Broken Hearts and Botox: A Drag Queen’s Guide to Sustainable Coping Mechanisms

content warning: minor surgical procedures 

My heart had been breaking almost three weeks, the day I decided to experiment with botox and filler. I had slowly realized, through a whirlwind of pain and bewilderment, that I was looking down the barrel of dissolving a four-year friendship. If you’ve ever parted ways with a best friend, you’ll know how it feels: swimming through catastrophe in slow, slow motion. 

That Friday, I awoke to a buzz on my phone.  

“Reminder: 12:00 Bianca Clinic @ Ginza.”  

Oh good lord, I thought. With everything happening, perhaps I shouldn’t go. 

I’d made the appointment a month earlier when I was in a very different place. Jamie, my friend from the ballroom, the brother of my soul, and also my self-appointed “cosmetic enhancements buddy,” had found the Bianca Clinic and sent it my way.  

“They’re doing a special campaign!” he’d trilled. “Their procedures are 50% off if you agree to let them film a testimonial. It’s a steal, luv.” 

Cosmetic procedures. I had warm, if complicated feelings, about cosmetic surgeries and alterations (nips and tucks and injecting cc’s), and felt almost an academic intrigue in the idea of trying a squirt of botox or filler. Compared with the rhinoplasty I’d had years before, which involved peeling off half my face, poking a little botulinum into my forehead seemed quite minor. 

“Really though,” I’d told myself and Jamie at the time, “It’s all about having the right mindset before throwing the money and taking the plunge. You have to be grounded about these decisions, responsible – in the right headspace.” 

Which brings us to the present: as the queen of good decisions dragged themself out of their depression bed to make their clinic booking in time. 

My eyes, I noted in the mirror, were still quite swollen from crying in my roommate’s arms the night before. I groaned.  

What if they take one look and say I’m too ugly to model? I wondered, poking my pillowy eye bags. Well, that would be counter-intuitive – their whole business model is beautification. Maybe they’ll make a gaffe and ask ‘are you here for eyelid lipo?’ 

Riding the train – Oedo Line to Aoyama-Itchome Station, then transferring to the Ginza Line – I stared at my reflection in the black window across the aisle from me and willed my eyelids to drain. Since I live on a subway route, I never get those cinematic window moments you get with an above-ground train – the piano montage as the streets and buildings of Tokyo whip by, growing steadily glitzier and glitzier as I near the Ginza shopping district – but in my mind I could imagine it.  

Instead I thought more about the upcoming clinic visit. I’d felt gleeful and a tad wicked a month ago, but during the awful weeks that followed, I’d forgotten all about it. I’d forgotten to feel excited.  

My train stopped at Ginza station and I hopped off, weaving through the thin midday commuting crowd. It wasn’t hard to find the Bianca Clinic just a few blocks down Ginza’s wide, sparkling clean streets, and I was gorgeously on time to my appointment. One point for Kat. 

The clinic itself made me gasp – I stepped out of the elevator into a glistening, upscale-minimalist lounge. Pale cement walls, tiled floors, recessed lighting. The entire wall to my right was a massive window of striped glass looking out over the Ginza skyline, stretching down the adjoining waiting room. It was surprisingly empty this Friday morning. 

The receptionist, Sonoka, was an extraordinarily beautiful woman, with a creaseless oval face, manicured hair, and natural make-up and lip gloss. I wondered how many clients walked in and thought, God, get me a face like that, please! She steered me to a row of winged arm-chairs angled along the waiting room wall. Already I was feeling far too pampered, a consignment store drag queen sneaking in among the richies. 

About ten minutes later, Sonoka called my name and led me down a labyrinth of featureless, spa-like hallways to a consultation room: more ambient lighting, a desk with two chairs, a computer, and a massive mirror. We took seats, our eerie mood-lit faces reflected back at us like dark twins. 

“I’ll be completing your intake form,” she said, switching suddenly to English and making me jump. 

“Sweet Jesus – I wish I hadn’t been struggling in Japanese all this time,” I said and she giggled.  

