Botox won't inherently make you look worse long-term if used correctly, but overuse or improper technique can lead to an aged or unnatural look over time, causing weakened muscles, skin thinning, sagging, or reliance on surrounding muscles to create new wrinkles, say experts. The key is moderation with a skilled provider; otherwise, muscles can atrophy, leading to loss of expression, or nearby muscles compensate, creating new lines. However, stopping Botox doesn't cause accelerated aging; wrinkles just return to their natural state.
“If you do too much Botox on your forehead for many, many years, the muscles will get weaker and flatter,” cautions Wexler, adding that the skin can also appear thinner and looser. Moreover, as your muscles become weaker, they can start to recruit surrounding muscles when you make facial expressions.
You Won't Look “Worse” Than Before – One of the biggest misconceptions is that stopping BOTOX® Cosmetic will make your wrinkles deeper or more pronounced. This isn't true. Your face will simply return to its natural state.
After 10 years of regular Botox, you generally look younger with smoother, brighter skin and significantly fewer deep wrinkles because the muscles have been trained not to frown, but you might experience subtle muscle weakening, less facial expression (which some find positive), and potentially thinner skin or more visible veins in some areas, while the skin remains refreshed and well-maintained.
Gen Z is saying "no" or "not yet" to Botox due to a desire for natural beauty, individuality, and healthy aging, rejecting the overdone "Instagram Face," fearing irreversible damage, and prioritizing serious skincare and non-toxic alternatives over the costly, repetitive nature of injectables, despite social media pressure to do them. They're focused on "skinimalism," collagen support, and avoiding the potential for unnatural or frozen looks often seen online, opting for treatments that enhance rather than mask their natural features.
The "Botox Rule of 3" isn't one single rule but refers to key guidelines: 3 areas (forehead, frown lines, crow's feet are common), waiting at least 3 months between treatments to prevent resistance and maintain results, and a 3-to-5 day period for results to fully appear after the 3-to-4 month duration of the treatment. Key post-injection rules include avoiding bending/lying down for 4 hours and other treatments for 14 days.
The Signs of Botox
1) Forehead
When too much Botox is used in the forehead, it can overly relax the muscles, leading to a lack of natural movement and expression. In severe cases, excessive Botox in the forehead can increase the heaviness of the upper eyelids, causing them to become hooded.
The good news is that Botox itself does not cause sagging, nor does stopping it lead to sagging skin. However, it's important to remember that the aging process continues, regardless of whether you've had Botox or fillers in the past.
The "Botox 4-hour rule" means you should stay upright and avoid pressure or lying down for at least four hours after injections to prevent the neurotoxin from migrating from the treated muscles to unintended areas, which can cause side effects like drooping or uneven results. This helps the Botox settle precisely where it's needed for optimal wrinkle-smoothing effects, so avoid bending, rubbing, or strenuous activity during this critical period.
If you decide to take a break from Botox, your facial muscles will gradually regain their full movement. This means: Lines and wrinkles that were previously softened will slowly reappear. Fine lines may become more noticeable again, depending on your skin's natural elasticity and aging process.
About three or four months after you've had an injection with Botox, your muscles will slowly start functioning again and once the Botox has completely worn off, your wrinkles will be back again.
7 BOTOX SIDE EFFECTS FROM LONG-TERM USE
The majority prefer to start in their late 20s or early 30s as a preventive measure to halt wrinkles before deep creases form. For those noticing early signs of aging or having a genetic predisposition to wrinkle early, earlier Botox would be beneficial. Early Botox keeps the skin youthful in the long term.
Exposure to light is a top cause of premature aging: Sun exposure causes many skin problems. Ultraviolet (UV) light and exposure to sunlight age your skin more quickly than it would age naturally. The result is called photoaging, and it's responsible for 90% of visible changes to your skin.
In short, yes – botox can make wrinkles worse. Having said that, it's not something that will definitely happen.
The Bottom Line on Botox
Risks aside, it's worth noting that those 65 and up might not receive the results they're looking for after receiving Botox, which is one reason the FDA lists this age as their recommended cut-off. Ultimately, the decision to receive or reject Botox at any age rests with you and your doctor.
How to Avoid Drooping Eyebrows After Botox Injections. The best way to avoid eyebrow droop is to choose a licensed, experienced practitioner. However, not all side effects are caused by inexperience- there are individual differences in how patients react to Botox.
These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections.
Avoid Having Treatment the Day of a Big Event
It takes a few days for the results to become visible, and you might have minor bruising. If it is your first time having Botox, give yourself a buffer of about a week. If you have it regularly, give yourself three to four days.
The riskiest areas for Botox involve locations with crucial blood vessels and delicate muscles, primarily the glabella (between eyebrows) due to arteries that can cause blindness if blocked, the forehead/brow area risking eyelid droop (ptosis) or unnatural brow shapes, and the perioral region (mouth area), where poor placement can affect speech, smiles, or cause puckering. The masseter muscle (jaw) and neck (platysmal bands) are also sensitive, potentially causing chewing difficulty or swallowing issues with improper technique, requiring expertise to avoid complications like necrosis or paralysis.
But if you're not ready for plastic surgery yet, it's better to opt for non-invasive treatments like Dysport, dermal fillers, microneedling, laser skin resurfacing, chemical peels, anti-aging skin care products, and wrinkle patches.
Botox Usage Statistics
In 2022, more than 9.2 million Botox procedures were reported worldwide. Approximately 85% of Botox patients are women, which equals nearly 8 million.
Botox can cause lasting unwanted effects from overcorrection and under correction. Examples of these are facial asymmetry ( when the two sides of the face look noticeably different) and some wrinkles may be frozen in place rather then smoothed out.
After customized treatment, the crow's feet are reduced, the area between the eyebrows is soften, and the brow contour and position is improved. The medication effect fades over time.