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Was the concept of preventative Botox perhaps dreamed up by the wordsmiths behind clean beauty and anti-aging?

A woman’s face with dewy skin and lip gloss and hands are holding two needles up to her face

Vanessa Granda

A hashtag with more than 60 million views.

You slather onretinoids, you wear sunscreen, you get Botox … you get fewer wrinkles, right?

There are some studies, albeit a small number, pointing to the benefits ofpreventative Botox.

Now we have patients in their 20s asking about Botoxand most of them just dont need it.

Doctors are seeing a similar phenomenon in practice.

Now we have patients in their 20s asking about itand most of them just dont need it.

How is preventative Botox different from regular Botox?

(When we say Botox here and throughout the story, were referring toneuromodulatorsin general.

Bypreventingmuscle activity, theypreventthe skin from creasing, therebypreventingexpression lines from forming or deepening.

Theypreventmigraines, muscle spasms, gummy smiles,perspiration, and more.

Thus, one could argue that all Botox is preventative.

But if you expectBotoxto stop the aging process, you will be disappointed.

Getting Botox in your 20s will notwe repeat,willnothalt aging, says Dr. Hirsch.

Im never going to make someone happy whose goal is to not wrinkle, ever.

Thats an achievement I cannot guarantee.

In fact, I can only guarantee that Icantdo it.

Neurotoxins arent designed to stave off every crease, and Ive got thenasolabial linesto prove it.

Whats more, the expression lines they do target are only one manifestation of aging.

All of which are fairly worthless if youre not protecting your skin from the sun.

Whats the right time to start Botox?

Heres where things get a little divisive.

There are two main schools of thought on the ideal age to begin preventative Botox.

In his opinion, after you snag etched-in lines, its kind of a little bit too late forpreventativetoxin.

Relaxing the mighty corrugators may also postpone the arrival of horizontal forehead lines.

In some people, deep forehead furrows form as a result.

Its best to start countering forehead lines in youth, should you be so inclined.

The patient left her office upset and got her forehead injected elsewhere.

Weeks later, she called her original doctor to apologize for not heeding her advice.

The crows feet are an iffy area to treat preventatively.

Dr. Sarkar feels the same: I hate preventative Botox for crows feet, she says.

Her reason is a bit more complex.

Mounting research shows that neuromodulators can improve well being; theyre actually being investigated as a treatment fordepression.

(In a2018 study, crows-feet Botox was correlated with increased depression scores.)

And I dont want to interrupt those happy hormones.

The closest thing to it is a 19-yearcase reportof identical twins initiated in the early 90s.

One twin, living in Los Angeles, got Botox injections every four to six months for 19 years.

Her sister, in Munich, received only four treatments total during the study.

Her sister formed creases across her forehead and around her eyes.

Neither woman used retinoids or had other cosmetic treatments throughout the trial.

Proponents of preventative Botox often point to the work ofShannon Humphrey, MD, a board-certified dermatologist in Vancouver.

Even when injectingBotoxinto muscles, theres a measurable impact on the skin, Dr. Humphrey adds.

Theres science backing her observations.

In vitro modelsshow fibroblasts make collagen when incubated with neuromodulator, she tellsAllure.

And collagen-digesting enzymes are less expressed in the presence of Botox.

By intervening earlythe late 20s or early 30swe can impact the trajectory of aging."

The risks of preventative Botox

So, whats the catch?

Atrophy has become a dirty word in the context of neuromodulators (preventative treatments, in particular).

Think about how withered an arm looks after being immobilized in a cast for months.

In some cases, doctors use atrophy to our advantage.

The latest social chatter focuses on theforehead, however, which is not a target for intentional atrophy.

So when treating it, they usually avoid freezing it.

They aim to preserve its form and function by lessening lines with as few units as possible.

Sometimes, whats perceived as forehead atrophy, especially in those 40-plus, is actually something more.

The skin goes slack.

This happens to everyone, regardless of neuromodulator use.

And all of these factors can contribute to a flat or fallen brow.

I really venture to keep people on schedule, especially if theyre doing preventative Botox, says Dr. Hausauer.

One of the biggest things that cause those neutralizing antibodies is repeat exposure, says Dr. Bloom.

Getting Botox too frequently is a recipe for developing Botox resistance.

Key words: regular intervals.

You’re giving the body more chances to get confused.

But there is some element of the unknown here and anything too extreme is never going to be great.

Before boarding the preventative Botox bandwagon, research the pros and cons as well as alternatives.

Think critically about your goals and expectations.

Choose a doctor whose aesthetic and ethos aligns with your own.

And if they someday say No, listen and be grateful.

Now watch Kendall Jenner try nine things she’s never done before: