The Dirty Little Secret About Botox That Nobody Tells You
For years, you might have believed that Botox and similar products are your ultimate wrinkle erasers. You wake up one morning, look in the mirror, and think they’ve worked their magic. But there’s a dirty little secret that people get fooled on, time and time again. Let me tell you a story that might ring home for many.
Imagine someone in their 30s or 40s who has been getting neurotoxin treatments for a while. We’re talking about Botox, Dysport, Xeomin, and Jeuveau—all botulinum toxin type A products. They have similarities and differences, but their mechanism of action is the same: they stop muscle movement. People commit to these treatments, and by their 40s, 45, or especially 50—particularly for those with skin types one through three, as estrogen declines and skin thins—they start to say, “The Botox I had recently just didn’t work. It didn’t take.”
Now, sometimes it’s a normal part of the drug’s response in the body, but let’s put that aside. What do they mean? They’ll try to move their frown, forehead, or eyes—the most common FDA-approved areas—and they’ll have maybe 20% movement. A good response to these products is 70% to 80% reduction in movement for a given dose. But that 20% movement, which didn’t bother them at age 30, now creates lines that look much older. They’ll say, “The same dose worked for me when I was 35, but at 40, it’s just not doing it.”
What’s this dirty little secret? The problem is that these products stop muscle movement but do not build collagen. They don’t get to the root of the problem. It’s like hiding rust in a car: you don’t see it, and then one day it bubbles through the paint. You wonder what’s going on. The same happens with neuromodulators. The movement creates the line, and because there’s no collagen building, the skin becomes more vulnerable over time.
Why Increasing the Dose Isn’t the Answer
In many cases, people think the solution is to increase the dose. Let’s say you’ve been using 20 units for glabella or forehead—already a significant amount. You come back in two weeks, which is the appropriate time, and you increase the dose to get another 10% of the muscle fibers. This might buy you another two or three years. But by age 50, with declining estrogen and thinning skin, it doesn’t work at all. There are 20 years of neglect to catch up on, from age 30 to 50. You focused on the quick hit of the product, which gave you an instant lift and masked the problem, but at a certain age, you pay the price for not paying attention to collagen.
This is something to be very aware of. Of course, sunscreen, avoiding smoking and pollution, healthy habits like diet and exercise are all important. But from a younger age, collagen building with devices like radiofrequency is crucial. Treatments like plasma sculpt, plasma glow, microneedling, erbium YAG lasers, fractals, and halos—your provider will have their own recommendations. I personally like radiofrequency because it doesn’t see color, builds collagen with less downtime, and fewer side effects. I used to use a lot of erbium YAG and CO2 lasers, which people often don’t tolerate well.
There are also things you can do at home. Hyaluronic acids and retinoids are important. If you’re on all these things, your need for services at a Med Spa or doctor’s office is greatly reduced. That’s the goal. It’s not about saving money on cheaper neurotoxins or the perils of self-injecting and home Botox. It’s about taking care of the skin so that muscle movement doesn’t create lines in the first place.
Skin Type and the Real Trick
Skin type is vital. People with darker skin types, four to six, are less likely to get lines and wrinkles compared to lighter skin. There are many factors involved. The single most important thing to understand is this dirty little secret: Botox and similar products stop muscle movement but do not build collagen. You don’t get the long-term effect of building healthy, beautiful, vibrant skin.
Keep this in mind the next time you go for a neuromodulator appointment and your provider recommends ancillary services. They’re not trying to take money from you; they’re trying to help you achieve great skin. What do you do to build collagen? What has been your experience with neuromodulators? Reflect on these questions as you care for your skin and body, keeping them healthy, beautiful, and vibrant.