Joelle O’Connor, a healthcare executive in New York City, had her first Botox treatment at 24. “My aunt had a facelift and my mom didn’t have the greatest skin, so I asked my dermatologist, what can I do?” she recalls. After that first visit, she continued to go back to for Botox injections every three or four months.
Flash forward a decade, and O’Connor, now 35, says she’s thrilled with the results. “I always say to my husband, 'look at everyone’s girlfriends and wives and mistresses,'” she says. “I look 10 times better.”
She adds that she thinks of Botox as akin to eating right or exercising. “If you care about whole-body wellness," she says, "that includes your face."
At first blush, the idea that a fresh-faced, 20-something would consider paying a doctor to inject her face with botulinum toxin (Botox) may seem surprising—if not downright unnecessary. But dispensing with any knee-jerk scoffing or vanity shaming, dermatologists say the practice of “preventative Botox” actually makes sense and is rapidly gaining steam.
“If you asked me 10 years ago, I’d say 'I never do this,'” says David Goldberg, a clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai and director of Skin Laser & Surgery Specialists of New York and New Jersey. “Five years ago, maybe I’d do it once in a blue moon. But now it’s all the time.”
Goldberg says there’s no clinical data to support the practice of preventative Botox, but based on his knowledge of how wrinkles form, it may be more effective than Botox injections later in life.
He explains that there are two types of wrinkles: static and hyperkinetic. “The static wrinkles are there all the time, and the hyperkinetic wrinkles appear when you frown, move your eyebrows, etcetera,” he says. Over time, those hyperkinetic wrinkles tend to become static ones. “In your 20s, you might have crow’s feet when you smile, but eventually, even when you’re not smiling, those lines will still be there,” he says.
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This is where Botox comes in. Once injected beneath the skin, Botox paralyzes the muscles of the face, which partly or completely prevents those hyperkinetic wrinkles from forming. While this can mildly reduce the appearance of existing static wrinkles, it could also slow their formation, Goldberg says. “I tell my older patients that the goal of Botox is to stop wrinkles from getting worse,” he adds. “We can make [static wrinkles] a little better, but we can’t remove them once they’re there.”
“Think of [the skin] like a leather jacket,” says Adam Friedman, an associate professor of dermatology at George Washington University. “The more you wear it and move around in it, the more lines will develop.” Botox injections are kind of like putting a leather jacket on a mannequin; if there’s no movement, the jacket won’t develop elbow crinkles and creases. “Same thing goes for the skin,” Friedman says. “Decreased muscle action prevents wrinkles.”
Of course, muscle action isn’t the only thing that causes the skin to age. Friedman says sun exposure, pollution, genetics, and bad habits like smoking can all contribute to the development of wrinkles. If a young person is thinking about Botox injections but isn’t also keeping their face protected from the sun, then it’s “not really worth it,” he says.
Another big sticking point: Since it’s impossible to know what a person would have looked like had they not had Botox, it’s tough to gauge the size or significance of the benefit a patient may derive from preventative injections—or if there’s any benefit at all. “In terms of being effective, there have not been any studies conducted showing that if Botox is administered in a person’s 20s or 30s, it will prevent wrinkles,” says Paul Yamauchi, a clinical assistant professor of medicine at UCLA’s Geffen School of Medicine. “But, intuitively, it should work,” he adds.
While he offers preventative Botox at his private clinic, Yamauchi says the practice is not universally accepted or practiced by dermatologists. (“It’s controversial,” he says.) When asked about side effects or risks, he mentions the potential for headaches, swelling, or bruising in the week following injections. Botox is also an allergen, and can (in rare cases) cause anaphylaxis or other allergic reactions.
Of course, there’s always the risk of a botched job. “If not properly done, you can have drooping of the eyelids, or you can lose the natural arch in the eyebrows,” Yamauchi says, referring to the notorious “frozen” or “Frankenstein” effects linked to bad Botox. (These side effects usually aren’t permanent since Botox tends to wear off after a few months.)
But as for long-term risks, Yamauchi says Botox is safe. “We have patients who’ve had regular injections for 10 or 15 years, and so far there haven’t been any long-term safety issues,” he says.
So who’s a candidate for preventative Botox? When people in their 20s or 30s ask him about it, Goldberg says he tells them to look at their parents. If mom or dad has developed “pretty broad forehead lines or significant crow's feet” by their 50s or early 60s—assuming it's not from excessive tanning, smoking, or other controllable factors—that’s a situation where he would recommend preventative Botox. “An ounce of prevention is worth a pound of cure, and it can be less expensive than waiting because you won’t have to do it so much,” he adds.
How much is Botox, exactly? Anywhere from $250 to $750 per visit—and insurance companies almost certainly won’t cover it for cosmetic purposes, he says. Also, he recommends young people who want to do this have injections every six to eight months.
If you’re 25 or 30 and wondering whether preventative Botox will change your appearance in the short-term, the answer is yes—though ideally, not by much. “I want some expression and some degree of movement,” Yamauchi says, mentioning that some of his clients are actors, and so being able to emote is rather important to them. “I really just want to prevent those deep furrows.”
Goldberg agrees. “If done correctly, the goal is not to get a perfect result with no lines, because that’s more apparent,” he says. Instead, he says he’s looking to mitigate those movement-induced wrinkles in order to slow the formation of deeper static lines.
“The leap of faith,” he says, “is that the [number of] static lines will be reduced over time.”
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