We quickly reviewed my medical history, that I wasn’t taking medication, and that I definitely wasn’t pregnant. Not unless it’s Jesus or the Anti-Christ, I thought dryly. 

Next, Sonoka offered me a magnified hand mirror from the desk. 

“Please take a look and tell me what procedures you’d be interested in today.” 

The lighting was not so generous, but my eyes were not bad, I was happy to see – gravity had pulled fluid out of my lids at last. 

“Well… to be honest, I’m fine with my face,” I began. “I take pretty good care of myself, as far as sun protection and retinol cream go. And I do clay masks, gentle exfoliators, that sort of thing.”  

You have to if you spend weekends caked in two-millimeters of powder-set greasepaint.  

“Mainly, I’m thinking about the future and that I want to continue to age well, and I heard that baby-botox is a good way to prevent lines from forming.” I peered closely at my reflection, my familiar face looking back at me with curiosity. “The only place I’ve started to notice I’m showing my age is these deepening lines, here and here.” 

“Your smile lines,” Sonoka confirmed. “I think you’ve been taking care of your skin very well. You look really beautiful! But I think the doctor can give you a consultation about your concerns.” 

She excused herself. I immediately took out my phone and started texting Jamie. 

I’m at the Bianca Clinic now, I reported. Wtffffff, this place is amazing. 

Bitch, I told you, he texted back. Isn’t the clinic beautiful? And so cheapppp. 

Well, cheap was relative, but anyone’s nostrils flare at 50% deals. 

What a swanky place. The real Ginza experience, I typed. 

A few minutes later Sonoka returned with a handsome baby-faced doctor named Dr. Saiga – a real Doogie Howser. Naturally, my first thought was the doctor had been a patient of his own craft, but a quick internet stalking later told me he was, in fact, a very young twenty-something doctor. God, I hate when people are real. 

A male staff member came in soon afterward and started filming – this was, I supposed, the beginning of the modeling campaign. 

“It’s nice to meet you, Mx. Joplin,” Dr. Saiga said in Japanese, Sonoka hovering behind us in case we needed interpreting. “So I’ve heard you’re here to try out a few of our services. Botox, right?” 

“Yes, botox,” I said. 

“So our standard botox for preventing wrinkles will be 12 units, injected here, here, and here,” he said, snapping on gloves and then lightly touching my forehead in the mirror. He went on about the type of botox – Allergan Botox Vista – and different assurances about its quality and reliability and that it wouldn’t flatline me like an unfortunate of the Spanish-American war.  

“As it freezes your muscles, it’ll reduce the appearance of fine lines and wrinkles. Some people also get it injected around their jaw, as the freezing effects of botox will tighten and shape some areas as they sag. It will be absorbed by your body in about three to four months, after which all the effects will disappear.” 

I nodded. This was all very in line with what I’d read, and what cosmetics enthusiasts like Jamie had told me.  

“I also hear you are concerned about the appearance of your smile lines,” Dr. Saiga continued, indicating the faint lines forming to either side of my nose. “To reduce these lines, we would use filler – 1 cc of firm hyaluronic acid above the sunken area in the nasal wing area here, and here.” He touched a spot on my cheek above the target area, where the flesh sunk just a little.  

“It is extremely subtle but would serve to tighten these areas and balance the appearance. It’s a very common procedure, and we have one of the highest success rates.” 

“I think even with the campaign, the filler will be a little out of my budget,” I said with a sigh. I’d discussed pricing and budgets on Instagram messenger with Sonoka in the weeks before. 

“That’s perfectly okay,” Dr. Saiga said. “Even with just botox, I believe you will be satisfied.” He excused himself, and a few minutes later Sonoka returned with an iPad of digital price sheets and contracts. 

“Here is the price sheet and signature form for the botox, with the campaign discount applied,” she sang happily. Only 16,000 yen! I was picking my jaw off the floor. Especially in Ginza, this was a steal.  

“And here is one for the filler. I took the liberty of calculating the cost, now that Dr. Saiga has examined you, and making a price sheet as well. It is a bit more expensive, but…” 

“Oh, you’re trying to sell me!” I said.  

