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Dr. Wars: Is it OK for 20-year-olds to get Botox?

It’s often debated if women should enhance their looks with surgery, injections and other purely cosmetic procedures. With so many photoshopped advertisements, magazine photos and other forms of entertainment being edited, people of all walks of life are striving to look their best.

Woman in 20s having botox

It’s a personal decision, after all, but we wanted to know: How young is too young? More specifically, should women in their 20s get Botox or Xeomin injections? We pooled a few doctors to get their opinions.


YES, says Dr. Anthony Rossi, M.D., of NYC’s Juva Skin & Laser Center

SheKnows: Should doctors perform Xeomin on women in their 20s?

Dr. Anthony Rossi, M.D.: If a patient in their 20s has concern of facial wrinkles, such as glabellar frown lines, then it is OK to use Xeomin for this area. Dermatologists know that the etched-in facial wrinkles appear over time due to the contractions of the underlying musculature. Repeated contractions and actions of these muscles dictate how one’s wrinkles will look over time. These include forehead wrinkles, frown lines and crow’s feet. There are also sleep lines that form from how a patient sleeps.

SK: Is this treatment a preventative measure for additional wrinkles?

AR: Yes, these treatments are preventative measures for additional wrinkles. By not allowing the muscle to contract, it is preventing the occurrence of the skin fold and thus preventing the wrinkle from setting in. By initiating Xeomin neurotoxin in a patient’s 20s, it helps to prevent the movement of the specific facial muscle and therefore diminishes the occurrence of etched-in wrinkles. This could have a dramatic effect on how the patient will look in their 40s or 50s.

SK: What is the appropriate starting age for Xeomin? How young is too young?

AR: There is no set age to start Xeomin. I see some patients who are in their early 20s and already have etched-in wrinkles, whether it is because of strong facial muscles and excessive sun exposure [or something else]. They may be good candidates for Xeomin neurotoxin to diminish wrinkles and prevent further ones. The longer one waits, the more etched in wrinkles become. In the same vein some patients ask, “Is it too late to start?”

SK: Where is the site of injection for most 20-somethings?

AR: The FDA approved Xeomin for moderate to severe glabellar lines. This is the site of frown lines (scowl lines) and therefore is a common place for injection. These lines also occur when patients may be pensive.


MAYBE, says Dr. Harold Lancer, M.D., FAAD

SK: Should doctors perform Botox on women in their 20s?

botoxDr. Harold Lancer, M.D., FAAD: All too often I see cases where there have been overly injected young people who have had too much filler and neurotoxin in their face for so long that their skin is stretched, cells full and in overall poor condition inside and out. They have been “overdosed” and we have to work very hard for months to come up with a plan to rectify the issues. There are so many other ways to achieve beauty — this is not the only answer.

I am an advocate of Botox (and similar injections) as long as it is used in the right circumstances, on the right person with the right understanding, and to achieve the right result. I liken receiving Botox to taking Advil when you have a headache. You take a little when you need it as opposed to a daily event. It works as it should and provides relief. It is not to be used as a crutch or to maintain your existence.

SK: Do you feel that younger patients aren’t mentally prepared for this, or that it can be addictive for younger individuals?

HL: Honorable (board certified) dermatologists will say to their patients that there is an important and significant difference between “need’ and “want.” A patient may want to receive Botox (or similar injections), but a good practitioner will ask their patient why they want the procedure and try to figure out what psychologically is behind this so-called need and find alternative ways to help them feel good and look good without administrating unnecessary injections. Very often we find that facials, oxygen, lasers, power peels, micro-dermabrasion, light and radio frequency treatments, microcurrent and the first line of defense — great home care — can often have patients finding complexion perfection and feeling beautiful avoiding these more invasive protocols at such a young age.

SK: How young is too young?

HL: While it is perfectly legal for any age group to receive Botox (or similar injections), as they are used for things other than cosmetics including excessive gum recession, sweating, headaches and other medically diagnosed purposes, I believe in ensuring that cosmetic neurotoxin injections are used ethically, morally and safely. If used in very low dosages, these injections are usually safe, but the consumer should always be made aware that these injections can and do sometimes have negative effects and can be mentally addicting.


NO, says Dr. Richard Norden, M.D., F.A.C.S, of New Jersey’s NORDEN Laser Eye Associates, which offers Botox.

SheKnows: Should doctors perform Botox on women in their 20s?

Dr. Richard Norden, M.D., F.A.C.S: No studies or evidence show that Botox at a young age will prevent wrinkles from forming in the years to come. Is it possible it could work that way? Yes, but nothing has been proven yet. I wouldn’t want to tell my young patients that getting Botox in their 20s will equate to them never getting wrinkles as they mature. That simply hasn’t been proven and I wouldn’t want to mislead anyone.

SK: What age is it OK to start Botox?

RD: Women in their 20s frequently don’t have many wrinkles and sometimes they may not see a huge difference because there wasn’t much to improve on in the first place. When I work with women in their 40s or 50s, the results are generally much more noticeable. Botox can also be costly. It can cost a young woman thousands of dollars if she starts treatments at a young age and continues receiving them in the upcoming years.

SK: Do you feel that younger patients aren’t mentally prepared for this, or that it can be addictive for younger individuals?

RD: Botox is in fact a drug that you are injecting, so side effects are possible despite one’s age. That being said, it is an extremely safe procedure and there’s a reason why it is one of the most popular in our country. So, if someone wants to get it done at a young age, it’s a better option than something more permanent (plastic surgery, etc.).

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