Figuring out when to start Botox — or if a treatment like that is even right for you — can be more complicated than it seems. While there's no perfect age to start and everyone's experience is unique, experts say there are some signs that you keep an eye out for.
For Dr. Shasa Hu, the time to start getting Botox was at age 35 after her first pregnancy. "After pregnancy, your body and your face change," Hu, an associate professor in the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine, tells TODAY.com.
"All of a sudden, you notice your facial aging is much more accelerated," she explains. "So that's what I noticed I was starting to get a little bit of lines in between my eyebrows. I just looked tired."
Hu waited until she finished nursing her new baby and then started getting injections. Today, 12 years later, she has no regrets — and she still gets injections every four months.
"I was never the type who wanted to freeze the aging process," she says. "I always wanted to be proactive, but never wanted to be too overly aggressive about it."
Hu's experience mirrors that of many of her patients who are trying to decide when it's time to look into getting injections like Botox.
What is Botox?
Botox is an injected medication that's used to manage wrinkles and fine lines. It's also approved by the Food and Drug Administration to treat migraines, excessive sweating and other conditions.
While Botox is probably the most well-known neuromodulator, it's not the only one on the market. Other options you might come across at a dermatologist's office include Dysport, Daxxify, Xeomin and Jeuveau. Some of those products, also called neurotoxins, might cost more or last longer than others, but they all generally work the same way.
"They block the release of a specific neurotransmitter (acetylcholine) from your nerve and that prevents the contraction of a particular treated muscle," Dr. Joshua Zeichner, associate professor of dermatology at Mount Sinai Hospital, tells TODAY.com.
Depending on the amount of neurotoxin that's injected, "it either softens the way that muscle contracts or completely paralyzes it," Dr. Evan Rieder, a dermatologist in New York City, tells TODAY.com.
That essentially relaxes certain areas of facial muscles, Hu says, which then prevents the facial movements that contribute to what experts call dynamic wrinkles or dynamic expression lines.
When should you start thinking about getting a neuromodulator treatment like Botox?
There's no specific age that's considered the best or perfect time to start getting neurotoxin injections, the experts say.
"The most common age group that I see is young women coming into the office for Botox for their 30th birthday," Zeichner says. "That just seems to be a milestone for a lot of people." But, he adds, that's not true for everyone.
Dr. Fatima Fahs, a board-certified dermatologist in Michigan and founder of Dermy Doc Box, tells TODAY.com that she also most commonly sees patients in their 30s. But there's a wide range.
"I see patients of all ages for first-time Botox in the clinic," she says, including people in their 20s and those in their 60s.
The experts agree that there's really only one sign to look out for that you might be ready for Botox or another neurotoxin: When you notice the first signs of fine lines or wrinkles on your face at rest (meaning you're not making a facial expression), that's a good time to chat with a dermatologist.
Most commonly, the first wrinkles people see forming are horizontal lines on the forehead, vertical "11 lines" in the middle of the brow, fine lines around the eyes or "bunny lines" along the bridge of the nose.
You should start the conversation when you first see those lines because, if you get neurotoxin soon enough, the lines can actually be reversed, Rieder says. "However, with time and increased muscle activity and facial movements over months to years, those lines become permanently etched in," he explains.
At that point, "they can be softened a little bit, but they'll never totally go away," he adds.
The effects of Botox-like injections typically last between three and five months, Zeichner says, while Rieder puts it at around four to six months. Other neurotoxins, like Daxxify, are marketed as longer-lasting alternatives to Botox, Hu says.
Zeichner and Rieder both started getting Botox in their 30s during their time in medical school residency, Ziechner at Mount Sinai and Rieder at New York University. It’s not uncommon for residents in dermatology to “teach each other how to do it,” Ziechner explains.
“I have actually gone through my fair share of bad Botox from inexperienced co-resident injectors,” he says with a laugh. That experience, “and seeing what I liked and what I didn’t like, really shaped my injection patterns,” he adds.
At the time, Rieder hadn’t even really considered whether or not he wanted it. “But once I had it, I was like, Oh, wow, I look a lot better now. And when I look in the mirror, I’m happier with what I’m seeing,” he recalls.
Dr. Fahs also got Botox for the first time as a 27-year-old dermatology resident. "We were receiving training on its proper use and I wanted to experience it first-hand to better be able to counsel and treat my patients," she explains. "Needless to say, I’ve been hooked since then."
In particular, she uses neurotoxin to address her "gummy smile" by injecting it into the upper lip area. Doing so gave her a lot more confidence when smiling, she says. Now 33, Fahs injects herself every three to six months around the mouth and eyes, between the brows and in the forehead.
What about preventive Botox?
In recent years, another school of thought has emerged: preventive Botox, also called "prejuvenation" or "baby Botox."
The idea here is exactly what it sounds like. Rather than waiting to treat wrinkles when they've already taken shape, some dermatologists use it in younger patients to prevent wrinkles from fully forming in the first place. This isn't a full treatment; preventive Botox usually requires a much smaller amount of product.
"They're coming in to get a tiny little sprinkle of Botox in key areas to prevent this from happening at all," Rieder explains. While some patients come in asking for this specifically, he adds, it's "never something that I bring up."
Because the effects of neurotoxin typically last less than six months, it's something patients need to get regularly to keep up the effects. "It will only work if you keep doing it," Hu explains.
The cost of neuromodulator treatment, which is generally in the hundreds of dollars, may depend on your location, the provider that you're seeing, the specific product they're using and the amount of product needed for your desired results, TODAY.com explained previously.
"If it's in your budget and it's something that you're interested in doing, I would encourage you to (consider neurotoxin) at the first sign that you're starting to develop a line," Zeichner says. "But there's a difference between preventative Botox and presumptive Botox."
Fahs also reminds young patients that the ability to be expressive and emotive is important. "Blunting this response at a young age isn’t natural," she says. "A much more important preventative process for wrinkles is regularly wearing sunscreen to avoid the breakdown of collagen."
Still, everyone's skin and muscle movements are different, she adds. And some patients really do benefit from neuromodulators earlier in life than others.
The best way to figure out if preventative Botox — or any Botox-like treatment — is right for you is to speak with a knowledgeable, experienced professional, the experts agree. "The injection pattern and dosage that you get is really dependent on the style and aesthetic of your injector," Zeichner says. If you can, he suggests getting a word-of-mouth recommendation for someone whose work you've seen and liked.
Ultimately, the experts say, the decision to start getting neuromodulator injections is an individual one that should be made with the input of a trusted expert.
“Starting neurotoxin is a very personal decision and there isn’t one right way of deciding,” Fahs says. “After all, it isn’t a necessary procedure. So first and foremost, do it for yourself only.”