Tiffany Rose Goodyear was 24 when she started getting Botox injections. She wanted to smooth the forehead wrinkles that she blamed on the habit of frequently raising her eyebrows.
The forehead lines did not make her look old, Goodyear said, and after the treatment few people besides herself noticed a difference. But at 29 she says she still uses injections, seeking to erase her existing lines and prevent future wrinkling.
"If I start at a younger age, when I'm older I'll continue to have that youthful appearance that our society so values," said Goodyear, who lives in Denver and owns a cupcake company. Getting wrinkle treatments now will spare her from more-drastic measures such as plastic surgery later, she reasoned.
Over the last few years, there's been a tremendous increase in the number of 20-something patients using Botox and similar treatments as a way to ward off future wrinkles, experts say. Many don't even have lines when they plop themselves into a chair to get injections.
There is no definitive evidence that Botox can prevent wrinkles from forming, and many plastic surgeons say using Botox before lines show up doesn't make sense.
A patient who starts in their 20s may receive decades of injections before they are actually needed, said Arthur Perry, a plastic surgeon who is the author of "Straight Talk About Cosmetic Surgery" (Yale University Press, 2007).
"The concept of trying to prevent future wrinkles is nutty," said Perry, who has a private practice in central New Jersey. "You don’t want to use a drug unless you need the drug, and Botox is a drug."
Can Botox prevent wrinkles?
Doctors have observed the trend of using Botox and a similar product, Dysport, for wrinkle prevention, and data show that injection use by the young is on the rise. In 2010, close to 78,500 people in their 20s received Botox in the United States, up 11 percent from the previous year, according to the American Society for Plastic Surgeons.
Botox contains botulinum toxin, a protein produced by the bacteria Clostridium botulinum. The drug is thought to work by blocking nerve signals to the muscles, thus relaxing them.
It's possible that Botox could prevent future wrinkling. Regular use of Botox seems to make the muscle-relaxing effect last longer so patients don’t need to come in as often for treatments, said Brian Glatt, a plastic surgeon in private practice in Morristown, N.J. This may occur because the muscle undergoes atrophy, or wasting, after prolonged periods of not being used, Glatt said, which could mean that wrinkles wouldn't form as readily on a young person who's had treatments for years.
In addition, if Botox is used regularly, the wrinkles that return when the drug wears off may not be as severe, Glatt said.
But even if injections were proven to prevent future wrinkles, they should not be used for that purpose, Perry said. "It makes no sense whatsoever to do that," he said.
"If you don’t have wrinkles, why do you need to treat it?" said Steven Pearlman, a plastic surgeon in New York City.
Although wrinkles appear on some people in their mid-20s, Perry said, they most commonly show up in the 40s or 50s.
A person who starts injections for wrinkle prevention in his 20s can spend about $30,000 on Botox treatments before real wrinkles show up in his 40s, Perry noted.
Furthermore, the products may cause serious side effects at any age. Botox can cause problems swallowing, speaking or breathing, plus symptoms of botulism, including muscle weakness, according to the company website.
What's the motivation?
The trend may result from a changing view of aging in our society. "We look at aging and any sign of aging as a disease," said Debbie Then, a California-based psychologist who specializes in women and appearance. "And therefore, people want to try to prevent that earlier and earlier and earlier.".
"People don’t even want to be over 30 these days, and nobody wants to look 30," she said.
While youthful looks have perhaps always been prized, the pressure on women to look young these days may be even greater, Then said.
With the rise of social media, the first thing someone might learn about you is what you look like in a photo, Then said. A young woman might be mortified when she sees someone else's looks ridiculed by social media commenters, and not want the same thing to happen to her.
And if your friends start doing Botox, there's more pressure on you to do Botox. "If you get one little line, you might look less attractive in comparison," Then said.
When should you get Botox?
Pearlman said that if you want Botox, you should wait until lines show up. And the wrinkles must be there when your face is at rest, not contorted through smiling or grimacing, he added.
"If you look at a 4-year-old when they smile, they're going to have lines next to their eyes" or on their forehead, Pearlman said. "Unless someone has lines at rest, they're not a candidate for Botox."
Until then, experts encourage other preventative measures to counter wrinkle development. Young people should wear sunscreen, practice good eating habits and avoid smoking to preserve youthful skin, Pearlman said.
Perry said, "If you're going to spend money, spend it on sunscreen, not Botox."
Pass it on: Adults should wait until wrinkles appear on their face while their face is at rest before seeking Botox treatment.
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Rachael is a Live Science contributor, and was a former channel editor and senior writer for Live Science between 2010 and 2022. She has a master's degree in journalism from New York University's Science, Health and Environmental Reporting Program. She also holds a B.S. in molecular biology and an M.S. in biology from the University of California, San Diego. Her work has appeared in Scienceline, The Washington Post and Scientific American.