Wrinkle in Time

// by Ashley Williams
Gone are the days when beginning anti-aging treatment before a woman’s 30th birthday simply meant reaching for the latest collagen-boosting night cream or retinol-infused serum. In increasing numbers, 20- to 30-something-year-olds are turning to preventative injections to get a head start on freezing fine lines and crow’s feet in their tracks before they appear in the first place. It appears that injectibles like Botox, which was first approved by the Food and Drug Administration for cosmetic use in 2002, might be a way to beat wrinkles to the punch. The average age range for Botox injections remains between 40 to 59, but with a steady rise in younger patients opting for the procedure, it raises the question: Is preventative Botox actually effective?
Dr. Vartan Mardirossian, a board-certified facial plastic surgeon, says about a quarter of his patients are in their 20s and 30s, with a sizable chunk of that percentage seeking Botox injections. “I recommend that [my younger patients] come back twice every year, because they really don’t have a lot of wrinkles going on,” he says.
Experts say that preserving the skin’s collagen early on will help delay collagen’s breakdown, thus delaying the aging process. “If you think of your skin like a piece of paper, then muscle movement is like folding or crinkling it,” says board-certified plastic surgeon Dr. Dana Goldberg.
Botox helps to limit motion in areas of the face in which creasing breaks down collagen over time, like the forehead or around the mouth. “If you wait until after wrinkles are deep, it’s harder for the body to fill them back up with collagen,” Goldberg says.
Because it’s easier to preserve existing collagen rather than attempting to stimulate new collagen in already-damaged areas of the skin, experts believe injecting Botox as a preventative measure is effective for younger patients. Goldberg says her youngest Botox patient is 24, which is around the age which most people have the highest collagen levels in their skin. Collagen slowly diminishes after that, causing skin to lose its plumpness and firmness.
Those who begin the process early, experts say, will often have the luxury of avoiding more extensive procedures in the future. If a patient considers surgery in the future after receiving Botox injections in her 20s and 30s, skin with good collagen content will heal better and enhance the surgical result, Goldberg says.
“Not smoking, using sunscreen and starting Botox early are kind of the best preventatives against wrinkles, other than just having lucky genetics,” says board-certified plastic surgeon Dr. David Pearson, who occasionally sees patients in their mid-20s. “The nice thing about younger patients is they still have enough elastin and hyaluronic acid naturally in their tissues that if you just prevent the creasing, they don’t permanently etch those wrinkles.”
He added that the 30s are a good age range to begin Botox injections.
“If I’m seeing patients for Botox who have already permanently creased the skin, where you actually get thinning of the dermis, which is the deeper layer of skin, Botox alone isn’t going to do it,” Pearson says. In those cases, he recommends pairing Botox with dermal fillers, including Restylane and Juvederm.
Experts seem to agree that there’s no real harm in jumpstarting the anti-aging process with injectables, but Goldberg notes that there is such a thing as too much preventative Botox. Not only can overdoing the procedure create opposite of the intended effect by snatching away a youthful appearance, but it’s a waste of money, Goldberg says.
“You are supposed to be able to move your face,” she says. “I have seen several women in their late 20s who go too far, and instead of looking their age, they look like a 40-year-old trying to look 35,” she added.
One drawback to beginning Botox early is that it’s a commitment that requires more than just a visit to the doctor’s office every year or two. Repeat injections may be needed every two to five months, Goldberg advises, while keeping in mind that everyone metabolizes Botox at different rates.
Experts also recommend that patients choose a doctor and practice they like and stick with it, rather than jumping from office to office, in order to avoid unsatisfactory results by doctors who haven’t learned the nuances of their individual muscle patterns.
“Botox is probably the only thing I advocate people starting earlier,” Pearson says. “Everything else, we say, ‘No, wait until there’s something meaningful for us to correct.’”