It’s the fastest-growing cosmetic procedure in the industry, and a multi-billion dollar business. But when it comes to Botox side effects long-term, many concerns seem to be growing. The risk of looking older after it wears off is one of them. That this popular drug might actually accelerate skin aging and cause more wrinkles over time.

So what are the facts? Does Botox make you look older after it wears off? And how does it age your skin when used over time?

In short, studies show that when Botox is used over time, it will lead to decreased muscle mass in your face. And even loss of bone bass. Which in turn will accelerate the loss of facial volume, and cause sagging skin. Something that indeed can make you look older.

Another concern is that prolonged use of Botox may cause thinning of your skin. Which also will have a negative impact on your skin’s appearance and youthfulness.

If you are interested to learn more about the Botox facts and myths, including all risks and side effects. Then this is the article for you.  

At the end of the post, I will also explain why I will never try Botox myself. And why I am such a firm believer in natural beauty.  But let’s start with the facts. 

Below is what I cover in this meaty post, and you can choose to jump quickly to any part by clicking on the headlines below.

If you’re in a hurry, you can jump straight to the summary or the short version of the pros and cons. 

• The basic Botox facts
• How Botox works for wrinkles
• Preventative Botox – the big myth
• The short term side effects
  • Can Botox cause droopy eyelids?
  • Can Botox give you a frozen face?
• The long term side effects – How Botox can make you look older
  • Can Botox cause your skin to sag?
  • Can Botox cause more wrinkles?
  • Rare but severe side effects
• The unknown risks
  • Long term safety
  • Does Botox travel through the body?
  • Can Botox cause death?
  • Botox and pregnancy
  • Botox and breastfeeding
• Too much Botox – examples of people who have had enough
• Botox pros and cons – the short version
• Summary – 4 ways Botox can make you look older
• Botox or not – My personal opinion

The basic Botox facts

So let’s just start with some of the most basic facts about this popular, but also very debated drug. You have probably heard of at least some of them.  

• Botox is the largest brand name for the drug botulinum toxin type A.  Which is a neurotoxic protein produced by the bacterium Clostridium botulinum. 

• Other brands with the same toxin and purpose are for example Dysport, Xeomin, Azzalure, and Jeauveau. And there is also Myobloc, which uses botulinum toxin B. (Despite all the different brands, the common language for injections with botulinum toxin A (or B) is simply Botox. And I will use that word too, for convenience).

• The drug works by temporarily paralyzing muscles that create foldings in your skin. This causes a smoothing effect on the skin that lasts about three to four months before it gradually wears off.

• It’s the most popular non-surgical procedure for the face. 

• Besides the so-called “dynamic wrinkles”, Botox is also used in other cosmetic procedures. Such as to slim a jaw or change the form of the mouth.  

• The original use of Botox was to treat certain eye muscle disorders. It is also used for treating other medical conditions such as excessive sweating and migraine.

• It’s the deadliest neurotoxin known to mankind. And just 1 gram of botulinum toxin has the potency to kill over 1 million people. The amounts used in injections are therefore extremely low.

• Botox has generally been considered safe, with most side effects being concerned with the actual injection site. But there are also more distressing long term effects and risks that have emerged over time. Which this post will get to the bottom of.

How Botox works for wrinkles

So this is what happens during a Botox procedure. Any of the brands containing botulinum toxin is injected in extremely small concentrations into certain muscles of the face.

The toxin works by blocking signals from the nerve cells to these muscles. And therefore paralyzing them. When the muscle can’t contract, the dynamic wrinkles will relax and soften. 

With that said, Botox cannot be used on any wrinkles. It is most often used on forehead lines, lines around the eyes (crow’s feet), and frown lines (glabellar/eleven). But does not help with for example the nasolabial fold.

Very often you hear people calling Botox a wrinkle remover and anti-aging miracle drug. While in reality, it is not removing any wrinkles at all. And it sure does not improve skin aging either.

