Botox is the tradename for Botulinum toxin, a neurotoxic protein that inhibits the release of the neurotransmitter acetylcholine which causes paralysis. Among the most common usage is cosmetically to prevent or reduce wrinkles in the skin.

The use of toxins to paralyze the muscles for its aesthetic effect will have the long-term effect of aged skin because the treatment both disrupts natural muscular function and prevents cosmetic and surgical anti-aging methods from being effective. 

When using Botox, the muscles near the injection site become paralyzed for approximately 6 months, and this prevents facial movement in the affected area. The short term effects include temporary wrinkle reduction. However, the long-term effects include an atrophy of the muscles to the area. When muscles are not used, they shrink, sag, and with aging become less able to recover. In terms of appearance, this means that with every injection, the muscles lower in quality, sag, and cause the skin to sag and wrinkle. 

It is for this reason also that long-term users of Botox have noted that their muscles and skin stop responding to injections after many years of treatment, necessitating more injections within a shorter time period. Users have noted that their skin sags quicker, wrinkles faster and this creates a need to get more and more injections just to have the same effect the injections once had. 

There is a threshold to Botox, and after injection toxin into your body for years, the need to get more and more injections just to get a past effect indicate that the injections themselves are what cause the skin to age faster.

The lasting damage

Botox can even cause permanent skin damage just after one treatment. The following have been noted to occur in patients after receiving a Botox injection:

Overcorrection- A.K.A the hallmark "Frozen Face" associated with Botox injections. When someone's face eerily ceases to move except for their mouth when they're talking, this is indicative of overcorrection caused by Botox.

Undercorrection- AKA "Spock Eyebrows" where the eyebrows overlift, giving a somewhat permanent surprised appearance. 

Asymmetric result- Seen when one side of the face is more lifted than the other, giving the face a lopsided symmetry. 

Upper eyelid ptosis- Perhaps the most common complaint from Botox is sagging of the upper eyelid. 

Additional complications include:

Dysphagia, neck weakness

Perioral droop

Compromised result in elderly

Bruising

Intravascular injection

Lagophthalmous, exposure keratosis

Globe perforation

Diplopia (lateral rectus)

 

 

Botox Psychosis

Research has also found that Botox injections can lead to psychological problems in patients. Women have reported significant psychological side effects after receiving Botox including heightened sensitivity to noise and lights, acute anxiety, severe fatigue, and insomnia. 

Psychological effects such as depression and thoughts of suicide were also reported. Such psychological effects may have also been compounded by user report of  from minor and unwanted physical skin changes to fear of potential, future side effects such as addiction to injections and permanent skin damage. 

 

Botox ages the skin

When you don't exercise, your body is less toned, the skin sags and has a lowered aesthetic quality. The same is true for your face. When Botox is used over a long period of time, the lack of muscle usage causes muscle atrophy which causes the muscle to shrink and sag just like how it would anywhere else on the body.

When facial aging occurs over the natural course of one's life, there are many causes at play. There is a loss of facial fat, elasticity, collagen, and there is also a loss of muscle to the area. The loss of muscle tone underneath causes the skin quality to decline as well. This is why filler injections do not cause a 65 year old woman to look 18, there is more to facial aging than just wrinkles.

Botox also increases skin wrinkling in neighboring areas of the face because when once area of the face is paralyzed, this causes the other areas of the face to work harder to make an expression. The result is deeper wrinkling to non-paralyzed areas. This can be tested in the following way: raise one eyebrow and notice the muscle movement and feel. Then press your finger over that eyebrow firmly and now try to raise it. New muscles now have to work to raise the eyebrow and they are working harder and this causes new creases to form. 

What is also concerning about Botox is how it prevents anti-aging measures from working. If you have been receiving Botox injections, this means that fillers, facelifts and skin care will not work for you. Fillers require muscle tone in the face to keep the filler in place, without proper muscle tone, the filler will migrate easier. Modern facelifts involve folding the muscle instead of just pulling and nipping the skin, if the muscle has been ruined over time from toxin injections, that means facelifts will not work. And for skin care, skin care cannot lift the skin, so very droopy, damaged skin from Botox will not be fixed by skin care serums or exfoliation. 

