Will getting Botox in your 20s and 30s prevent future wrinkles?

In 2020, more than 800,000 Botox procedures were carried out on Americans in their 30s. Photo / Sam Moqadam, Unsplash

In this Times beauty Q&A, experts talk about the pros and cons of starting Botox young.

Q: Will Botox injections in my 20s or 30s mean smoother skin and fewer wrinkles down the line?

A: While the majority of 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.

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 Americans in their 30s, which was approximately 18 per cent 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.

While 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 Dr Shereene Idriss, a dermatologist and the founder of Idriss Dermatology in New York City.

We talked to more than a dozen experts to find out whether "preventative 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, the director of the Dermatology Laser & Cosmetic Center and the 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, Dr Idriss said, is essential. "That's what makes you you."

And even though the neurotoxin wears off in about three to four months, some doctors say it is delaying the natural aging process.

"If I'm starting at 25, and I use it until I'm 40, then I've saved all of those years of not getting the wrinkles," said Dr Patricia Wexler, the founder of Wexler Dermatology in New York City. "So if you stop using the Botox at 45 or 50, you have a new baseline. You're going to get wrinkles at that point, but they're not going to be what you would have had."

What's the evidence?

Most dermatologists agree that Botox is a safe and reliable treatment. 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 preventative Botox. One 2006 study looked at identical twins, just two people, over 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, aged 30 to 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.

But several dermatologists pointed out the negative effects of pausing treatment.

Dr Loretta Ciraldo, the founder of Dr Loretta skincare who has practised dermatology for over 40 years, spoke of patients who had used Botox for decades, and then took a break. When they returned to her office, she said, "it did not help whatsoever. Once it wore off, it wore off."

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.

Dr Berkowitz, the 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", Dr Berkowitz said, adding, "This wrinkle-free, ageless face becomes totally normalised. 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.

"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.

And few women in their 20s and 30s have deep, static lines, which means they have little use for the so-called preventative injections. If you're considering Botox in your 30s, seek a dermatologist who will talk to you about why you want the treatment. Sometimes, dermatologists will suggest patients wait.

Dr David A. Colbert, the co-founder and head physician of the New York Dermatology Group, said he worries that some patients have internalised damaging messages about aging and beauty.

"It's a pretty toxic, heavy message," he said. "People don't even really analyse it any more. They're just like: 'I can't get too many wrinkles or I just will look awful.'"

Written by: Amelia Nierenberg
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