyalty programme.)
“People need to be very educated about getting [anti-wrinkle injections] done and should not take it lightly,” said New York dermatologist Dr. Shereene Idriss. She said that while the Instagram advertisements she has seen for Botox have been educational, such posts can make the treatment seem more simple than it is. “[Influencers who are not doctors] are talking about it almost like it’s a haircut,” she said. “Not everybody is a good candidate.”
“We are educating physicians on the scientific information on the product so they can evaluate the safety and efficacy,” Muilenburg said. “Consumers are interested in things that are new, and right now they will be able to talk to their doctor about what’s new.”
Allergan is continuing to spend big on influencer marketing, working with personalities like Bridget Bahl, or @bridget as she goes on by on Instagram, whose content largely features the 36-year-old New Yorker posing around the city or beside a plate of pasta.
She started using Botox when she began her commercial relationship with Allergan about 18 months ago.
“I thought there was going to be some negative backlash,” she said. “There wasn’t at all. I think people appreciated the honesty.”
Bahl made sure to be photographed smiling and laughing to show her followers the treatment didn’t change her appearance too drastically, she said.
While Bahl declined to disclose the details of her relationship with Botox, it is likely a lucrative partnership. In early 2018, a well-known fashion influencer said she was offered seven figures by Allergan to work with Botox but declined, according to a person with knowledge of the proposed deal.
Medical companies typically pay higher than market rates to work with influencers, said James Nord, the chief executive of influencer management platform Fohr.
And follower counts are not the only qualities companies take into account when working with influencers, he said. Beauty editors have an added value.
“These are women who are influential in the industry,” he said. “They are looked at as leaders in their respective space and there is a value to that.”
Magazine beauty editors have long enjoyed perks from brands — from lavish trips to free products and treatments. But they must tread carefully, as readers see their editorial coverage as an objective source for recommendations and education.
While Hearst did not comment on the nature of the partnerships, sources with knowledge of the deals said that Cardellino and Franzino’s were individually negotiated, i.e. not part of a larger advertising deal with the publishers. And editors at the company are discouraged from forming commercial relationships with brands without the company’s approval. Meredith confirmed that Muir Maffei’s post was also not part of a publisher deal.
“Meredith Corporation requires its employees to adhere to a Code of Business and Ethics and to abide by all applicable laws and guidelines, including appropriate disclosures when promoting client products or services,” said a representative for the company.
Still, editors are influencers in their own ways, and readers have different expectations when reading a magazine’s website than they do when viewing the writer’s Instagram feed, said Kathleen Hou, the beauty director at New York Magazine’s The Cut.
“Anyone on Instagram is used to seeing ads at this point,” she said. Hou does not publish ads on her social media accounts and is careful to point out that she did not receive payment for her beauty product recommendations there. “The Instagram user now is pretty savvy. They are very skeptical and people are skeptical of the beauty industry in general.”
Hou also said Botox is a less controversial advertiser because it is an established market leader.
“It’s not like these editors are doing ads for SugarBearHair vitamins,” she said.