Botox gives a temporary effect on your wrinkles, by paralyzing the muscles. But it does nothing to the elasticity or firmness of your skin (which is the real culprit). Instead, it has actually been shown to have some negative effects on these concerns. But I’ll get back to that further down. 

Botox resistance

Some people (approximately 1 percent) seem to develop a Botox resistance. This means they develop antibodies to the toxin and after doing the treatment for a while, it simply won’t give any effect.

Preventative Botox – The big myth

I know there are still dermatologists and nurses out there that will try to sell Botox to you even if you don’t have any apparent lines and wrinkles. Telling you Botox prevents wrinkles from emerging.

I’m not saying they are doing this to consciously fool you. Or at least I want to believe they are doing what they think is in your best interest. But it makes me sad that so many clinics simply lack the knowledge about this assertion.

Because if something, starting with Botox to early, can not just give you unwanted side effects and less money in your pocket. But it can also make you age faster. 

For this article, I contacted one of the most experienced facial aesthetic doctors in the UK, Dr. Darren McKeown. Often sought by media for his knowledge about these kinds of treatments. I wanted to get his opinion about the claims of Botox being preventative. 

McKeown confirms that “The chemical injection is not a preventative measure and there is no evidence to prove it does so”. He explains that the statement of Botox being able to halt the development of wrinkles is nothing but a myth. And that it instead could have the opposite effect. 

I also contacted Patricia Wexler, who is one of the most acclaimed dermatologists in New York, and highly demanded among celebrities. And she explains that people who start with Botox before they have wrinkles can end up with thinner and looser skin.

In the magazine Vogue, I read another claim from a dermatologist saying almost the same thing. That it’s simply a myth that botox can help to stop wrinkles from getting worse.

So how come so many people, and less-educated practitioners, still promote Botox as a preventative method?

Well, the argument you will hear is that it’s your facial muscles that cause wrinkles. That when you keep folding your skin at certain places by smiling and doing other expressions. Then over time, these folding will become permanent which results in lines and wrinkles in your face. And while to a certain point that is correct. It is far from the whole picture of what really is going on within your skin.

Please read the next section and I will explain what you need to know about the real cause of wrinkles.

Elasticity – what really matters

So when talking about the formation of lines and wrinkles due to muscle activity. There is one important detail that makes all the difference. And that is elasticity. 

Over time, as you age (and depending on how you treat and nourish your skin), your skin loses its ability to bounce back from the foldings caused by facial expressions.

When the elasticity gets weaker. That’s when the wrinkles will start to form. 

And just to be clear. Your biological age and your skin age, are not the same thing. Genes play a certain role. But mostly, what determines your skin age are other factors. To learn more about the aging process of your skin read this post.

So, the elasticity and the youthfulness of your skin are what determines how lines and wrinkles will form. Not the other way around. And it’s important to understand this sequence in order to improve your skin status and to work truly anti-aging.

With that, I mean to chose methods that strengthen your skin, making it younger and more elastic. Believing that Botox will save you from aging further, is a devastating mistake.

With Botox you only treat, or I should rather say disguise, the foldings. Which does nothing to the elasticity problem or your skin’s aging process.

Instead, what happens over time is that Botox will decrease muscle mass in your face. Which will cause volume loss that can lead to even more flaccid skin. Less volume in the face can worsen many signs of aging, such as a deepening nasolabial fold, jowls, and marionette lines.

So if something, what Botox can do is to speed up the aging process, rather than to work preventatively. I will explain more about that further down the article. 

Short term side effects of Botox

When it comes to side effects from Botox injections, the short term ones are the ones you will hear about most often. I will list some of them here and then explain more in detail about two concerns that many people seem to worry about. 

