Would You Instagram Your Botox Appointment?

“You okay, hon?”

The woman who asks me this question, a registered nurse named Adrienne Cuccia, has spent the past half-hour creating tiny wounds on my face with a pen that ends in a cluster of super-fine needles. In other words, she’s microneedling me — a process said to jump-start collagen production and make skin look younger, glowier, and dewier.

This is my first-ever cosmetic treatment, though the room feels designed to make me forget I’m having a medical procedure at all. I’m sitting in an ENT chair, but there’s a gold chandelier on the ceiling, a gold accent chair in the corner, and succulents hanging on the wall.

The experience is new for Cuccia, too. Although she’s been administering treatments like this for over six years, it is one of her first days on the floor at the new Manhattan outpost of Alchemy 43, an aesthetics bar specializing in minimally invasive cosmetic procedures including Botox, facial fillers, and wellness shots.

Alchemy 43 has been called the “Drybar of Botox,” the implication being that you can drop in for an injection as easily as you might stop at Drybar for a blowout. (Drybar’s founder, Ali Webb, is one of Alchemy 43’s investors.) But most of us are pretty comfortable admitting to paying someone to blow-dry our hair. Casual medical procedures, on the other hand, still carry somewhat of a stigma — although Alchemy 43 is trying to change that.

New York has seen a wave of beauty bars opening in recent months, but Alchemy 43 is the most ambitious. Founded in 2016, the company has four locations in Los Angeles (Beverly Hills, West Hollywood, Santa Monica, and Downtown L.A.), and, as of April, one in Flatiron. Bolstered by a recent
$2.5 million round of funding led by Forerunner Ventures — also an early investor in Glossier and Warby Parker — the company plans to add 50 stores across the country in the next six years. Half of its clients are under the age of 35.

Founder-CEO Nicci Levy knows a thing or two about selling cosmetic procedures — she was once the highest-volume sales representative at Allergan, the pharmaceutical giant that manufactures Botox, Juvéderm, and other fillers. I first meet Levy, who is 40 and wears her chestnut hair in long, structured curls, for breakfast at the Smith in Midtown East. She believes her model is viable because the pendulum is swinging so quickly toward injectables becoming just another part of a beauty regimen. “There was a time, even in my lifetime, that was like, ‘You don’t dye your hair blonde — only a slut does that!’ Now, everyone gets highlights. I think that Botox is at that critical turning point, too.”

Though Levy takes some issue with the Drybar comparison — it implies, she says, that the company doesn’t take micro-treatments seriously as medical procedures — she says her goal is to rewrite the narrative: “These treatments were typically framed as, you know, you’re sitting in a medical office,” she says, “next to sick people, next to acne patients, next to surgical patients — and you’re there to look pretty, you know?”

The pursuit of looking pretty — or, rather, the idea there’s no shame in using injectables to help you look pretty — is the overall ethos at Alchemy 43. In its New York flagship, the consultation area is a large communal table (private rooms are available upon request) against a backdrop with a neon cursive sign that reads “BRB … Taking Care of Me.” Treatment rooms have signs that read “All Filled Up” and “No Lines Here.” The store’s bathroom wallpaper features shimmering gold lips — puckered and primed for selfies.

Consultations themselves involve 3-D imaging via health-care-technology company Canfield’s Vectra M3 system, which is often used on rhinoplasty patients to simulate results. The day I visit, after having three photos taken of my face from different angles, I ask to have myself edited to mimic the results of various treatments, including lip enhancement and a jawline contour. The sensation is one of having a selfie FaceTuned by a stranger. (Indeed, on the company’s website, a description for the treatment Finely Tuned reads, “Selfie editing will be a thing of the past with this comprehensive micro-treatment.”)

Injectibles are on the precipice of being just as common as FaceTune. But Levy notes that not everyone is there quite yet: “I have [male] investors that are like, ‘I don’t even tell my wife I invested in this [company] because if she knew about it, she’d come in.’ And I’m like, ‘So what? What if she comes in? You think she’s going to look like a crazy person?’”

