With thick, wavy hair and glowing skin, Jill* looks even younger than her 25 years. But two pesky lines, furrowed deep into her forehead thanks to a brow-raising habit, had bothered her since college. "I eventually became obsessed with the concept of getting Botox to stop raising my eyebrows," she recalls. At 24, Jill got Botox as a preventative measure to keep the lines from getting worse.
We know what you may be thinking. Botox? At 24? The cosmetic procedure, first approved by the FDA in 1991, brings to mind older women obsessed with youth and reality stars with freaky, frozen faces. Plus, it’s technically a toxin that's injected with a needle. It just doesn’t sound like something tons of 20-somethings would seek out—right?
But Jill is hardly alone. In 2015, more than 6.7 million Botox procedures were performed, according to the American Society of Plastic Surgeons, making it the most common minimally invasive cosmetic procedure, with fillers a distant second.
And among those opting in, not all fit the preconceived demo. According a 2014 report, about 411,000 of those procedures were performed on men (a trend some have coined "brotox"), while about 100,000 were performed on people aged 20 to 29, a six percent increase from 2013. And in 2015, 64 percent of plastic surgeons saw an increase in young people under age 30 getting aesthetic procedures like Botox, reports the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
This surge of popularity isn’t slowing down any time soon. As Edwin Williams, M.D., president of the AAFPRS, stated in a press release, “We expect the demand for facial cosmetic procedures to continue to expand.”
Frozen in Time: How Botox Works
Before we get into why, let’s talk about how. Botox is a prescription drug known as a neurotoxin that’s injected into facial muscles and temporarily reduces the appearance of lines around the eyes, mouth, and on the forehead. (Note: Botox is a trademarked name, and it goes by other brand names, such as Dysport and Xeomin, as well.)
“It temporarily interrupts the connection between nerves and muscles—it actually paralyzes the muscle,” says Arthur Perry, M.D., a plastic surgeon and adjunct associate professor of surgery at Columbia University. When those muscles aren’t able to contract, you can’t make those repeated facial expressions that, over time, create folds in the skin (a.k.a. wrinkles).
Another way of looking at it: “Think of your skin as piece of paper,” says Julie Russak, M.D., a dermatologist and associate professor at Mount Sinai Hospital. “The more you crinkle that paper, the more lines will be there. The less folding and crinkling, the smoother the paper will be.”
Is It Effective?
Yep. The real reason Botox has become so popular is because it works, Perry says. Study after study shows that it is an effective and safe way to reduce the appearance of facial lines.1
Though research is ongoing, studies suggest even more potential benefits to going under the needle, from improving hard-to-treat depression to decreasing excessive sweating to treating movement disorders.2
Is It Safe?
While getting a toxin injected into your face sounds terrifying, all of the docs we spoke with agreed the health risks are minimal.
It’s easy to get a funny appearance (think Spock-like eyebrows) if done wrong.
“It’s an extraordinarily safe drug,” Perry says. “The downsides are related to the artistic abilities of the doctor.” Translation: It’s easy to get a funny appearance (think Spock-like eyebrows) if done wrong. Perry also adds that while there is a remote chance of an allergic reaction, “the worst thing I’ve had happen is bruising,” he says.
In Pursuit of Perfection Prevention
While it may be safe, it's still scary for those with a fear of needles—not to mention pricey: A typical procedure usually runs between $300 to $500. So why are so many women opting to get Botox before they’ve reached 30?
The main reason: prevention. Proponents say that Botox can help prevent wrinkles from forming long before they’re ingrained on your face. And the research backs them up. One study followed twin sisters over a 13-year period, during which one received Botox two to three times per year and the other only got it only twice.3 You can probably guess the result: The regularly treated twin had less noticeable facial lines and crow’s feet.
Russak, for one, believes it’s best to start Botox before wrinkles develop. “We use it much sooner to prevent progression from dynamic wrinkles to static wrinkles,” she says. “But we use it in smaller quantities to give a much softer, relaxed look rather than a frozen one.”
A typical before-and-after. (Photo: Botox Cosmetic)
That’s what spurred Alexa*, now 28, an interior designer, to start getting Botox at age 25. “My dermatologist, who I’ve seen for years, suggested I start it to prevent lines from forming,” she says. Although she worried she wouldn’t be able to show emotion or that people would notice, she ended up loving the results. “They aren’t noticeable to anyone but me, and I definitely feel good about doing something that might prevent future, more drastic measures, like a facelift,” she says.
Jill had similar concerns, but when she worked up the nerve to initially ask about Botox during a routine check-up, her derm assured her that “with a very small amount, she'd be able prevent the constant movement without making me appear frozen or crazy-looking,” she recalls.