According to RXlist, these are some of the common and short term side effects of botulinum toxin injections: 

• Bruising, pain, redness, or swelling where the injection was given.
• Muscle weakness
• Trouble with swallowing
• Muscle stiffness, pain in your neck, arms, or legs
• Blurred vision, puffy eyelids, dry eyes, drooping eyebrows and eyelids
• Dry mouth
• Headache 
• Tiredness

Can Botox cause droopy eyelids?

Yes, there is a risk when treating the forehead with Botox since the brow can be pushed down and cause the eyelid to droop. Giving you a so-called hooded eye.

Usually, that should not happen with an experienced practitioner. But since Botox can diffuse, it’s always a risk and it does happen occasionally. 

Another risk due to the fact that Botox can affect nearby muscles, is that the eye-lid holding muscle itself can be affected. And therefore causing the eyelid to droop. 

The droopy eyelid will recover as the toxin wears off. But (there is always a but) there have been accidents when Botox has caused a permanent hooded eye. If you scroll down to “Too much Botox” you will get an example of that. 

Tip: See this post to learn more about causes and treatments for hooded eyes and saggy eyelids.

Frozen face with Botox?

I think this might be one of the things that people in general associate with Botox. The inability to move your face the way you are used to. Or worse, a face with a total lack of expressions. And yes, that is still quite common to see.

But what is even more common these days are procedures done with less amount of Botox. Trying to avoid the dreadful “frozen look”. 

With a lower dose, you are still able to do some movements, even though they are different from before and not as expressive as before. 

Something to consider, even for those who are using smaller doses. Is that a youthful face is full of expressions and movement. And a face with less movement can very often reveal the opposite.

It might give you a certain appearance on still photos and selfies. But the movements and overall behavior of faces treated with Botox, will often give the impression of having had something done. And that will not radiate youthfulness.

So try to see the face in its whole. And don’t obsess over a few wrinkles. There are so many more aspects and signs of aging and you really must try to see the whole picture. 

The long term side effects – How Botox can make you look older

These are the side effects that most people don’t seem to be aware of. And that, sadly, not all practitioners will tell you about either. And even if these effects aren’t life-threatening, they sure can cause a lot of distress and anxiety. 

For everyone who is doing Botox or thinking of starting. This might be the most important part to read. No matter what you choose to do, it’s always a good idea to have all the facts.

Can Botox cause your skin to sag?

Yes. Botox works by paralyzing the muscles and making them unable to function. Over time, this will make the muscles to atrophy. Which will cause the face to lose volume and the skin to be more flaccid. 

Recent studies have also shown that Botox (if used over time) accelerates the breakdown of facial bone mass. Causing even more volume loss and sagging skin.

This long-term effect. Which will make a face look older, has been left out quite a lot in the discussions about Botox. And scaringly overlooked according to this recent study.

But some authoritative figures in the field have known this for a while. For example, the renowned dermatologist and author Dr. Nicholas Perricone who is a strong opponent to Botox.

In an interview with the magazine Marie Claire he says he always tries to talk his patients out of using the drug. And that people who use it, start to lose volume in their faces with time. Which in turn will accelerate the appearance of aging.

The article quoted him: “Someone who’s been on Botox for a while is going to look like a wrinkle-free older person” — Meaning they will be expressionless, and with facial features that have flattened.

Dr. Patricia Wexler, as I mentioned earlier, also explains that when the muscles in the forehead get weaker, it can sometimes result in heavier brows and eyelids. 

So, muscle atrophy in the face can indeed be an unpleasant experience for many people. Once they start to notice it.

Studies have also shown that some individuals are more prone to the atrophying effect. And may see that effect much sooner and much more severe than others. Individuals with diseases such as diabetes type 2 and obesity could also have a greater risk.

Besides the muscle atrophy, Botox will also cause loss of bone mass in the face.

Studies have examined this phenomenon. Especially after injections in the masticatory muscles. Bone atrophy will increase sagging skin even further and is something you want to avoid as much as you possibly can.

Can Botox cause more wrinkles on your face?

