Will getting Botox now prevent future wrinkles?

Most dermatologists agree that Botox is a safe and reliable treatment — but long-term use has been little studied, and the evidence is overwhelmingly anecdotal. (Photo: NYTimes)
Q: Will Botox injections in my 20s or 30s mean smoother skin and fewer wrinkles down the line?

A: Although most people who use botulinum toxin, the neurotoxic protein known by its brand name Botox, are women over 40, there has been chatter on social media about how starting it when you’re young can help stall the signs of aging — before they even start.اضافة اعلان

The basic premise: If you start using Botox, which freezes wrinkles, when you’re young, you won’t form the grooves people try to “correct” later in life.

In 2020, about 811,000 Botox procedures were performed on people in their 30s, which was approximately 18% of the national total, according to a recent report from the American Society of Plastic Surgeons. This “prejuvenation” trend seems especially persistent on social media, with testimonials from influencers on YouTube and TikTok.

Although most dermatologists agree that this approach works, some worry that patients are making interventions too early, or warn against the long-term financial cost of repeated injections.

“You do it to slow down the aging process, not to stop it,” said Shereene Idriss, a dermatologist and founder of Idriss Dermatology in New York City.

We talked to more than a dozen experts to find out whether “preventive Botox” is a wise investment.

What’s the claim?

Botox limits movement by blocking acetylcholine, the chief neurotransmitter. Over time, the theory goes, a repeat user of Botox weakens her facial muscles, slowing the process in which dynamic lines (those that form when she is making an expression) settle into static lines (those visible when her face is at rest).

“Basically, you’re inhibiting the muscle contractions and decreasing the facial movement,” said Dr. Kristen Broderick, an assistant professor of plastic and reconstructive surgery at Johns Hopkins Medicine. “And then, therefore, you’re preventing or slowing the formation of wrinkles over time.”

Doctors stress that the wrinkles are postponed, not prevented. (“Mother Nature always wins,” said Dr. Mathew Avram, director of the Dermatology Laser & Cosmetic Center and director of dermatologic surgery at Mass General Hospital in Boston.)

Even if you start Botox young, you’re still going to have emotions. Unless you’re frozen solid, you’re going to show those feelings on your face — and eventually wrinkle.

The good news is that doctors are no longer serving up the “Botox-face” — think, eyebrows frozen in perpetual surprise, foreheads unwrinkled but not exactly youthful. Now, dermatologists try to smooth while still allowing for movement.

Movement, Idriss said, is essential. “That’s what makes you you.”

What’s the evidence?

Most dermatologists agree that Botox is safe and reliable. Millions of procedures are performed each year, with almost no reports of serious side effects.

But long-term use has been little studied, and the evidence is overwhelmingly anecdotal. Many dermatologists point to their own smooth foreheads as proof of concept.

“I need very little Botox now,” said Dr. Debra Jaliman, an assistant clinical professor in dermatology at the Icahn School of Medicine at Mount Sinai and the author of the book “Skin Rules,” who said she began injecting herself in 1991. “My muscles have given up.”

There are no large scale clinical or observational studies of preventive Botox. A 2006 study looked at one set of identical twins over the course of 13 years. One received regular Botox injections. The other did not. The researchers found that lines were “not evident in the regularly treated twin” where she had received injections, but did appear in her sister. The untreated areas of both their faces showed “comparable aging.” In a follow-up, when the twins were 44, the twin who received treatments did not have static lines at rest; her sister did.

A 2011 study looked at whether the effects of repeated injections reduce or eliminate forehead wrinkles long term. Every four months, a group of 45 women, ages 30-50, received small amounts of botulinum toxin in their foreheads. Doctors assessed them two years after they began treatment, once the last treatment would have worn off, and found that the neurotoxin significantly reduced their wrinkles.

What if you stop treatment?

You’re not going to reverse your progress if you stop treatment — you’ll just get your full mobility back, slowly creating wrinkles.

The effect of pausing treatment is hard to track, though, since few people stop injections once they begin. Even though botulinum toxin itself does not form chemical dependence, many people become “addicted” to how their face looks, said Dana Berkowitz, an associate professor of sociology at Louisiana State University.

Berkowitz, author of “Botox Nation: Changing the Face of America,” has interviewed dozens of people who used Botox for her book. Only one — a man — had ever paused treatment, she said.

Your face without Botox “looks ugly to you,” Berkowitz said, adding, “This wrinkle-free, ageless face becomes totally normalized. We expect it and then we view that as beautiful.”

Are there downsides to using Botox when you’re young?

Botox is expensive, and repeated procedures add up. The average cost of a treatment is $466, according to the report.

“Neurotoxin injections are a huge cash cow for dermatology offices,” said Valerie Monroe, the former beauty director at O, The Oprah Magazine and the author of a Substack newsletter on beauty.

Alternatives do exist. Many doctors pointed to sunscreen or retinols, which can increase collagen in the skin and work to counteract the visible effects of aging.

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