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Vanderpump Rules star and preventative botox devotee Scheana Shay
Gabe Ginsberg/Getty

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Is Preventative Botox a Farce?

Can getting injections in your twenties really prevent wrinkles later on?

If you watch enough Bravo reality shows or wait for a table at enough popular brunch spots, you’re bound to hear twentysomethings make mention of "preventative botox." The procedure entails getting botox (a popular brand name of the drug Botulinum toxin type A) injections before wrinkles have formed on your face to prevent them from forming, versus trying to correct them later.

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As the product on the forefront on the noninvasive procedures trend (with fillers like Juvederm and Restalyne, anti-aging micro-current treatments such as Ulthera, and fat-freezing treatments like CoolSculpting not far behind), botox works by weakening or paralyzing certain muscles or by blocking certain nerves, according to the U.S. National Library of Medicine. It has been used to treat a range of issues, from wrinkles to severe sweating, uncontrollable blinking, chronic migraines, and more.

Like what you see? Get ready to shell out more dough just a few months from now… and a few months after that.

While botox procedures have been steadily on the rise since the early 2000s, the sizable buzz around preventative botox has only begun in recent years. One of the main reasons for its popularity, and the popularity of procedures like it, is the temporary nature of the results — it’s rarely a one-and-done type deal. Like what you see? Get ready to shell out more dough just a few months from now… and a few months after that, for as long as you want your results to be maintained. So, the question is: Is potentially being forever wrinkle-free worth getting needles stuck in your face a few times a year for the next several decades? Is preventative botox more than a ploy to get younger and younger people aboard the cosmetic-enhancement train?

Botox has remained in the top spot when it comes to the most popular minimally-invasive procedures for years. According to the American Society of Plastic Surgeons’ 2015 Plastic Surgery Statistics Report, the amount of botox administered on people ages 13 to 19 in 2014 was up by 7% — a 19,170 person increase — from the previous year. (Conversely, for what it’s worth, the top two most popular cosmetic surgical procedures — rhinoplasty and breast augmentation — have both decreased during that same time period.) The same year that study was published, Vogue briefly tackled the trending topic by talking to NYC-based doctors, some of whom said that getting botox before wrinkles form is presumptive, not preventative. They also cautioned jumping the gun because it can potentially cause the face to look older more quickly.

Despite these warnings, many dermatologists and plastic surgeons say there are few drawbacks, if any, to starting botox injections pre-wrinkles. Atlanta-based plastic surgeon Dr. Carmen Kavali, 46, regularly administers botox to patients and has been getting injections herself for the past 14 years. "I started with my crows’ feet, because that’s where I was starting to see small lines," she says. "Once I was seeing results from my crows’ feet treatments, I started treating my '11s' prophylactically." "11s" is shorthand for wrinkles in between the eyebrows that resemble two vertical lines. "Now I have no 11s at all," Kavali says, and she plans on getting botox treatments "for life." She explains that the plus side of regular treatments is that you can begin spacing them out after a few years, from every three to four months to every six to eight months.

"I had a thought, 'Would I take dental advice from a dentist with crooked teeth?'"

The youngest botox patient Dr. Kavali has injected with botox was 19 years old. While botox is FDA-approved for people between 18 and 65 years of age, she says doctors can opt to use it off-label in patients both younger and older, as long as the off-label use is disclosed to the patient. "For anyone under the age of 18," she explains, "a parent or legal guardian would have to consent, unless the youth is emancipated and doesn’t legally require adult consent."

Esthetician and cosmetologist Tiffany Bioski says that her job was what first prompted her to begin getting botox six years ago (she’s 31). "I actually debated with the topic for about a year, then I had a thought, 'Would I take dental advice from a dentist with crooked teeth?'" She began getting preventative botox at 25 after realizing that "if I wanted to be proactive, I would have to be preventative." Bioski adds that, through her education, she knew that if she started earlier, she’d need eventually need fewer injections less often. "It was the most logical decision for me and my lifestyle," she says, adding that her results from getting preventative botox were "in a word, phenomenal."

