New York took the top spot in Avinity Health's newly released "Botox Obsession Index" with a score of 84.1, narrowly ahead of Colorado at 84.0. California, Florida and Massachusetts rounded out the top five states ranked by population-adjusted search demand, provider density and overall interest.

The Scottsdale, Arizona-based medical aesthetics practice analyzed search, provider and interest data across all 50 states, tracking 31 Botox-related search terms. The study recorded roughly 508,000 estimated Botox-related searches a month nationwide.

What does "jaw Botox" actually mean?

Masseter Botox — neurotoxin injections into the masseter muscle — pulled an estimated 74,020 monthly searches. That makes it the second-most-searched term among the 31 the study tracked.

The treatment can slim the lower face and ease clenching and grinding. Using neurotoxins in the masseter is an off-label application in the U.S. Because "Botox" functions as shorthand for all neurotoxins, the search terms may reflect interest in several brands — Xeomin, Daxxify, Dysport and Jeuveau.

Where does demand outpace supply?

The states searching hardest are not always the states with the most providers. "Attention and access do not sit in the same places," said Emily Dawson, DHA, MBA, MSN, RN, co-founder and clinical director of Avinity Health.

Search demand outpaces provider density most in New York, Virginia, Illinois, Washington, Texas and Minnesota. Provider density outpaces demand most in Florida, Idaho, Arizona, Colorado, New Hampshire and Montana.

Does income predict interest?

Not as cleanly as one might expect. Maryland has the third-highest median household income in the country but ranks 18th on the index. Alaska ranks 11th for income but 41st on the index. Florida lands fourth overall despite a below-median household income.

What does the regional split look like?

Nine of the top 10 states sit in the West or Northeast. Florida is the only exception. No Midwestern state made the top 10. North Dakota, South Dakota, Indiana and Iowa landed in the bottom 10, alongside Arkansas, West Virginia and Mississippi, which came in last.

New York's per-resident search rate ran 2.3 times Mississippi's.

How was the index calculated?

Each state's score weighs 50 percent on estimated monthly Google searches across 31 Botox-related terms per resident. Another 35 percent is provider and clinic density, drawn from the NPPES clinician registry and mapped aesthetic clinic locations. The remaining 15 percent comes from Google Trends interest over the past 12 months.

The data was collected in August 2026 and adjusted using U.S. Census Bureau population estimates. Washington, DC, was measured but not ranked.

What does the index actually measure?

The study measures interest and market presence, not procedures performed or money spent. "Colorado beating California is only visible because we divided everything by population before ranking anything," Dawson said. The most "obsessed" states are the ones searching for Botox most — not necessarily the ones receiving the most injections.

With roughly 74,020 monthly searches and provider supply still trailing in coastal metros, masseter neurotoxin looks set to keep its off-label audience expanding through the rest of 2026 and beyond.