Wendy Ouriel
Botox is the trade name for Botulinum toxin, a neurotoxic protein that blocks the release of the neurotransmitter acetylcholine that causes paralysis. Among the most common uses are aesthetics to prevent or reduce wrinkles in the skin.
Using toxins to paralyze the muscles for its aesthetic effect will have the long-term effect of aging skin because the treatment disrupts natural muscle function and prevents the effectiveness of cosmetic and surgical anti-aging methods.
When you use Botox, the muscles near the injection site are paralyzed for about 6 months and this prevents facial movement in the affected area. Short-term results include the temporary reduction of wrinkles. However, long-term effects include muscle atrophy in 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 each injection, the muscles decrease in quality, droop and cause sagging and wrinkling of the skin.
For this reason, too, long-term users of Botox have noted that their muscles and skin stop responding to the injections after many years of treatment, requiring more injections in a shorter period of time. Users have noted that their skin sags faster, wrinkles faster and this creates the need to do more and more injections just to get the same effect that the injections once had.
There is a threshold for Botox and after years of injecting the toxin into your body, having to do more and more injections just to get a past effect shows that the injections themselves are what make the skin age faster .
The permanent damage
Botox can even cause permanent skin damage immediately after one treatment. The following have been noted to occur in patients after a Botox injection:
Overcorrection– AKA the ‘Frozen Face’ feature associated with Botox injections. When someone’s face eerily stops moving except for their mouth when they speak, this is indicative of overcorrection caused by Botox.
Undercorrection– AKA ‘Spock Eyebrows’ where the eyebrows are raised, giving a somewhat permanent surprised look.
Asymmetric effect– Seen when one side of the face is more elevated than the other, giving the face a skewed symmetry.
Upper eyelid drooping– Perhaps the most common complaint from Botox is drooping of the upper eyelid.
Additional complications include:
Dysphagia, neck weakness
Perioral decline
Compromised outcome in the elderly
Bruises
Intravascular injection
Corneal, exposure keratosis
Bullet piercing
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 increased sensitivity to noise and lights, acute anxiety, severe fatigue, and insomnia.
Psychological effects such as depression and suicidal thoughts were also reported. Such psychological effects may also have been exacerbated by user reporting of small and unwanted physical changes to the skin with fear of potential, future side effects such as injection addiction and permanent skin damage.
Botox ages the skin
When you don’t exercise, your body is less toned, the skin sags and has a reduced aesthetic quality. The same goes for your face. When Botox is used over a long period of time, the lack of muscle use causes muscle atrophy which causes the muscle to shrink and sag just like it would anywhere else in the body.
When facial aging occurs during the natural course of one’s life, there are many causes. There is loss of facial fat, elasticity, collagen and also there is loss of muscle in the area. Loss of muscle tone underneath also causes skin quality to drop. This is why fillers don’t make a 65 year old woman look 18, facial aging isn’t just about wrinkles.
Botox also increases skin wrinkling in adjacent areas of the face because when one area of the face becomes paralyzed, it makes other areas of the face work harder to make an expression. The result is deeper wrinkles in non-paralyzed areas. This can be tested in the following way: raise one eyebrow and observe the movement and sensation of the muscles. Then press your finger firmly over that eyebrow and now try to lift it. The new muscles now have to work to lift the brow and they work harder and this causes new folds to form.
What’s also worrying about Botox is how it prevents anti-aging measures from working. If you are getting Botox injections, this means that fillers, facelifts and skin treatments 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 more easily. Modern facelifts involve folding the muscle instead of just pulling and pinching the skin, if the muscle has been damaged over time by the toxin injections, this means the facelift will not work. And for skin care, skin care can’t lift skin, so very sagging, Botox-damaged skin won’t be fixed with serums or peels.
Poisoning by toxins
Research has also found that the Botox botulinum toxin can move to other areas of the body. The possibility of poisoning increases in those who inject more frequently (several times a year). Symptoms include dysphagia (difficulty swallowing), fatigue and vision problems.
Botox can also enter the circulatory system and affect the immune system. Effects on the immune system have been seen in both high and low dose Botox patients.
Bone loss
Botox has also been shown to cause bone loss. Warner et al (2006) in their study of mice injected with Botox noted the following:
Muscle mass of injected quadriceps and calf muscles was reduced by −47.3% and −59.7%, respectively, compared with saline-treated 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 the Botox-injected limbs decreased −43.2% and −54.3%, respectively, while cortical bone volume of tibia decreased −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 injection of botulinum toxin type A into the masticatory muscles, the mandible shows bone loss as an adverse effect. Since this procedure is a widely used approach for various motor disorders in clinical dentistry, the potential damage to the mandibular bone should be considered and patients should be informed.
– 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 also occurs because muscle is needed for bone growth. Muscle is a local source of growth factors that build, grow and repair bone. Bone mass is primarily regulated by mechanical forces derived from muscles. Therefore, changes in muscle mass/strength also affect bone. This is why strength training has been shown to prevent bone loss.
Therefore, the above can be inferred that injecting the skin with Botox will cause bone loss in the area over time, leading to a deterioration of the skeletal structure and causing an aged appearance.
conclusion
I do not believe that Botox is a safe, antiaging procedure and the risks, including permanent aging of the skin, far outweigh the benefits.
The best thing to do is to simply maintain your skin with daily natural skin care, avoid skin-damaging practices like smoking, sunbathing and drinking, and be realistic about aging.
bibliographical references
Balanta-Melo, J., Toro-Ibacache, V., Kupczik, K., & Buvinic, S. (2019). Mandibular bone loss after masticatory muscle intervention with botulinum toxin: an approach from basic research to clinical findings. Toxins, 11(2), 84.
Niamtu III, J. (2009). Complications of fillers and botox. Oral and Maxillofacial Surgery Clinics of North America, 21(1), 13-21.
Vartanian, AJ, & Dayan, SH (2003). Complications of botulinum toxin A use in facial rejuvenation. Facial Plastic Surgery Clinic, 11(4), 483-492.
Rouientan, A., Otaghvar, HA, Mahmoudvand, H., & Tizmaghz, A. (2019). Rare complication of botox injection: 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, SE, Sanford, DA, Becker, BA, Bain, SD, Srinivasan, S., & Gross, TS (2006). The muscle paralysis caused by Botox rapidly degrades the bones. Bone, 38(2), 257-264.
Goodman, CA, Hornberger, TA, & Robling, AG (2015). Bone and skeletal muscle: key players in mechanotransduction and potential mechanisms of encapsulation. Bone, 8024-36.
Hamrick, MW, McNeil, PL, & Patterson, SL (2010). The role of muscle-derived growth factors in bone formation. Journal of Musculoskeletal & Neuronal Interactions, 10(1), 64.
Cianferotti, L., & Brandi, ML (2014). Muscle-bone interactions: basic and clinical aspects. Endocrine, 45(2), 165-177.