Sonoka laughed loudly. “I think it really is a good deal, especially with the campaign. Our clients all really love the filler to fix the smile lines.” 

“It is really, really tempting,” I said, flicking through the sheets. “And – oh! It’s not that expensive.” It was about 55,000 yen. The total for both botox and filler was around $575 when converted to USD. My eyes were getting wider. 

It was a rare chance, a very good deal. But it was still quite a bit of money, even with all the long hours at my company, article commissions, and drag show tips I’d been saving. It was also, I mulled, probably a terrible time for me to be making major financial decisions. 

“I’ll do it!” I cried, slapping my hand on the table. Sonoka burst out laughing again. I was definitely her favorite client for the day. 

“I’ve actually been wanting to have the filler for my smile lines, too,” she said. “I haven’t had anything yet.” 

“But you’re so pretty!” I gasped.  

“No... No...” She chuckled. “Just something small.” 

It turned out she had been working at Bianca for five months; starting at six months, she would be getting hefty staff discounts. Already, she said, she had received some free skin treatments when the nurses and technicians needed to practice their laser skills. Much like in Repo! The Genetic Opera or The Angry Princess in Thirteen Ghosts, I felt there was something tragically dystopian about the beautiful girl working at a plastic surgery clinic, saving up for her own treatments. 

Well, I texted Jamie. Just kidding, I will get some filler. Second, Sonoka said they’re throwing in a complementary laser skin treatment since I’m getting a bigger procedure done. 

All told, I’d calculated I was saving some 180,000 yen ($1,226) thanks to the campaign and the skin treatment lagniappe. I was in love with Bianca Clinic. They’d got me good. 

Jamie was ecstatic. I felt bizarrely elated. Giddy, numb like the lidocaine had already been injected. A sublime feeling, like an angel had come down to bless me with cheap cosmetology, a divine voice saying, “You are good, my child, you will be well. Do try some filler.” It was a loony way to feel, but then the whole last month had not been normal. 

Jesus, who even am I, I gushed to Jamie. A Hollywood starlet? Princess Di? Now I can see why people get addicted to this expensive self-care stuff. 

Sounds like you needed some rich person self-love today, Jamie wrote back. 

For the first time in weeks, I laughed to myself in the empty room. 

Sonoka returned and gave me several long informational PDFs about the botox, lidocaine, and hyaluronic acid filler they’d be using. The pain from the injections would be “tolerable.” I’d have some swelling and achiness for twenty-four to forty-eight hours. Make-up should be just fine – a relief as I realized I’d be getting in drag the following day. With all the documents signed and the payment complete, Sonoka and Dr. Saiga steered me into a photography room where they took photographs and videos of my face at different angles, making different expressions (smiles, frowns, looks of surprise).  

Into the procedural room itself, where there were brighter lights and more big mirrors. A white leather chair, like the ritzy version of the kind you’d find at the dentist’s, stood in the middle. I sat down and a nurse tucked a soft throw around my legs. I was amazed that this was all happening on the same day. My previous experiences with Japanese clinics and hospitals had made me think everything took days of consultations and bureaucracy, but not for botox and fillers, I guess. 

The same staff member with a camera came in. 

“We’ll film the testimonial now,” Sonoka said. “Please tell the camera why you chose to come to Bianca Clinic, and why you were interested in these procedures.” 

I smiled into the lens. 

I wasn’t sure what I was trying to buy. This was actually the biggest mystery, more mysterious than you’d think for botox. I didn’t care much about those buzzwords surrounding the industry, “tightening,” “smoothing,” “erasing.” 

At thirty, I was aging well. I had lost some of the babyfaced roundness of my early twenties, but a lifetime of sun protection and sun avoidance had paid off, as well as the thick, resilient skin I’d inherited from the Vietnamese side of my blood. On a typical day, I didn’t sit around obsessing over faint lines and wrinkles. 

