Can Botox Make You Look Older?

It’s the stuff of horror movies: Your go-to anti-aging treatment suddenly ages you. Fortunately, in the case of Botox, the nightmare is not only treatable, but preventable.

By Alexandra Parnass
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My friend J. looked different the last time I saw her. No stranger to Botox and filler, J. has always looked years younger than her age (51), and never like she's had ‘something done.’ It had been about a year since we’d gotten together, and while she had definitely lost some weight, there was something funny about her face that I couldn’t quite put my finger on. (Another friend at the table had acquired lips that entered the room before she did, but that’s another story.)

By the time the waiter poured the Pinot, I realized what it was: J.’s brow line had dropped. A lot. While her forehead was lineless, there was a distinct heaviness to her brows, which made her beautiful eyes look hooded, smaller, and tired.

Her expensive cosmetic work was making her look older. 

For the next week everywhere I went, I noticed women over 40 who were clearly fighting the good fight (Retin-A’d poreless skin! Volumized cheeks!) with wonky-looking foreheads that were smooth but weighed down with heavy brows. This was clearly a thing. Why were so many otherwise fabulous-looking women afflicted with this brings-to-mind-a-Neanderthal brow?

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REALITY CHECK

For many women, Botox has become a bi- (or tri-) annual ritual as routine as going to the dentist. Often the gateway drug to more extensive cosmetic treatments, Botox is a highly effective wrinkle reducer that some women begin as early as their late teens. Now, if you've been getting Botox for many years, you may come to expect your doctor to inject you the same way every time, particularly if you’ve always been happy with the results. But the reality is that we all age continuously, and consequently, what’s good for your 35-year-old forehead lines might not be right when you’re 50, particularly if you want to look as natural as possible. “When you see someone whose forehead looks funny, it can be because they are being treated too generically. There are right ways and wrong ways to use Botox,” says New York dermatologist Robert Anolik.

WHY BROWS FALL

“With time, your brow naturally drops,” explains New York plastic surgeon Steven Pearlman. “And you get a natural heaviness to your forehead.” A quick primer on Botox: If you raise your brows, you are engaging the muscles that hold up your brow line. When you’re young and your brow line hasn’t started to sag, injecting those muscles simply serves to smooth out the lines on your forehead. But “if you continue to use the same dose of Botox in the same place in your forehead when you already have some falling of the brows, it can cause ptosis (drooping of the brows), which encloses your eyes,” says New York dermatologist Neal Schultz. Note to self: This explains J.’s funny-looking forehead. 

Mind you, not everyone thinks a droopy brow line is a bad thing. “Some people don’t mind having a lower brow as long as they have no lines or folds on their forehead,” says Pearlman.

What’s good for your 35-year-old forehead lines might not be right when you’re 50, particularly if you want to look as natural as possible.

WHAT TO DO ABOUT DROOPING BROWS

If you feel that Botox is exacerbating your droop, the experts agree that you may want to consider a surgical brow lift. But do you need to stop using Botox in your forehead the second your brows start to droop? Not necessarily. 

First of all, if you’re going to a reputable injector, he or she will alter the placement of your Botox over time so that the droop in your brow is not as pronounced. “We don’t go from full Botox to none,” says Schultz. “We start doing less in the lower forehead, then less in the entire forehead, then we stop all injections in the lower forehead and do less in the upper forehead. And if your brow is still drooping, that’s your last Botox,” he says, adding, that some doctors are not aware of these limitations because they haven’t had the experience or training or don’t understand the musculature of the face.

Anolik echoes the strong recommendation to seek out an experienced dermatologist or plastic surgeon: “If you go to a place for Botox that is drive-through and standardized, it will be poorly done.”

Anolik says that no matter your age or level of brow droop, you don’t need to stop using Botox between your brows, where it smooths the deep vertical lines created when you furrow. “When you treat that area properly it will also give your forehead a lift because it releases the downward pull of those muscles,” he explains. 

Loretta Ciraldo, a dermatologist in Aventura, FL, has a novel solution, claiming she has achieved successful results for some patients by cutting out the Botox entirely and injecting volumizing filler right above the hairline, which she says produces a good lift if your skin has enough elasticity. It’s “a nice alternative when Botox stops looking good in your forehead,” she says.

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Of course, every good doctor has an arsenal of tools such as fillers, lasers, and radiofrequency devices that can be used on the face to help your overall look. “The view I take is [doctors] need to be like artists. An artist has a palette of many different colors,” says Ciraldo. Strategic use of Botox in the jaw and neck, and filler in the cheeks, temples, and lips can all help make you look younger.

Ciraldo, who admits to having had too much Botox into her own forehead, only to realize she looked worse, says, “Is it advantageous to have no lines at the cost of looking older?” Clearly too much of a good thing is no good.

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