While Bioski doesn’t administer botox through her job, plenty of clients have asked her about it, and she does mention precautions. "I adhere to a 'less is more' policy — most people don't want to appear constantly surprised or walk out with a droopy eyelid." She says side effects can include tenderness, swelling, headaches and flu-like symptoms. "I encourage people to do their research."

"I adhere to a 'less is more' policy — most people don't want to appear constantly surprised or walk out with a droopy eyelid."

While various studies have been done on botox and its effects, less has been published specifically on preventative botox. It’s also worth noting that no studies have come out to definitely say that preventative botox can actually prevent wrinkles from forming, though many medical professionals enthusiastically stand by the claim.

In late 2013, the Journal of the American Medical Association’s Dermatology sector published an opinion article by two Massachusetts-based skincare physicians claiming it was "rarely too early" to begin getting injections, fillers, and other noninvasive treatments. The article goes so far as to say that the injection of soft-tissue fillers earlier on could help stimulate collagen production, making results last even longer and possibly making the need for re-injections no longer necessary. However, "We’re not advocating treating infants, children and people in their teens," co-author of the piece Dr. Kenneth Arndt tells TODAY. The same article also quotes him explaining that it’s easier and more effective to prevent progression versus beginning 10 years later — he calls it "prejuvenation."

For some, wrinkle prevention is merely an added bonus of getting botox in your 20s. Meghan, a 32-year-old international account executive and operations coordinator for a clothing brand, started getting injections six years ago to help correct a high-school sports injury that left her with nerve damage on the left side of her face, resulting in a sagging eyelid. "Plus," she says, "when I smile my right eyebrow goes crazy high, which makes me self-conscious in pictures." Meghan says she’d much rather just get botox over the alternative eyebrow lift — "I do not plan to go under the knife anytime soon," she adds, "so I plan to keep getting it for a while."

"The most obvious skin prevention tool is sunscreen. Use it aggressively and you will not have to pay to have brown spots removed or your skin cancers cut off — same with botox."

Regardless of the supposed effects, what’s inarguable about getting botox procedures earlier in life is that it’ll cost you. Botox can range from approximately $200 to $500 (or more) per session, depending on factors like the doctor, injection sites, and number of injections. If you get injections three times a year, that’s $600 to $1,500 annually. If a 25-year-old woman began getting botox, by 35 she would have spent anywhere from around $6,000 to $15,000 total, or perhaps a little less if she eventually decreased the number of annual sessions. (According to the nonprofit research company Catalyst, the median income for a full-time working woman in the United States is a little under $40,000 a year.) Georgia-based dermatologist Rutledge Forney has herself gotten preventative botox, and says the only downside she can think of is the cost. "But, as with your 401(k)," she says, "a little investment today will pay off in the long run."

Whether you’re needle-averse, strapped for cash or just don’t feel comfortable filling your face with low-grade muscle-paralyzing bacterial toxins, there are, of course, alternatives for working to prevent wrinkles. "The most obvious skin prevention tool is sunscreen," says Dr. Forney. "Use it aggressively and you will not have to pay to have brown spots removed or your skin cancers cut off — same with botox."

Noting the steady increase in botox’s popularity in the last several years, Live Science has reported that many experts feel preventative botox is an unnecessary procedure — basically, if you begin these treatments in your 20s for wrinkles that may not have shown up until your 40s or 50s, that’s a whole lot of cash spent to keep something at bay that may not have developed until decades later anyway. This reasoning is coupled with the risk of the potential negative side effects like speaking, breathing, or swallowing issues and muscle weakness.

It’s hard not to take in all the rave reviews docs and derms offer when it comes to preventative botox (and let’s be honest, the thought of having skin that’s nearly as smooth, luminous, and wrinkle-free in 20 years as it is now is pretty appealing). For those with enough cash to shell out more than a grand each year to prevent facial lines with an unknown ETA, the general consensus seems to be that the results will be worth it. For the rest of us, we can probably just stick with a once-in-a-blue-moon facial and a good daily SPF — at least until those 11s start to show up.

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