That said, with drag, I had become more mindful that these signs would increase over the years. Long hours spent staring at my reflection, seeing the transition from patchy, irregular normal skin to gleaming featureless foundation. You can see how porous your skin is with every swipe of pan-stick, see all the lumps and divots like the pockets in a toad’s back. It’s hard not to develop a little bit of a complex about your skin and face when you spend three hours at a time sculpting and beating it. And there are always photos, at all angles and in all types of lighting. No one loves a photo like a drag queen, but still – if an imperfection’s there, an off-photo will catch it. That’s when I’d started to dislike how the slick, painted skin caught the light and dimpled on either side of my nose, how small grooves and cracks formed as the hours of the night went by.  

Drag culture fixates on youth, a byproduct of its worship of beauty and glamor in general. I’d started performing when I was about twenty-six, and sometimes that feels piteously late in the game. There are always younger and younger queens debuting with more limber bodies, fancier tricks and acrobatics. You envy the ones who became interested in drag in their teens, when they could easily learn to dance, do gymnastics, or sing. And we all want smoother, plumper, prettier canvases to paint on, to add a little extra zhuzh to a beat. 

“Oh dahling,” says one. “When I go back to Korea I’m getting my whole face done. Next time I see you my face will be like this.” She mimes a frozen, Barbara-Walters-like mug. “In Korea one injection is the equivalent of 1000 yen. It’s wicked cheap.” 

Another queen in boy-mode prances in, lips pursed. 

“Bitch!” we all cry. “You got lip filler!” 

For some of us it’s for the drag aesthetic, for others it’s for gender dysphoria. I’ve known a few girls who got face feminization after they came out as trans – and afterward, they just glowed, like a candle had been lit inside of them. Gorgeous, happy girls.  

I can’t blame anyone for doing what makes them happy, if it truly, deeply makes them happy. I had the good fortune of getting my rhinoplasty done too, years and years ago, when I had my chance, and in the coming years I think I’d do surgery again (a tasteful face lift, perhaps – God I hope I’m rich). But I am quite harshly critical of the capitalist culture surrounding these markets and how it inflames and then preys on our insecurities, self-consciousness, Peter Pan Syndromes. Nose and mouth “finger tests,” hip dips, thinspiration blogs; all just farms for unhappiness – and unhappiness sells high. 

So why am I getting my forehead frozen and my cheek bones puffed? There is certainly a small element of societally programmed body dysmorphia that’s wiggled its way in. It is a small element, but it’s there. 

Looking into the camera lens, I turned on ‘powerpoint presenter Kat.’ 

“Cosmetically,” I said, “I’m interested in preventing the development of further lines and wrinkles as I get older and to reduce the appearance of my smile lines. But I’m also interested in experimenting with new things, and having never had botox or filler before, I wanted to take advantage of this campaign and give it a try.”  

Sonoka nodded and silently golf-clapped like a proud mother at a speech contest. 

Dr. Saiga and several nurses came in, now with masks and glasses on. One nurse handed me two purple foam balls – like giant grapes – for either hand.  

“Squeeze them if you have any pain or tension,” she said. 

Dr. Saiga raised and reclined my chair and I closed my eyes.  

“This will be a little cold,” he apologized, swiping several spots of my forehead with an alcohol wipe. With the tip of his pencil, he began marking injection points on my skin.  

“Scrunch your eyebrows, please,” he said, and I frowned deeply. He marked three points across the mountain range of my brow. “Okay, relax.” 

A nurse began to rhythmically pat my shoulder, as if keeping seconds. Another nurse placed a small metal device on my forehead and it began to buzz and vibrate loudly, a tool to ease the pain of facial injections. 

“Here we go,” Dr. Saiga said. “You’ll feel just a little prick…” 

It was like five mosquitos biting me at once, up on the side of my forehead near my hairline. It wasn’t too painful, and over in seconds.  

“Moving to the other side now.” 

The hand kept patting my shoulder. Thump, thump, thump. It was incredibly reassuring. 

The vibrating device moved to the other side of my forehead and went buzzing away. 

A second injection of the botox. Not pleasant but “tolerable,” just as the informational document had said.  

Now down between the eyebrows. 

“This will hurt just a bit more,” Dr. Saiga said. “Thank you for your cooperation.” 