Even though Botox is used to temporarily diminish the appearance of wrinkles. There are concerns about this treatment actually causing more wrinkles over time. So what is true and what isn’t?  

To start with, there is a risk of getting new wrinkles in other places of the face. Due to the fact that when you can’t contract certain muscles the way you used to, for example when you smile. Then other muscles will kick in and contract instead. And if the skin is lacking elasticity that will cause more wrinkles in those places. 

Also, since the skin can get thinner after many years with Botox use (see the section above) that also means a higher risk of getting more wrinkles.

And besides wrinkles, the muscle atrophy that happens over time can make your skin to start sagging. Which will put you at risk of looking older than any wrinkles did in the first place.

Rare but severe side effects

Let’s go over to the rare side effects that can be even more distressing and even life-threatening. 

Some serious adverse effects that have been reported over the years are for example dysphagia (difficulty swallowing), pseudoaneurysm, infection of the fascia, granuloma, and death due to botulism or anaphylactic shock.

These are not at all common, instead very rare. Especially when it comes to procedures where smaller amounts are used. But they have been noticed, even after cosmetic treatments, and needs to be mentioned.

Some other interesting (or scary) incidents that have been reported are for example generalized muscle weakness, years after continued use of botulinum toxin. And spreading of the toxin to contralateral muscles.

When it comes to spreading, there are many more discoveries about Botox, that I will talk about in the next section. 

The unknown effects and risks of using botox injections

So now that we have covered what is known about Botox. Let’s talk a bit more about what we don’t know. 

Long term safety

After reading tons of articles about botulinum toxin, the conclusion that seems to be recurring is that there is a huge lack of data on its long-term safety. Especially when used for cosmetic procedures. 

The toxicologist Dr. Ian Musgrave has told the magazine Sydney Morning Herald that Botox has been shown to be “safe for a reasonable amount of time”. But, that the researchers really are in the dark beyond this point.

He explains that long term safety is a big question mark and that this matter really needs to be looked at in great detail.

Another expert who is skeptical is Peter Misra, a leading neurophysiologist. He has told the Dailymail news, that those having treatments like Botox are putting their health at risk. And that its long- term effects on the brain, nervous system and muscles are unknown.

It has also been shown in animal studies that botulinum toxin can affect the way nerves behave and may inhibit the release of vital brain chemicals. 

What do governments say about Botox safety?

Botox is approved by the FDA (Federal Drug Administration) to be used on the glabellar lines for temporary wrinkle reduction.

But, since there have been cases with severe side effects, the FDA warns that Botox may spread from the area of injection to produce symptoms of botulism. Including muscle weakness and difficulty breathing.

Also, since there have been situations when Botox and other brands of botulinum toxin have caused death (even if very rare), the FDA mandates the strongest safety action. Which is that all consumer information pamphlets should contain a black box warning. Something that is typically reserved for medications known to have serious or life-threatening risks.

When it comes to the UK government, they simply announce that “Products that contain botulinum toxin are associated with the risk of serious adverse reactions due to distant spread of toxin.”

Does Botox travel through the body?

Yes, it seems like botulinum toxin can spread to other body areas beyond where it was injected. And some people have suffered serious life-threatening side effects due to this event. That includes both medical treatments with Botox, and treatments for cosmetic purposes.

Earlier, animal studies have shown that Botox can spread to a distance around 3-5 cm from where it was injected. But today it is known that the toxin can spread much wider, especially after long-term use. These circumstances are really not well studied at all.

Until a few years ago it was also believed that Botox couldn’t cross the blood-brain barrier. But then, researchers at The University of Queensland found that some of the toxin actually does escapes into the central nervous system. Something that really needs to be investigated much further.

Has anyone died from botox injections?

The most horrifying side effect of a drug would probably be death. And since Botox is the most potent toxin known to mankind, it might be a fair question to ask if someone has ever died from it. And yes, as mentioned earlier, it has happened even if very rare. 

