Are You Beyond What Botox Can Fix?

Many dermatologists advocate for early action because it keeps fine lines from becoming deep creases, which are harder (and, frankly, pricier) to treat. We investigate what the sweet spot really is when it comes to efficacy.

By Genevieve Monsma
woman with crinkly eyes


About Starting Botox Treatments Early

Marnie Nussbaum, M.D., a Manhattan dermatologist and a clinical instructor of dermatology at Weill Cornell Medical College, began getting Botox twice a year at thirty, took a four-year hiatus in her mid-thirties to have two kids, then started back up in her late thirties. She believes that being an early adopter (even with the hiatus) “kept the muscles in my face from getting bigger and stronger and accelerating the deepening of fine lines,” she explains. She also says starting early kept fine lines around her eyes and on her forehead from deepening and becoming permanent creases. But is 30 the ideal age to start? Not necessarily. 

“It all depends on your DNA,” says Dr. Nussbaum. “Genetics do play a role in how quickly we age, so some women may want to start Botox at 30, while others still don’t really have deep wrinkles at 40 or even 45.” Hence, if you’ve never had Botox and are still relatively wrinkle-free, thank your parents—and think about whether preventive Botox is right for you, while you still have that option.

If, however, the prevention ship has sailed, and you already have deeply-etched crow’s feet or vertical lines between your brows 24/7, you have two choices: Accept them and move on, or get thyself to a cosmetic dermatologist.

The Facial Fountain of Youth?

Getting neuromodulator injections at any age, even if you’ve never had them before, will garner you some visible improvement, says Dendy Engelman, M.D., a Manhattan dermatologist and the director of dermatologic surgery at Metropolitan Hospital. No matter how old you are when you start, they work the same way. “Botox temporarily weakens muscles that causes dynamic lines, and it’s the dynamic lines that eventually turn into static lines that are present all the time, even at rest,” she explains. So, by minimizing dynamic lines, even if you’re 55 or 65, you can still impact the depth (present and future) of static lines. That’s the good news. The reality check, however, is that if you have deep lines, you’ll likely not see instant-smoothing like those in Dr. Nussbaum’s camp, who started and invested early.

If you’re okay with moderate improvement, great; Botox alone will probably get you that. But if your goal is to completely erase your creases, you may have to invest in more than just neuromodulator injections. Why? Well, consider this analogy: When you promptly remove your bed sheets from the dryer, wrinkles are pretty easy to smooth out with your hands. But if you delay an hour, and the linens cool inside the drum, the wrinkles become set. Now, to remove them, you will need hand-smoothing, linen spray, and  a hot iron.

Pairing Botox Injections with Restylane or Fraxel

Similarly, to really smooth out deeply-etched lines in the skin, doctors may couple Botox with a hyaluronic acid filler (like Restylane) to plump deep creases—or laser resurfacing (like Fraxel) to make them shallower. Both of these treatments can also stimulate your skin’s own production of collagen, the bouncy substance that makes skin plumper and firmer and lines less apparent.  This multi-pronged approach may, over time, even get you results that rival those of early Botox adopters and may also eventually enable you to downshift to just twice- or thrice-yearly Botox maintenance. But the initial supplementary treatments come with a cost: The average price of Restylane injections is $750, while the average amount of a Fraxel session is $1600. So, while you may have saved money early on by skipping years of Botox, you will have to pony it up now to achieve results similar to the Botox early birds. 

Preventing Wrinkles? Or Reversing Aging?

The bottom line? The better tactic is really up to you. If you start Botox early with an eye toward prevention, you may spend more money and time in a doctor’s office initially, but you’ll probably never develop deep creases and may be able to avoid extra anti-aging costs down the road. Conversely, if you wait(ed) on Botox, and now want to get rid of deep lines, you should understand that Botox, on its own, may not be enough to make them disappear. 

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