Reading: The Dangers of Using Wrinkle Relaxers – Too Early

Since cosmetic Botox’s debut in 2002, neurotoxins (including Dysport and Xeomin) — which freeze muscle movement in order to reduce the appearance of wrinkles and furrows — have become the gold standard for anti-aging treatments. In fact, some dermatologists encourage women to start using one of these three FDA-approved neurotoxins while in their 20s and early 30s to get an early start in the fight against wrinkles. The idea: If you can’t furrow your forehead in the first place, you won’t end up with etched-in lines and wrinkles.

But not everyone agrees with this logic, including prominent New York dermatologist Pat Wexler. While she is a big fan of neurotoxins (she started using Botox on her own forehead in 1990, was part of the original Botox  clinical studies, and administers it daily in her offices today), Dr. Wexler advocates pumping the brakes, not just for younger patients but also for women who may have been overdoing the treatment for years.

Katie Becker: You’ve said that you’re not on board with the concept of “preventative” neurotoxins. Why is that?

Pat Wexler: I don’t think you should be treated anywhere until you see wrinkles at rest, when they persist after using the [muscles]. Before you see wrinkles or folds, you’re not seeing evidence of damage. I do believe in being proactive about aging by using sunscreen and anti-aging products, not smoking, being careful about the environment. But this is the deal: The paralysis [caused by Botox] can cause the muscle to atrophy, which can leave the forehead looking older.

Katie: How does a weaker forehead muscle make you look older?

Pat: We’re born with a certain tone to our skin that’s dependent on the structure: your muscle, your fat, your dermis, your epidermis. When you start using [neurotoxins] and preventing the muscle movement, you eventually decrease the volume of the muscle as it atrophies over time. In fact, you can find total absence of the muscle on autopsies of somebody who’s had a botulinum toxin such as Botox in the same muscle over a period of 30 or 40 years. If you don’t use the muscle, you become like somebody who’s had a stroke or a muscular disease — the muscle gets weaker and weaker until the fibers are basically no longer there. Then the skin over the muscle gets slack because there’s no longer volume to support it. In my own case, I could no longer feel my muscle that I used to inject — it had gotten so small after 25 years.

Katie: So overusing neurotoxins can, essentially, backfire?

Pat: I find that patients who’ve used toxins for enough years have thinner, looser forehead skin [that lacks] that youthful curvature. Veins are starting to show, and their brows are getting lower. Sometimes patients complain of getting wrinkles that they didn’t have before; that’s because they’re recruiting muscles from other areas. If you’re using toxin from a very young age, and you don’t have wrinkles to begin with, you’re going to pull [muscle support] from other areas of the face; that’s why people develop bunny lines [wrinkles that appear between the nose and the tear duct of the eye]. We never treated bunny lines 25 years ago; we started because people who couldn’t use their forehead anymore started squinting with their noses.

Katie: Can you talk more about how overuse became an issue for you personally?

Pat: I had been using Botox every three months for 25 years. I used to have a very thick forehead muscle and I would pinch the muscle to inject it, but there’s nothing to pinch anymore because the muscle is so diminished. So, I stopped using Botox for two and a half years and now I realize that my muscle’s coming back. I’m just starting to squint again, so I may give myself a little diluted Botox. This is a dynamic process and it’s been very interesting to watch. I’ve been my own little study. Sometimes you need to take a break, and now I tell my patients — when they don’t need it — that we can wait for another six months.

Katie: If a woman has overused neurotoxins and is now seeing a lax forehead or a dropped brow, what should she do?

Pat: First she should take a break. Beyond that, now we’re doing procedures on the forehead like Infini  and Fraxel (laser treatments) and Ulthera (ultrasound) to make the skin tighter and lifted. It’s also not unusual for people to have volume injected into their foreheads, right above their brows.

Katie: What would you say to younger women who are considering preventative toxins?

Pat: Don’t use Botox before you need it. It’s not really preventative, and then at what age do you start? Your 20s? Your teens? There is a point when it is reasonable, when you see physiological symptoms of needing it (such as wrinkles that persist even after you stop making a facial expression), but you shouldn’t treat to prevent something that may or may not happen for 10 or 15 years.  Instead, you could have a microdermabrasion or a DermaSweep to improve the skin tone and texture. Take care of your skin now and you won’t have to worry about treating imaginary wrinkles.

Katie: What should you say to your dermatologist to prevent him or her from overtreating you? 

Pat: Say you want to look natural, you want to be conservative. That you want to relax the muscle, not necessarily have perfection-like total paralysis.

Katie: Is overuse of toxins commonplace today?  

Pat: Yes, and the same with filler. I think people tend to have full faces with little expression. But I like to leave expression. Sometimes people feel inhibited by not being able to lift their brows. If that’s how you express yourself and that’s part of your persona, you may experience a very claustrophobic feeling when you can’t. So leaving some movement for expression is important. We need to communicate with each other. For some people, it’s not much expression [laughs], but it’s helpful to get signals from people about how they feel.