Pros and cons of ‘preventative Botox’

While the average patient starts Botox at age 40, Gillian, now 35, received her first Botox treatment at age 30. “I knew I was interested in Botox by my late twenties, but I hesitated to get it before my wedding, at age 29, because of the advice not to do anything drastic to your appearance before the big day,” she tells Fortune. “Now I wish I would have gone for it. The Botox I get is very subtle and understated and really freshens up my face.”

According to the American Society of Plastic Surgeons, Botox procedures for people ages 20 through 29 have increased by 28% since 2010, perhaps due to the rise of social media and Zoom calls though there’s been no definitive research in this area yet. Weighing the pros and cons of receiving Botox is an essential step for the four million Americans who receive these procedures each year. 

For Gillian, the potential side effects of the treatment and the cost were her two main concerns. “I was nervous about drooping, but haven’t experienced that and am told it’s fairly rare,” she says.  A single unit of Botox costs $10 to $15, with the average treatment consisting of 30 to 40 units. 

Still, since receiving her first Botox treatment at age 30, Gillian has received three injections per year, only pausing her procedures during her two pregnancies. (The FDA recommends pausing Botox treatments while pregnant unless “the potential benefit justifies the potential risk to the fetus,” which include miscarriage, malformation, and, for the mother, botulism.)

“Obviously, the cost is a downside I had to factor in, but ultimately it feels like it’s worth it as an investment in keeping frown lines and crow’s feet at bay,” Gillian says. 

What is preventative botox?

Botox is a neurotoxin that blocks the release of the neurotransmitter acetylcholine, thereby decreasing the muscle’s ability to contract. “When done artfully, Botox can decrease the muscle’s ability to contract rather than completely block or paralyze the muscle,” explains Dr. Kenneth Mark, a cosmetic dermatologist with practices in New York and Colorado. This can reduce the appearance of wrinkles and lines, such as the ones that crop up on the forehead or around your smile. 

“Preventative” botox is a slippery term in the medical community, and many experts refuse to use it altogether. “Preventative Botox involves using Botox injections before wrinkles and fine lines become deeply etched into the skin,” explains New York- and California-based dermatologist Dr. Karyn Grossman. “Regular Botox typically addresses existing lines and wrinkles. Preventative Botox can be advantageous as it helps to relax the facial muscles that cause these lines, potentially delaying their formation.” 

Once dynamic wrinkles, or wrinkles caused by repetitive facial expressions, are formed, it can be difficult to reduce their appearance. That said, how old you are isn’t always an indication of how many lines and wrinkles you have. 

“Rather than ‘preventative’ botox, I prefer to use Botox when it is most appropriate and not just considering age,” says Mark. “For instance, you can have an 18-year-old who grew up in the sun and was constantly squinting their eyes and scrunching their eyebrows. In that case you can forget about ‘preventative’ Botox.” On the other hand, he adds, you may have a 40-year-old patient with zero wrinkles. “Rather than preventative Botox,” he notes, “the saying should be ‘preventative and appropriate’ Botox.”

In other words: The decision to get Botox should depend less on how old you are and more on the appearance of your skin and your feelings about how much it matters. 

Potential side effects of getting preventative Botox at a young age

“There are no long-term health concerns with Botox, as it has been FDA-approved for cosmetic reasons for over 20 years,” Mark says. 

No studies have indicated a long-term negative effect of Botox, though there are possible side effects to be aware of: Swelling, pain, and bruising at the injection site, headache and flu symptoms, droopy eyelids, crooked eyebrows, watery or dry eyes, and infections are all rare but potential side effects of Botox. It’s also possible for the toxin to spread to unintended parts of the body, causing toxic botulism which could lead to vision problems, muscle weakness, breathing problems, trouble talking or swallowing, an allergic reaction, or bladder issues, according to the Mayo Clinic as well as Botox’s own label insert. 

Also noted as risks on the product’s label include anaphylaxis (allergic reaction), breathing or swallowing difficulties, corneal exposure or ulceration due to less blinking, and transmission of viral diseases from the ingredient albumin (extremely low risk).

More research is needed to fully understand the long-term effects of these treatments. 

Is Botox right for you? 

First thing’s first: You should always consult a medical doctor if you’re considering receiving Botox. If you have the time and means, a second opinion may also be valuable.

Mark recommends Botox to his patients when fine lines and wrinkles first start to appear. “The advantage of this is if you wait until it’s too late then the wrinkles will be so deep that they cannot fully be corrected with Botox alone,” he says. “Then patients will need filler in addition to the Botox. However, when done consistently, which means every four months for about a year, a patient will experience the full effect or correction from it.” 

Kim has a slightly different approach and doesn’t recommend starting Botox when fine lines and wrinkles first appear. “The FDA indication for botulinum toxin is dynamic rhytides, aka wrinkles with movement,” he says, meaning that the lines of your face disappear when you relax, but appear when you smile or squint. “If a patient comes in with zero movement, I wouldn’t offer toxins. I don’t believe in preventative botulinum toxin [Botox]. I would only treat the patient if they have deep lines and wrinkles with movement.”

These varying approaches to Botox make it important to have an ongoing dialogue with your dermatologist or plastic surgeon. Come to your intro appointment with questions, and remember: This is ultimately your decision. Just keep in mind that there is such a thing as too much, too soon when it comes to Botox. 

“Preventative Botox should be used typically once per year, at low doses, to soften movements,” says Grossman. “If you use it more than this, you may cause muscle atrophy, cause other lines or wrinkles to form, and risk developing tolerance to the toxins over time.”

Gillian’s advice? “I would say [whether or not to get Botox] depends on your priorities. If you don’t care about wrinkles, that’s great! If you’re not a fan of needles, it might make sense to skip. It’s definitely a personal decision,” she says, adding that many of her friends have begun receiving treatments as well. “I’ve also been surprised how many girlfriends my age tell me they’ve gotten it, too, or ask who I see if I share that I’ve gotten it. I think the stigma is less than it used to be, and it’s more normalized and understood that this is something a lot of people are integrating into their cosmetic routine earlier these days.”

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