One of the victims was a 32-year-old woman in Singapore. But the circumstances are still unclear. As with anothert woman earlier this year. 

Botox and pregnancy

There is not much data on how Botox affects a fetus.  Studies on animals have shown that Botox may reduce fetal body weight, cause a delay in bone formation, and/or cause fetal malformations.

But when it comes to humans, there are no clinical studies performed, for understandable reasons.

Make sure to tell your doctor if you are pregnant or are planning on becoming pregnant. He or she can recommend other treatments for you. Never let anyone inject Botox into your skin if you are planning on having a baby. 

Botox and breastfeeding

As with pregnancy, there is a lack of data regarding the safety of botulinum toxin during breastfeeding.  Any serious clinic will tell you to stay away from these kinds of procedures during pregnancy and breastfeeding. 

Too much Botox – examples of people who have had enough

We have all seen those faces that scream way too much botox. Some worse than others. I am not going to give any examples since I don’t like to pinpoint someone by name or photo. Plus, we all have different perceptions of what is too much and whether or not a face looks overdone by Botox.

But instead, I want to share stories from two women who have been doing this treatment but decided to quit for different reasons. There are many horror stories out there but I picked these two examples as they highlight some of the risks discussed in this article.

So one example is Actress Dana Delany. Who has told Prevention magazine that her doctor hit a nerve when injecting her forehead with Botox. Which happened to cause a large hematoma. This accident permanently killed the nerve, and unfortunately gave her a droopy eye that she still has, years after the treatment.

As a celebrity, she was probably going to a very qualified dermatologist. But even in that case, an incident like that could happen.  

Another example of a woman who has had some sad experience with Botox is Melina Borrero. She used the treatment for many years before she paused and discovered that her forehead had lost all its firmness and texture.

She decided to stop this treatment before it would get worse. And you can see her full story on this youtube link.

Summary: 4 ways botox can make you look older

So to summarize the main question for this article, “Can Botox make you look older?” Yes, there are four different ways this injection can make you looker older. Loss of volume, sagging skin, thinner skin, and lack of movement.

So whatever you decide to do regarding this treatment. Make sure to be cautious. And consider taking a break every once in a while. Discuss further with your dermatologist.

Botox pros and cons – the short version 

This is the shortest version of the entire blog post. For those of you who don’t have time to read the whole thing, but still want to weigh the pros and cons in a summation.

The table below is assuming you are going to an experienced medical professional. Because if not, the cons list would be much longer.

BOTOX PROS:	BOTOX CONS:
It is a quick procedure It is highly effective for smoothing out wrinkles temporarily It is non-invasive and can be done on a lunch-break	It does not improve your skin or elasticity Your face will over time lose volume due to muscle atrophy (and even bone loss). Which will lead to more flaccid skin Prolonged use can also lead to thinner skin As Botox is used, it also removes some of the youthful movements of a face Botox can cause other side effects such as bruises and swelling. But also more severe effects that in worst case can be permanent. The long term safety of Botox is very unknown

An experienced, skilled and honest dermatologist can inform you further of all risks and outcomes. Both short term and long term. 

And remember that there are many other treatments that your dermatologist can offer. Treatments that aren’t quick fixes, but that instead helps your skin to improve naturally.

My personal favorite treatment is microcurrent. And I even perform it on myself in my own home. You can read about this amazing and all-natural anti aging technology (and the devices I use myself) in this post.

Also, be aware of the fact daily choices of sunscreen, diet, stress, sleep habits, etc, will determine greatly how quickly your skin will age. So those factors need to be fixed in the first place. See this post to learn more about the foundation of preventing wrinkles.

I will continue to fill this blog with as much information as I can about the daily actions that truly affect your skin. Not just because it’s proven by science. But also because I can guarantee it works, from own experience!

Botox or not? – My personal opinion

I wanted to be as transparent as possible during this post. But in this section, I will tell you exactly how I reason around Botox on a very personal level.

