The young woman looks straight into the camera and raises her eyebrows. Instantly, a mass of wrinkles appears on her forehead. "Before Botox," reads text superimposed on the video.
Over the next 20 seconds, the now-viral video uploaded to TikTok in March documents the woman's rapid transformation. In the video, she appears to be able to still easily lift her eyebrows post-treatment, but with each passing day, the movement triggers fewer wrinkles. The final clip shows her with a smooth, unlined forehead.
"Yes I had preventative Botox at 28," reads the caption on the video, which has been watched more than 2.2 million times. "I am so happy with the results!!"
Viewers agreed, flooding the video's comments section with compliments about the woman's youthful appearance and how natural the result looked.
"This might have just convinced me," one person wrote.
In recent years, the tool kit for warding off visible signs of aging has expanded to include preventive Botox, also known as "baby Botox," which aims to soften the movement of facial muscles to reduce the appearance of fine lines and wrinkles before they become permanent. While Botox received FDA approval to fight existing wrinkles in 2002, experts say preventive injections are a more recent trend, fueled in part by influencers on social media and advertisements targeting younger people. For many people in this age group, particularly women, "the gospel of prevention has just seeped into their everyday vocabulary," said Dana Berkowitz, a sociologist and author of "Botox Nation: Changing the Face of America."
From 2000 to 2019, injections of Botox — a neuromodulator scientifically known as botulinum toxin, which blocks certain nerve signals to muscles — rose 878% in the United States, according to a report from the American Society of Plastic Surgeons. One possible indication that preventive Botox is responsible for some of that increase is the fact that people ages 20 to 39 made up about 20% of all botulinum toxin procedures reported in 2019.
While some dermatologists and plastic surgeons say they are seeing rising numbers of men coming in for preventive treatments, the majority of people interested in starting Botox at a younger age, they say, are women in their mid-20s to mid-30s.
"This is a generation who is getting facials and taking care of their skin and using natural makeup," said Ashley Amalfi, a plastic surgeon in Rochester, New York. "Doing Botox to prevent aging and to prevent wrinkle formation has just become an extension of that."
But while experts say preventive Botox can be a safe and effective, they also caution against thinking that it's the norm — or the only approach to slowing signs of aging. Some people may think "if you're not doing it, you're not beautiful, and that's simply not the case," said Tina Nandi, an assistant professor of dermatology at Johns Hopkins University. "It's an option for people to consider, but absolutely not requisite."
Here's what Nandi and other experts say you need to know about this treatment trend.
Understand how preventive Botox works
When you frown, smile or furrow your brow, your facial muscles contract and "crease the skin over and over," said Naomi Lawrence, director of micrographic surgery and cutaneous oncology at the Center for Dermatologic Surgery at Cooper University Health Care in New Jersey. As your skin ages and loses elasticity, this creasing can leave permanent lines, "so it just makes sense that softening that movement before the lines form really can do a lot to making you look better at every age."
Injecting small amounts of botulinum toxin into targeted muscles temporarily weakens and relaxes them, according to the American Academy of Dermatology. Preventive Botox typically requires less product and fewer treatments than if you were tackling existing wrinkles. If done correctly, you should be able to retain natural facial movement where the injection was administered, "but you won't be able to scrunch that area hard and cause those lines," Lawrence said.
Effects typically last about three to four months, but Amalfi noted that if you're starting in your 20s or 30s, you may be able to space out treatments to once or twice a year.
However, experts warned that complications can arise if Botox isn't injected properly, which may lead to bruising, facial asymmetry and drooping.
"The big complication with Botox would be if the Botox drifts into an unintended muscle," Lawrence said. "Sometimes it's used around the lips for the radial lines and it drifts into a muscle that can cause the corner of the mouth to droop." This tends to be linked to injections that have been hyperdiluted to stretch supply, she said.
There doesn't seem to be much research on the long-term effects of preventive Botox, positive or negative. It is possible that prolonged use of Botox in traditional or preventive amounts may cause muscles to weaken over time and give skin a thinner and looser appearance. But, Nandi said, those issues are often the result of "poor administration" and can be avoided if you go to an experienced and qualified medical professional.
Consider the potential commitment
The cost of each treatment can range anywhere from several hundred dollars to upward of $1,000, experts said. Prices depend on how many areas of the face are being treated and how much product is needed. As with traditional injections, preventive use will require continued maintenance, Nandi said. A one-time treatment will only result in "transient improvement ... that doesn't really affect your long-term goal of wrinkle prevention."
While patients often ask Murad Alam, a professor and vice chair of dermatology at Northwestern University's Feinberg School of Medicine, if something bad will happen if they decide to discontinue treatments, the answer, he said, is "a very unequivocal and certain no."
But many people who start Botox can find it hard to stop, Berkowitz said.
"One of the problems with Botox is that it really exposes the flaws of our natural faces, and all of a sudden our natural faces just become not good enough really quickly and become something that we can improve relatively easily," Berkowitz said. "That process of upgrading and upkeep," she added, "it just never stops."
She said that out of the dozens of people she interviewed for her book, only one, a man, stopped using Botox. Even Berkowitz, who initially got Botox treatment for research purposes when she was in her mid-30s, became a user.
"I really very quickly understood the appeal of Botox," she said. She had several more treatments before stopping, but said she'd be open to starting injections again in the future.
Do your research
If you're interested in preventive Botox, experts recommend reading up on the procedure, having an idea of how you'd like to look and finding a qualified medical professional you trust.
Alam suggested asking your providers about their qualifications and how often they administer Botox injections. Then you should ask them what their injection plan is, what benefit they think you'll see, and what to expect during and post-treatment.
Before your consultation, consider looking at safety information on botulinum toxin provided by professional organizations such as the American Academy of Dermatology and the American Society of Plastic Surgeons, Lawrence said.
People who are pregnant or nursing or are planning to conceive should not receive injections, Nandi said. Use of neuromodulators should stop six months before conception. You should also avoid the treatment if you have allergies to any of the components or a family or personal history of neuromuscular disorders.
Potential side effects to watch out for in addition to the bruising, drooping and asymmetry mentioned above include pain at the injection site, and headache or nausea. After you receive Botox, avoid immediately lying down, rubbing the treated area or doing activities that would require your head to be in unusual positions.
"If you are doing yoga and you're doing downward dog and your face is in a not vertical or upright position, then you risk the migration of product after administration," Nandi said.
Social media and the rise of youth-obsessed trends in skin care and beauty can put pressure on younger people, especially women, to start treatments such as preventive Botox, Berkowitz said.
"I would really advise young women to just be critical about the messages they're getting about what they should look like and what sort of things they should do to make them look a certain way," she said.
And, experts said, you also can consider other skin-care treatments that can help delay the effects of aging.
"You can achieve almost the same results if you're dedicated to regular sunblock use and a topical retinoid," Nandi said. "You don't have to undergo these procedures to maintain a youthful appearance. It's absolutely not imperative."