How Young Is Too Young for Botox?

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You probably know someone who has been injected with Botox – and you might be surprised by how young they are.

Botox has become the most popular cosmetic treatment in the United States, accounting for 3.77 million of the 5.89 million injectable procedures performed in 2013, according to a survey conducted by the American Society for Aesthetic Plastic Surgery (ASAPS). And that number keeps rising: Injectable procedures were up nearly 16 percent last year compared with 2012.

The demand for Botox has become so strong that many doctors who are not plastic surgeons are now trained in the practice. But the concerns surrounding Botox have shifted in recent years from safety to the increasingly younger ages at which women are seeking injections. Women in their mid-to-late 20s are increasingly turning to Botox to prevent the onset of wrinkles. And men are too, actually: The number of cosmetic procedures for males rose 22 percent from 2000 through 2012, according to the American Society of Plastic Surgeons. 

Botox – a drug made from a neurotoxin produced by the bacterium clostridium botulinum, the same toxin causes a life-threatening type of food poisoning called botulism – works by blocking signals from the nerves to the muscles. Areas injected with Botox, or competitors like Dysport and Xeomin, become weakened or temporarily paralyzed, and the effect relaxes and softens facial wrinkles for an average of three to four months.

The appeal of Botox might be understandable for older women eager to hide signs of aging, but why would a 21-year-old be interested in such a procedure? Michael Edwards, MD, president of ASAPS, says celebrities’ obsession with Botox has raised its profile with teens and young women. Kim Kardashian, for example, admitted to trying Botox in 2010, at the age of 29.

“We’re seeing younger and younger people doing it,” he explains. “It’s not uncommon to have 22- and 23-year-olds getting Botox.”

Young people ages 19 to 34 underwent more than 546,000 Botox procedures last year, an 11.7 percent increase from 2012 and a 36 percent rise from 2010. To compare, those between 35 and 50 underwent 1.72 million Botox procedures in 2013, while teens 18 and younger got 1,149 procedures. Edwards says he would not accept Botox patients who are under the age of 18 unless that individual had parental consent. 

And while he has talked young women out of Botox, he will inject some younger individuals if the circumstances warrant it. “If it’s a healthy young person with an animated face I’ll happily do it,” he says. “I see a lot of young people with wrinkles.”

The FDA has approved Botox for 10 uses in the United States. The list includes crow’s feet, frown lines (wrinkles between the eyebrows), crossed eyes, uncontrollable blinking, chronic migraines, neck spasms, and excessive sweating, while injections in the forehead and around the corners of the mouth are not scientifically authorized by the government agency and performed “off label.”

New York-based plastic surgeon Doris Day, MD, says she has injected an 18-year-old patient with Botox. That particular patient had a “strong crease” across her forehead and it was more of a “medical than aesthetic” decision, Day explains. The Botox “took the edge off” and the young woman has continued with yearly injections for the last five years, according to Day. In general, Day – who has been practicing cosmetic dermatology in New York for more than 15 years – does not ask a patient for his or her age before treatment, but emphasizes that 17- and 18-year-olds asking for Botox are “misguided” and cautions that Botox “is not a spa treatment.”

According to Botox maker Allergan, the injectable was “approved in the United States in 2002 for the temporary improvement of moderate to severe glabellar lines (frown lines between the brows) for patients aged 18 to 65 years.”

Day suggests that young adults who want to age “successfully” focus on their skincare regime first before turning to Botox. That means wearing sunscreen on a daily basis, sleeping eight hours each night, and applying topical retinol and antioxidant creams and serums. She also educates individuals about “correct” facial postures – how to smile from the eyes and not the mouth, for instance – and “neutralizing” expressions that tend to breakdown collagen from repetition (like squinting and frowning).

Young adults, she insists, tend to forget one very important aspect of Botox: It’s not a wrinkle cure-all.

“Young people have this attitude that we can ‘laser it, fill it, Botox it’,” she says. “[Botox] can only repair so much.”