By Maryann Mikhail, MD
The short answer to this question is: before your wrinkles set in. Wrinkles appear because the muscles of the face repeatedly contract the skin. The more expressive you are, the more lines you will have in time. In the beginning, superficial fine lines are only seen when you make certain faces. However, over the years, the wrinkles deepen and can be seen at rest, in the absence of facial movement.
Botulinum Toxin (Botox) works by blocking signals from nerves to muscles. This forces the muscles to relax, and eventually, atrophy or shrink. The duration of results depends on the strength of the musculature and the depth of the wrinkles. Fine lines generally completely fade away leaving the skin perfectly smooth. Deeper wrinkles that have already set in typically will soften but still be visible. If this is bothersome to a patient, dermal fillers, lasers, or microneedling can be helpful. Muscles regain function approximately 3 months after a Botox treatment. Those with superficial fine lines can usually wait 6-9 months until the lines start to reappear. Meanwhile, those with deeper wrinkles will need a treatment closer to every 3 months.
There is no right age for starting Botox treatments. For those of us who do not want wrinkles, the ideal timing varies based on facial expression. Those who raise their eyebrows when they speak, smile with their eyes, or scowl when they concentrate will need Botox at an earlier age than people who do not. The important thing is to start before your wrinkles have deepened and require more invasive procedures to address.
Botox injections are quick and relatively painless. Most patients can have the treatment done and return to work without anyone noticing. It takes about 5 days to 2 weeks for Botox to fully kick in. The most common side effect is a small bruise that can be covered with makeup and will usually fade within a week. More rare side effects include asymmetry, which can be easily corrected, and eyelid drooping, which will improve as Botox wears off and can be treated with prescription eye drops. To minimize the risks, patients are advised to avoid touching or rubbing the area, exercising, lying down, inverting the head, and flying on a plane for at least 4 hours after Botox injections.
Botox is the most common cosmetic procedure in the country, with over 7 million procedures in 2016. There is good reason for this, why get wrinkles if you don’t have to? As they say, prevention is always better than a cure.