The vibrating tool buzzed against the bridge of my nose, making my teeth chatter. The needle went in – a burst of pain, like giant tweezers pinching my skin and grinding it to pulp. I clenched the purple ball in my right hand and tears budded under my eyelids. 

Thump, thump, thump.  

“Just two more,” Dr. Saiga said in a soothing voice.  

The second time was about as bad as the previous one, the needle threading through my muscles as I stretched my foot and leg reflexively. It made sense when I thought about it that there would be more nerves around the eyebrows; plucking used to make me tear up and sneeze. 

Thump, thump, thump. I decided I was in love with the shoulder-patting nurse. 

“Last injection,” Dr. Saiga said happily.  

Perhaps because it was the last, it was the least painful. Or I had finally gotten used to it. I heaved a sigh and let my hand relax its grip on the purple foam ball. 

“Botox done!” the doctor said, and the nurse gave my shoulder a comforting squeeze. “Are you okay? We’ll move on to the filler next.” 

So why was I interested in these procedures? Beyond the academic, of course – the will to study other humans and their longings. Youth and beauty and being wanted are the most poignant longings. I find some plastic surgery almost mystically alluring in a way that’s deeper than the skin. Amanda Lepore, for example, dazzles me – her face and body tell a story about searching for immortality. 

But for me, it wasn’t really physical attractiveness that I was after. I liked how I looked, generally. In a healthy, normal person way. Like Amanda, I like the strange and outrageous too sometimes, but I discovered that I could just use makeup and prosthetics to shape-shift into somebody else, whenever I wanted. 

I wasn’t trying to buy youth exactly either. I’d reached the most wonderful stage of my life so far. Still relatively young, but also at a point where I could be proud of how far I’d come, where my life had led me. I didn’t mind telling people I was thirty; on the contrary, I enjoyed it, and hoped I would never stop enjoying it no matter what decade I reached.  

The only times I hadn’t felt good about aging were when I’d felt I was falling behind. There had been a period in my mid-twenties when I’d felt terribly self-conscious. Peers from undergrad were posting about their MAs and PhDs on Facebook. Others were climbing career ladders, marrying, winning awards and beauty pageants, or just traveling on dream vacations to distant locales I knew I’d be terrified to visit on my own. I’d wondered if I’d failed somehow at becoming a fully-fledged, fully realized adult. My life, moving to Japan, had never been normal, but I felt at that time I hadn’t been reaching my personal goals either. I’d felt like a fuck-up. 

So much had changed in only a couple years. Building a solid base as a drag queen. Joining a major ballroom house. Graduating with my Master’s. Finding a day job I loved where I could be openly queer and dress how I wanted. Having rewarding, funny interactions with my students every day. Friendships, lasting friendships. Writing. There were so many things I’d achieved in my life to make me smile, the change of the decade hadn’t frightened me. I hoped I would never again be afraid of aging. 

Filler perhaps scared me more than botox, which merely freezes and tightens your features in place. I worried about how filler might change the actual physical contours of my face, however subtly. I’d seen outlandish and even avant-garde filler jobs on people, and just a tiny part of me wondered if too much would have changed when I looked in the mirror. 

The nurse who’d been patting my shoulder moved down to patting my arm to give Dr. Saiga room. I still felt tense after the frown line botox.  

“For this, we’ll inject the lidocaine first. It’ll pinch for just a moment and then it’ll go numb.” 

He wasn’t kidding. I’d never had dental procedures requiring lidocaine, so it was another first for me, but the discomfort evaporated in moments. Once both sides of my face were numb, he moved to inject the filler. The tapping on my arm resumed. 

“Just a few more seconds,” he said. 

Because of the lidocaine I couldn’t really feel the injection apart from a faint poke – instead, I was much more conscious of how long the needle was as it traveled from the spot near the corner of my mouth up to the trough of my smile line, and how hard Dr. Saiga’s finger was pressing on the syringe’s plunger. No pain, but a faint feeling of pressure.  

He finished and moved to the other side. 

“Last one, Mx. Joplin! We’re almost done.” 