I am not in any way judging other’s beliefs or choices. As long as you have all the facts, I hope you will do a conscious choice that makes you happy and fulfilled.

With that said, here are my own beliefs and thoughts around this highly debated procedure.

1:

First of all, I simply don’t want to paralyze any muscles. And definitely not induce any muscle atrophy either. I want my muscles to be strong, vital, and healthy. Keeping the circulation sound, and my skin glowing and alive! That is also proven to keep the skin more elastic and firm for longer.

I am 40 myself, and I still have no deep lines or wrinkles despite that I smile and laugh all day long. As mentioned before it’s the elasticity that counts. And the elasticity can be improved in many ways, which this blog is all about.

If you’re new to my blog, start with learning how to protect your skin from the aging sun rays in this post. What foods to eat daily to improve skin tightness in this article. And how to rejuvenate your skin while you sleep in this post.

2:

Secondly, I want to prevent sagging skin as much as possible. And as explained before, the muscle atrophy that happens over time with regular Botox injections will lead to more flaccid skin. And that is definitely not a process I would want to favor.

The best way to treat and prevent sagging skin is in my opinion to use microcurrent. You can read more about this natural and incredible treatment in this post.

3:

My third reason is that I would never do anything that could alter my looks. And doing Botox injections will to some degree change certain movements of your face.

I would not feel comfortable, nor happy, with having an altered version of myself looking back at me in the mirror.

For me, the face is a huge part of my personality and my soul. And I rather age naturally with grace, then to alter how I look and the way my face expresses itself.

4:

My fourth reason is that I believe it’s just so much better to focus on overall anti-aging and skincare methods. The skin is not just the face, it is also the neck, the chest, your legs, etc.

By working with the methods I teach in this blog, you will get younger-looking skin overall. Make sure you always follow these three rules as the foundation in anti-aging.

5:

Finally, besides all the scary side effects (at least I think they are scary) that I have already mentioned in this article. I would also like to mention another reason for not doing any of these kinds of injectables. And that is plain and simple, pride.

My pride in being authentic. Knowing that my face and my skin is what I am. Not because of injections. But because this is me and what I truly look like. I believe that is important for self-esteem and confidence. While being dependant on quick-fix-injections rather will be very negative to those aspects. I could be wrong. But that is my belief. 

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So these are the reasons why I personally advocate natural beauty without botox, fillers, and knives. It would be very interesting to know if you agree or disagree with any of them. So feel free to comment below!

Also. I sadly believe that these kinds of treatments can increase the risk of mental illnesses in our society. And I am not alone to think along those lines. 

Stephen Powis, NHS England’s national medical director, and Kitty Wallace from the Body Dysmorphic Disorder Foundation, both say that Botox (and fillers) can have a damaging effect on the mental health, especially among young people. 

This fact has encouraged me to write another article, about fillers. That post will explain all the risks and side effects of using so-called temporary fillers.

For example, you need to learn that these fillers aren’t even as temporary as once believed they were. And they can affect your skin in a very negative way and even increase aging. You’ll find the post here.

I wish everyone could love the way they look. And I hope I can help with that by advising on this blog on how to get healthier and younger-looking skin. Naturally.

With better skin comes better confidence. And I want you to be truly proud of what they see in the mirror. No fake. No temporary effects due to expensive injections. Just pure and real natural beauty. I think we all deserve that!

Once again, I am not judging those who use Botox, fillers or cosmetic surgery. I just want you all to know the facts and treat your skin with respect and love.  And either you go natural or not, you will benefit from getting all the tips and tricks in this blog to take care of and treat your skin in the best possible way.

If you haven’t read the 3 most powerful rules to delay skin aging, then that is a good article to start with. I also suggest you see my post about microcurrent, which is in my opinion the best anti aging facial out there.

Please let me know in the comments if you have any questions or thoughts about this treatment that you want to share.

Until next time, love your skin!