‘Baby Botox’ may worsen wrinkles

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published May 17, 2024

Key Takeaways

  • “Baby Botox” is a term that originated on social media for smaller-than-usual doses of the botulinum neurotoxin. This procedure has become a hit among younger patients for preventative anti-aging or regular touch-ups. 

  • Its use among those under 19 has risen, potentially leading to more frequent treatments over their lifetime. 

  • While the effects are temporary, long-term use may result in permanent changes, including muscle atrophy and reduced strength.

Originating on social media, the cutesy-sounding term "baby Botox" is essentially a form of preventative anti-aging treatment using smaller-than-usual doses of botulinum toxin. The technique has become a hit among young adults in their 20s looking to tackle signs of aging preemptively. 

Practically speaking, baby Botox allows for a more dynamic facial expression post-treatment, reducing the risk of the “frozen” look associated with regular Botox. It’s suited for those starting early on anti-aging regimes or preferring a lighter touch to their cosmetic enhancements. 

However, baby Botox is not just growing among young adults in their 20s—teenagers are seeking these treatments as well, begging the question: How early is too early?

Neurotoxin use increasing among youth

Approved by the FDA in 2002 for cosmetic use in individuals over 18, botulinum neurotoxin type A (BoNT-A) is increasingly being used off-label in younger populations.[] The American Society of Plastic Surgeon's 2022 report indicates that 25,308 patients aged 19 and under received neuromodulator injections (eg, Botox, Dysport, Xeomin, and Jeaveau), marking a 75% increase from 2019.[]

While Botox does have its place in pediatric and teen medical treatments (approved for conditions like strabismus and blepharospasm in those 12 and older, cervical dystonia in those over 16, and hyperhidrosis over 18) it’s the cosmetic use in youngsters that's raising eyebrows.[]

We’re talking about off-label applications for issues like forehead lines, glabellar lines, crow's feet, benign masseter hypertrophy, and subtle body contouring of the shoulder and calves.[][]

However, most of these kids don’t even have wrinkles yet, so they're using neurotoxins, in the form of baby Botox, at much lower doses—and preemptively—which might not always be the wisest choice.

Should we blame social media?

Our society promotes addictive behaviors, and social media eagerly plays along. In today’s world, people are quick to buy into the allure of beautifully packaged creams and serums, hoping they'll provide a quick fix for a problem that may not even exist. And if one product fails, there's always another to try—or perhaps a cosmetic procedure, like Botox.

According to a 2023 research study done in Saudi Arabia, “about 83% of the young population seeks medical information or attention over the Internet.”[] The study also found that around a third of participants expressed a willingness to undergo facial cosmetic procedures influenced by social media, with half of them already planning a specific procedure for the future.

Why starting early is a bad idea

In a 2023 review, Swedish researchers discussed the neurophysiology of BoNT’s long-term effects.[] BoNT-A, they explained, targets the SNAP-25 protein within nerve terminals, blocking acetylcholine release and preventing muscle contraction. This leads to a temporary paralysis of affected muscles. Initially, nerve recovery involves the formation of new sprouts, not vesicle turnover in the original nerve terminals, which takes about 2 months post-injection to resume. A secondary phase sees these sprouts retract as the original terminals regain function, possibly taking up to 6 months.

The authors concluded that “Aesthetic botulinum toxin injections may result in atrophy of the injected facial muscles.” Furthermore, “Serial injections of botulinum toxin in the facial muscles may cause permanent chemical denervation.” Therefore, starting Botox use early, especially in the teens or early 20s, could raise the risk of muscle atrophy with repeated usage in later years.

In fact, permanent changes in muscle composition, such as increased collagen and reduced strength, may occur even after the muscle regains movement. This has been observed in animals and humans, based on long-term studies as cited by the reviewers.

In one study involving two men, a significant reduction in muscle volume lasted up to 1 year post-injection.

While some might argue that cosmetic Botox is just another beauty fix, as a healthcare professional encountering young patients desiring these treatments, you must always gauge their mental maturity and understand their motives. In some cases, these desires may stem from body dysmorphia. Always involve parents if the patient is underage, and consider a psychological evaluation to fully understand the reasons behind the patient’s desire for these image-altering treatments.

What this means for you

Introduced for medical purposes and later approved for cosmetic use about two decades ago, neurotoxins like Botox initially targeted a middle-aged demographic. Now, it's a trend among the youth worldwide. While baby Botox is reversible within 4 to 6 months, frequent use can lead to muscle atrophy due to disuse. Always discuss the potential long-term effects with your patients and understand their motivations for seeking potentially harmful treatments.

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