Botox and the Power of Prevention

By Mark Pilatowski

A clinical guide to one of skincare’s most misunderstood products

Botox® can often feel mysterious or confusing. At Peachy, we believe in rigorous scientific evidence and accessibility to the information you need to make the right decisions for you. That’s why we’re breaking down the basics of wrinkle relaxers - what they are, how it works and when to start using it.

First, what is Botox®?

Botox® is one brand of the four FDA-approved neuromodulating proteins – the other name brands are Xeomin®, Dysport®, and Jeuveau.® All four FDA-approved brands act through the same general mechanism. 

As neuromodulators, they allow specific muscle groups to relax without changing their structure. Botox® is approved for three specific muscle groups – in between the eyebrows (procerus and corrugator muscles), forehead (frontalis muscle) and crow’s feet (orbicularis oculi muscle). 

Botox®  is preventative and not appearance altering  

Permanent lines manifest over time as repeated muscle contractions result in the breakdown of skin tissue. By directly targeting and relaxing specific muscles, Botox®  prevents the formation of these permanent lines. When used in controlled amounts for wrinkle prevention at the FDA approved sites, Botox® does not change one’s natural appearance or the shape of one’s face.

Once dynamic lines (think of lines visible when smiling) become static lines (those visible at rest), they can only be rectified by other more invasive treatments such as filler or skin resurfacing. Dynamic-to-static wrinkle transition is the main driver of wrinkle formation in persons aged 20-50. In the long term, Botox®  treatments dramatically slow, if not halt, this aspect of the aging process.

When should I start getting Botox®?

Whenever you feel comfortable! To get the full preventative benefits of Botox®, you should begin using it before dynamic wrinkles progress to static wrinkles.  For most people, this is around age 25 to 30, but everyone is different.

How to check for dynamic wrinkles at home:

Look in the mirror.  Do you need Botox Step 1: Look in mirror

    Raise your eyebrows. Are there lines that form on your forehead when you raise your eyebrows high? 

    Do you need Botox Step 2: Raise your eyebrows

    Furrow your eyebrows. Are there lines that form in between your eyebrows?

    Do you need Botox Step 3: Furrow your Brow

     Make an exaggerated smile. Do you notice lines extending laterally from your eyes (i.e. crow’s feet)?

    Do you need Botox Step 4: Make an exaggerated smile

      If you answered yes to any of the questions above, you likely have dynamic wrinkles. If you’re interested in incorporating Botox® into your skincare routine, this is a great time to find a provider and discuss wrinkle prevention. If the wrinkles are still there after relaxing your face, they have transitioned to static wrinkles. Don’t worry if you have some static wrinkles! Botox® can also help prevent those static wrinkles from becoming deeper and more pronounced. In either scenario, Botox® is an effective tool in the treatment and prevention of wrinkles and can be used without altering your natural appearance or preventing natural muscle movement.

      Citations

      Carruthers JA, Lowe NJ, Menter MA, et al.; BOTOX Glabellar Lines I Study Group. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol. 2002;46(6):840-849. 

      Carruthers JD, Carruthers A. The use of botulinum toxin type A in the upper face. Facial Plast Surg Clin North Am. 2006;14(3):253-260. 

      Cavallini M, Cirillo P, Fundarò SP, et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg. 2014;40(5):525-536. 

      Michaels BM, Csank GA, Ryb GE, Eko FN, Rubin A. Prospective randomized comparison of onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport) in the treatment of forehead, glabellar, and periorbital wrinkles. Aesthet Surg J. 2012;32(1):96-102.  

      FDA approves Botox Cosmetic to improve the appearance of crow’s feet lines [news release]. Silver Springs, Md.: U.S. Food and Drug Administration; September 11, 2013. http://www.fda.gov/newsevents/ newsroom/pressannouncements/ucm367662.htm. 

      Binder, W. Long-term Effects of Botulinum Toxin Type A (Botox) on Facial Lines. JAMA Facial Plastic Surgery. Nov/Dec 2006.

      Cohen, J and Ozog D. Botulinum Toxins: Cosmetic and Clinical Applications. 2017.