Toxin poisoning 

Research has also found that the Botox botchulism toxin can move to other areas of the body. The probability of poisoning increases in those who receive the injection with greater frequency (multiple times per year). Symptoms include dysphagia (difficulty swallowing), fatigue and vision problems.

Botox can also enter the circulatory system and have effects on the immune system. The effects on the immune system have been seen in both patients who have received high and low doses of Botox. 

Bone Loss

Botox has also been shown to cause bone loss. Warner et al (2006) in their study on mice injected with Botox noted the following:

The muscle mass of the injected quadriceps and calf muscles was diminished −47.3% and −59.7%, respectively, vs. saline mice (both P < 0.001). The ratio of bone volume to tissue volume (BV/TV) within the distal femoral epiphysis and proximal tibial metaphysis of Botox injected limbs was reduced −43.2% and −54.3%, respectively, while tibia cortical bone volume was reduced −14.6% (all P < 0.001). 

Which was further supported by follow up studies, including this study on  mandibular bone loss from Botox injection:

After botulinum toxin type A injection in the masticatory muscles the mandible exhibits bone loss as an adverse effect. Since this procedure is a widely used approach for several movement disorders in the clinical dentistry, the potential damage of mandibular bone should be considered and inform the patients.

- Balanta-Melo et al. 2019

 

And the above findings make sense, when you consider that muscle and bone work together in the body to support each other. When muscle loss occurs, bone loss is also seen because muscle is needed for bone development. Muscle is a local source for growth factors that build, develop and repair bone.  Bone mass is primarily regulated by muscle-sourced mechanical forces. Therefore  changes in muscle mass/strength affect the bone as well. This is why strength-training exercise has been shown to prevent bone loss.

 

 Therefore, the above can be inferred that injecting the skin with Botox will cause boneloss to the area over time, leading to a degredation of the skeletal structure and causing an aged appearance. 

Conclusion

I do not believe Botox is a safe, anti-aging procedure and the risks including permanent skin aging far outweigh any benefits. 

The best thing to do is to just maintain your skin with daily natural skin care, avoid skin destructive practices like smoking, sunbathing and drinking and to be realistic about aging. 

 

 

 

References

Balanta-Melo, J., Toro-Ibacache, V., Kupczik, K., & Buvinic, S. (2019). Mandibular bone loss after masticatory muscles intervention with botulinum toxin: an approach from basic research to clinical findings. Toxins, 11(2), 84.

Niamtu III, J. (2009). Complications in fillers and Botox. Oral and maxillofacial surgery clinics of North America, 21(1), 13-21.

Vartanian, A. J., & Dayan, S. H. (2003). Complications of botulinum toxin A use in facial rejuvenation. Facial Plastic Surgery Clinics, 11(4), 483-492.

Rouientan, A., Otaghvar, H. A., Mahmoudvand, H., & Tizmaghz, A. (2019). Rare complication of botox injection: a case report. World journal of plastic surgery, 8(1), 116.

Berwick, S. (2014). Not All Positive: A Feminist Phenomenological Analysis of Women’s Experiences of Botox Treatment and Other Injectable Facial Fillers (Doctoral dissertation, Mount Saint Vincent University).

Warner, S. E., Sanford, D. A., Becker, B. A., Bain, S. D., Srinivasan, S., & Gross, T. S. (2006). Botox induced muscle paralysis rapidly degrades bone. Bone, 38(2), 257-264.

Goodman, C. A., Hornberger, T. A., & Robling, A. G. (2015). Bone and skeletal muscle: key players in mechanotransduction and potential overlapping mechanisms. Bone, 80, 24-36.

Hamrick, M. W., McNeil, P. L., & Patterson, S. L. (2010). Role of muscle-derived growth factors in bone formation. Journal of musculoskeletal & neuronal interactions, 10(1), 64.

Cianferotti, L., & Brandi, M. L. (2014). Muscle–bone interactions: basic and clinical aspects. Endocrine, 45(2), 165-177.