In 2023, ageing is no longer a dirty word. Skincare brands are tweaking their packaging to reflect that growing older isn’t something to be feared, and more of us are questioning the effects of trends like face taping and ‘jello skin’ on our self-esteem. But while we’re embracing the ageing process a little more, we’re also on the lookout for subtle ways to rejuvenate skin.
One of those ways is Botox or wrinkle injections. A recent report suggested that the demand for Botox is on the rise, while another study found that it is one of the most popular aesthetic procedures. And experts agree.
Award-winning aesthetic doctor Dr Harris is known for his frank approach to cosmetic treatments on Instagram. A champion of natural-looking results amid what he calls an epidemic of ‘alienisation’, Dr Harris notes that Botox usage is increasing. “All aesthetic procedures involving injectables are on the rise in my clinic,” he tells R29, but there’s one popular injectable treatment he isn’t sold on. In fact, it could be a total waste of time.
Enter: preventative Botox.
Using Botox before lines show up doesn’t make a huge amount of sense. There is no convincing, scientific evidence that preventative Botox works.
Dr Harris
What is preventative Botox?
Botox or anti-wrinkle injections relax or paralyse the facial muscles. This makes the fine lines, wrinkles and crow’s feet which sit above those muscles less visible. But do these injections work as a preventative measure? Dr Harris thinks not.
“Preventative Botox exists as a concept,” says Dr Harris, and it is offered in various aesthetic clinics up and down the country. “The idea is that if you can’t move the muscles in your face, the lines above them won’t form.” In other words, the injections are said to stave off wrinkles for longer. But Dr Harris says there is no convincing scientific evidence that preventative Botox works.
“People are now starting Botox in their early 20s,” says Dr Harris, “but for most people, visible wrinkles tend to show up in the 30s and maybe even 40s.” Put simply, it’s absurd to start doing Botox unless there are visible lines to treat. “Botox is a drug and it should be looked at as any other drug,” says Dr Harris. He adds: “You don’t want to be taking it if it’s not necessary, because there are side effects to it.”
Does preventative Botox actually work?
“To my mind, using Botox before lines show up doesn’t make a huge amount of sense,” says Dr Harris. He continues that there are no definitive studies which show that Botox can prevent wrinkles from forming. Rather, it can minimise them once they are already there. “Even if the muscle itself becomes disused [thanks to regular injections over time], it would soon regain function,” says Dr Harris.
Are preventative wrinkle injections simply a money-making scheme, then? “Potentially, yes,” says Dr Harris, “as people do sell preventative Botox.” Sure enough, a quick internet search for ‘preventative Botox’ in the UK serves up thousands of hits, directing people to clinics which offer the treatment for hundreds of pounds a go.
Who is Botox suitable for?
So we’ve established that preventative Botox is a waste of time and money. But using Botox to treat wrinkles that are already there does work. A good potential candidate for Botox is someone who wants to treat their visible lines, says Dr Harris. “In some cases, lines may show up in your late 20s but typically it would be someone in their 30s or 40s with visible lines who wants to treat them.”
Dr Harris has been known to turn people away — particularly young people — for wrinkle injections. “A lot of people are determined to get [preventative Botox] even though I point out to them that there is no convincing evidence that Botox acts preventatively.” People often go elsewhere for the treatment but Dr Harris says that may not be the best idea. “I know this happens, especially with fillers. When I won’t treat someone, they will go somewhere else and often they return with botched lips for me to dissolve.” When it comes to wrinkle injections, it’s not uncommon for practitioners to go too far and give clients a frozen look.
“My preference is for a more natural appearance,” says Dr Harris, who tends not to use big doses of any injectables, whether that’s Botox or filler. “The doses I use are very conservative, generally, because more people want natural results. If someone comes to me and wants to look exaggerated in any sense, I will have a chat with them and try to educate them. But I certainly wouldn’t treat them.”
Botox is a drug and it should be looked at as any other drug. You don’t want to be taking it if it’s not necessary, because there are side effects.
Dr Harris
What are the best alternatives to preventative Botox?
Most aestheticians see Botox injections as a gold standard for minimising the appearance of wrinkles. But there are a handful of other, less invasive treatments which experts recommend for improving skin texture. A caveat: you don’t need us to tell you that fine lines and wrinkles are inevitable and entirely normal. But we understand that for some people they can be a point of insecurity. As R29 is a judgement-free zone, we’d rather arm you with the knowledge you need to make a safe and informed decision.
First up, chemical peels. Skin cell renewal slows down as we age, said Nicola Liberos, aesthetic nurse at Omniya Clinic and member of the British Dermatological Nursing Group. “Medical-grade chemical peels aid the shedding of old skin cells and stimulate new skin cell growth and collagen,” she explained. Chemical peels help to improve skin tone, skin texture and moisture levels, and leave the skin glowing and looking more youthful.
Chemical peels vary across the board in terms of ingredients used (for example, you could opt for a glycolic acid, lactic acid or retinol peel depending on your preference). The concentration differs, too. Higher concentrations can penetrate the skin deeply (though there may be more side effects, like increased skin shedding), while lower concentrations tend to be a little more gentle. The strength may depend on what you’re trying to treat, such as fine lines or deeper wrinkles, which is why it pays to have a discussion with a qualified practitioner beforehand.
Another treatment that cosmetic physicians and facialists are championing is Morpheus8, which combines microneedling and radio frequency. It tightens skin and kickstarts collagen, as well as helping to lift and tighten slack skin. As a result it’s known to target fine lines and wrinkles. But it can be expensive, with single treatments into the high hundreds. Again, a consultation is a must to ensure you’re the right candidate for the treatment.
Microneedling is also available as a standalone treatment in clinic but it shouldn’t be attempted at home. “Microneedling is a treatment to improve the smoothness and firmness of skin,” said consultant dermatologist Dr Anjali Mahto. “It offers benefits for various skin concerns, including wrinkles, fine lines and acne scarring.” Dr Mahto explained that tiny, sterile needles are used to make micro-punctures in the skin. “This stimulates [the skin] to produce new collagen — an important structural protein.” Booking a consultation with a qualified practitioner is a must to understand the benefits versus risks.
These alternative, nonsurgical cosmetic treatments are perhaps a better option than Botox for younger patients, said Nicola. When carried out by a qualified expert, she believes that they can provide a ‘preventative’ improvement in fine lines, wrinkles, skin texture and discolouration — without starting too early on Botox.
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