Besides minor bruising after the injections, she really liked the results: “It doesn’t look like I’ve done anything at all, because I’m still able to move my brows.”
If you do it too early you’re simply wasting your money. Getting Botox at 22? That's crazy.
How Young Is Too Young?
Of course, there’s always a catch. “If you do it too early, you’re simply wasting your money,” Perry says. “Getting Botox at 22? That’s crazy.” Say you spend $500 at three appointments per year, for example. That adds up to a whopping $1,500 per year—and easily more than $25,000 by the time you're in your 40s.
The right time to start, in Perry’s opinion, is when you begin to see the wrinkles. Anthony Youn, M.D., a plastic surgeon and author of The Age Fix, is even more cautious. “Injecting women in their 20s is a bit excessive to me,” he says, as most deep wrinkles aren't yet formed in that decade. And not only will you avoid the unnecessary cost, you’ll avoid the invasiveness of a toxin being injected into your body, he adds. “I wouldn’t recommend it for anyone under the age of 21 and ideally not before the age of 30.”
Still Considering It?
Let's be real: Does it hurt? Both Jill and Alexa say no. “It feels like a little pinch for just a second,” Jill says. Docs can also offer you numbing cream, which Jill used on her first visit but hasn’t since.
But here's the other big question you should ask: Why do you want to do it? “Give yourself a reality check about why you’re preoccupied with and afraid of getting older,” suggests Susan Krauss Whitbourne, Ph.D., professor of psychological and brain sciences at the University of Massachusetts Amherst. Here are a few points to keep in mind.
Give yourself a reality check about why you’re preoccupied with and afraid of getting older.
1. Don't buy into the Hollywood hype.
We live in a world that overvalues youth—just take a look at the wrinkle-free women on TV and in movies, as well as the stigma surrounding older actresses. (In an ironic twist, the media also applauds tan skin, Whitbourne says, making it difficult for anyone to achieve these impossible ideals.)
Remember that getting older is a beautiful thing with plenty of benefits—such as a more positive outlook and greater self-esteem. Rather than worrying about wrinkles, Whitbourne suggests devoting your energy to staying in good health by getting enough exercise, avoiding the sun, and eating a healthy diet. (If you need more of a mood boost, check out these 35 awesome body-positive mantras.)
2. You do you.
Make sure you’re only doing it for you, Jill suggests. “If I was doing it for what other people thought, I wouldn't have done it at all—simply because of the amount of judgment I've received from friends.”
But they don’t have to look in the mirror at your face every day, Jill notes. While it may seem trite, Perry doesn’t downplay the effect of seeing a wrinkle in your 20s. “It marks the exit of childhood and the entrance into adulthood and your later life,” he says. “Looking at your own mortality is the basis of lots of cosmetic surgery.” Plus, some people who have spent more time in the sun or have particularly expressive faces may be more prone to wrinkles earlier in life.
It’s not about doing one strong treatment once—it's everyday care that matters.
3. Turn to other techniques first.
There are plenty of anti-aging alternatives to try before resorting to a procedure, like over-the-counter retinol or prescription-strength tretinoin, Youn says. "Maintenance is important." Russak agrees. "It’s not about doing one strong treatment once—it's everyday care that matters." Make sure to apply sunscreen and an antioxidant cream every morning and exfoliate your skin two to three times per week, Youn suggests. “These steps will put you way ahead of the curve.”
4. Find a legit Botox specialist.
If you’re still dead-set on obliterating lines, make sure you go to a reputable provider. With scammy online deals and sketchy Botox clinics, it can be tempting to go for the cheapest option. But don’t! “Only board-certified dermatologists and plastic surgeons should administer Botox,” Russak says. Do your research online and ask friends or family for referrals. (Here's more info on how to find one.) And remember, if it sounds too good to be true, it probably is.
*Names have been changed to protect the privacy of individuals.
Works Cited
- The management of hyperfunctional facial lines with botulinum toxin. A collaborative study of 210 injection sites in 162 patients. Blitzer A, Binder WJ, Aviv JE. Archives of otolaryngology--head & neck surgery, 1997, May.;123(4):0886-4470. Botulinum toxin for the treatment of hyperfunctional lines of the face. Blitzer A, Brin MF, Keen MS. Archives of otolaryngology--head & neck surgery, 1993, Sep.;119(9):0886-4470.
- Botulinum toxin for axillary hyperhidrosis. de Almeida AR, Montagner S. Dermatologic clinics, 2014, Jul.;32(4):1558-0520. [Botulinum toxin in the treatment of focal hyperhidrosis]. Schnider P, Moraru E, Kittler H. Wiener klinische Wochenschrift, 2004, Nov.;113 Suppl 4():0043-5325.
- Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Binder WJ. Archives of facial plastic surgery, 2007, Feb.;8(6):1521-2491.
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