On the other end of the spectrum, in both Los Angeles and in Flatiron, Levy says, she’s seen mothers and daughters come in together. The teens, perhaps surprisingly, often come first: “There has been this empowerment of the teen beauty user,” she says. “They come in and get their lips done and they get their cheeks augmented. Two weeks later, they’re bringing Mom in for Botox.”

Alchemy 43’s model makes a clear play for millennials and even older members of Gen Z — and you can see why. According to the American Society of Plastic Surgeons, Botox procedures have increased 39 percent among 20-to-29-year-olds since 2010. Originally, the company experimented with different iterations of a monthly membership, including one that cost $1,200 up front annually — but millennials didn’t bite. “Millennials are scared of credit in a smart way,” Levy says. “If they don’t have it, they don’t spend it.”

The company settled on a $99-per-month program; the money is deposited into an account and can be used at any time toward any treatment. Members receive special pricing and perks throughout the year, but one-off procedures are available. Exact pricing isn’t listed, as treatments are based on an individual client’s needs, but the company does estimate a range for each on its website — for example, a “Perfect Pout” lip enhancement costs approximately $650 to $750. Consultations are always complimentary, even if you choose not to move forward with a procedure.

The company’s branding is equally targeted at the Instagram generation; users are encouraged to share their experiences via the hashtag #A43life, and the company partners with influencers, nicknamed Alchemy Agents, in each market.

This strategy has drawn its fair share of skepticism: “Millennials are young, and they’re looking for cost savings,” says Dr. Melissa Doft, a board-certified plastic surgeon in New York. “To capitalize on that group is awful, don’t you think? You’re not taking somebody who’s been around the block many times, who knows you should be going to a doctor [and that] they should know your medical history [and that] there are risks — you’re taking this young girl who wants her lips to be bigger. And her friend went and so it must be okay. I don’t know if I love that idea.”

There is also the question of safety. Alchemy 43 has one medical director per market — New York, for example, is overseen by Dr. James Chelnis, an oculofacial plastic surgeon — but Levy explains that medical directors are rarely on-site: “They’re not the people who are seeing our patients,” she says. “They’re [a resource] in case of an emergency and for clinical oversight of our injectors.”

Laws about who can inject Botox and fillers vary by state; New York allows physician’s assistants and registered nurses to do so. The risks involved — from ptosis, the drooping or falling of the upper eyelid, to blindness — are a main reason for the argument that injectables should always be performed by a board-certified plastic surgeon instead.

“Even doctors can inject into the wrong place,” acknowledges Doft, “but I think the benefit of having a doctor is that you know what to look for — you have a safety kit in your refrigerator of hyaluronidase, which is something used to dissolve hyaluronic acid [fillers]. You can prescribe medicine to help with ptosis, so you don’t have to just wait it out until the Botox goes away. Everything’s great when there’s no complication, but once there’s a complication, how do you manage that?” (Alchemy 43 stores do have emergency kits to dissolve hyaluronic acid.)

Another question for the company is how it’ll fare in New York. “The look here is very understated,” Doft points out. “It’s very easy to inject a certain volume, but to sculpt the face and to inject it in the right place, to change the shadows — that takes some skill and knowledge of anatomy and doing this a lot. I think the look in L.A. is a little bit bigger — bigger lips, bigger cheeks — and I think it’s easier to attain when you’re a newer injector.”

Levy, however, is confident: “I think [Alchemy 43’s model] is going to be embraced here in New York,” she says, “because people don’t even know that they’re missing it right now.”

Back at Alchemy 43 in Flatiron, Cuccia, the registered nurse, has finished my treatment. I touch my cheek; already my skin feels silky and plump, just as she said it would. She shows me my face in the mirror. I am pink all over, with little red indents in places where I’ve bled. The disparity between look and feel is stark and slightly disconcerting.

On the wall, there are photos of two smiling women and one smiling man. Before my treatment, when Levy gives me a tour of the space, she tells me the pictures represent how Botox should look. I ask which of the Alchemy 43 treatments they’ve had. None, she says.

Cuccia puts moisturizer on my face as a final touch and removes her gloves. As I rise, I ask if she needs anything else from me. “You’re done,” she says, brightly. “Unless you don’t want to be.”