I relaxed. Worse than the pain had been the anticipation, the not-knowing. 

Dr. Saiga finished his administration and everyone in the room eased and straightened. 

“Good work,” he told me. “You did very well. Take a look in the mirror and tell me what you think.” 

I think it’s actually the illusion of turning back the clock that I wanted to buy. I didn’t want more youth, I wanted to buy back time itself. 

In that moment – deeply, terribly – I was grieving the years, the moments, the acts and the words that had been rendered null in just three weeks. I won’t write here why a friendship that mattered so much to me had ended, why someone I’d cared for had made me feel so unloved. But as is the case when a longstanding relationship ends, it leaves in its wake a hollowness. My identity felt unhoused. For years I had thought of myself as “so-and-so’s friend,” “so-and-so’s champion,” “someone whom so-and-so loves.” Now I was just Kat.  

And a part of me felt that I had lost years: time I’d thought I was experiencing something profound, thought I was building a palace that would last a lifetime – only to realize, all along, I was laying my stones on marsh and sand, for it to be swept away in a moment. 

In spite of everything, I told myself, it was still meaningful. Everything is meaningful in its own way. Pain, too. Pain means that you are alive, that you are human, that you have a soul that can yearn and splinter and heal. And while I often wish I were not always such a bundle of raw, unfiltered feeling, I also know the day I go numb is the day I’ll have stopped being me.  

I will always, always choose to be someone who cared too much than cared too little. 

I sat up and Dr. Saiga and Sonoka and the nurses clapped, someone whisking the soft blanket from around my legs.  

My face felt weird due to the lidocaine – a warm numbness that made me feel like my nose and cheeks were protruding abnormally, like I was a Who from How The Grinch Stole Christmas. But the face I saw in the mirror didn’t look too different from the one I’d walked in with – just a bit redder around the forehead, maybe a little smoother in the smile lines. My own, familiar, perfectly fine face. 

Sonoka squealed, “Wow! You definitely look younger!” 

I smiled and said, “I look great.” 

One filmed post-procedure testimony later, Sonoka bowed me out of the Bianca Clinic.  

“We’ll talk soon, on Instagram!” she said. “We’ll schedule you for the complementary skin treatment!” 

“Can’t wait,” I beamed.  

Outside of the building, on the streets of Ginza, I opened my phone to a long voice message from Jamie. 

“Hey, so I just saw your story – you know, about how you’ve been crying on the train all week, and I’m sorry I didn’t see it sooner. I know you told me you’ve got some stuff going on. Anyway, I’m just sending this message to let you know I love you and I’m here for you, and we’re going to talk about it tonight. I’ll just be there to listen to you and give you some love. 

“Anyway, yeah, just wanted to say that because it made me really, really, really, really want to be there for you. Umm… and if all else fails, at least you’re going to look sickening!” 

I felt a small glow as I descended back down into the subway station, shifting from one foot to the other as the train arrived. I looked again at my reflection in the dark window: beneath the lidocaine numbness, my features blurred. 

I massaged away a few more tears that were forming in my eyes – Jesus, I’d cried more in a week than I had in the last decade – and smiled a little, looking down at the message recording. I wanted to give Jamie a long, warm hug. My friend, my brother. I was lucky to have such a large and wonderful family, an endless gallery of beautiful faces. Beautiful, beautiful people. All the people who loved me, who were waiting for me to come home. 

By Kat Joplin 

Le Horla 📷: @angel.heart.queen 

Bio: Kat Joplin (they/them) is a writer and journalist based in Tokyo. Their work explores queer sexuality and gender, as well as themes of foreignness and belonging. They have written articles for platforms such as GAY TIMES, Tokyo Weekender, and The Japan Times; have published creative fiction and nonfiction pieces with Beestung, Bloodletter Magazine, and The Examined Life Journal; and in 2024 was a contributing author for the book Planet Drag by Quarto Publishing (UK). As a drag queen, they perform internationally under the name Le Horla. Follow Kat at: 

Instagram: @kat_dearu / Bluesky: @katjoplin