‘Botox’ – correction or prevention?

Most people see botulinum toxin (often incorrectly referred to as ‘Botox’ following one of the brand names) as something for correcting significant lines and wrinkles once they are older. In clinic I often hear sentences like “When I am 50 or 60 years old, I might go for ‘botox’, but at the moment I am way too young”. Botulinum toxin is often seen as a kind of ‘last resort’ or ‘extreme measure’ to consider only once significant signs of skin ageing such as deep lines and wrinkles have already appeared. This is a misconception.

To understand why, let me give you an important piece of background information on lines and wrinkles. When we first develop lines, these are usually ‘dynamic’ lines. Dynamic lines (or ‘mimic’ lines) are caused by contraction of facial muscles. They include ‘frown lines’ between the eyebrows, ‘worry lines’ on the forehead, ‘bunny lines’ on the nose and ‘crow’s feet’ at the outer eye corners. They are visible when we contract certain muscles (for example when frowning or smiling), but smooth out when we relax our face. However, once we have had these dynamic lines for a while, they become partly independent of muscular movement and stay visible to some extent all the time. These are then so-called secondary ‘static’ lines.

Now, what most people don’t know is that botulinum toxin works best with purely dynamic lines in people with well preserved skin elasticity. Once our lines have partly turned static and once our skin elasticity declines, botulinum toxin alone will not do the trick any longer and we would need additional procedures such as fillers and volumisers. So for botulinum toxin to work best it is good to start early enough, when your lines are still dynamic and your skin elasticity is still high. And in this case, botulinum toxin not only beautifully corrects your lines and wrinkles, but also prevents dynamic lines from becoming static. As cosmetic dermatologists, we have known this for a long time.

However, when I visited the World Congress of Anti-Ageing Medicine in Monte Carlo last month I learned that it goes much further even. Not only does botulinum toxin prevent dynamic lines from turning into static lines, it also seems to preserve skin elasticity itself. Why this is the case, we don’t know for sure yet. Might it be that countless creasing of the skin (caused by our facial muscle contractions) has a negative effect on collagen metabolism itself? I am looking forward to further scientific studies to find out what exactly causes this benefit, but it certainly seems to work, not only in the upper face, but also the lower face.

I can thus answer my initial question with: Botulinum toxin not only corrects lines and wrinkles, but also has a great role in prevention. These are truly exciting times in cosmetic medicine not only for patients, but also for us as practitioners.