If you've spent any time on social media recently, you'll probably have come across the phrase “preventative Botox”.
It sounds sensible.
If Botox reduces muscle movement, and repeated muscle movement contributes to expression lines, surely starting Botox before you have wrinkles is the ultimate anti-ageing strategy?
Well… yes and no.
I absolutely believe there is a place for preventative Botox. But I don't believe everyone should start Botox in their 20s simply because they want to prevent future wrinkles.
In fact, sometimes your best anti-ageing treatment at 25 is not having Botox at all.
First, let's understand what we're trying to prevent
Botulinum toxin works by temporarily reducing the activity of specific muscles.
It is particularly useful for dynamic lines — lines that appear or become more pronounced when a muscle contracts.
Think about your frown lines.
When you're concentrating, annoyed, stressed or simply looking at your phone, the muscles between your eyebrows contract. Your skin folds.
When you're younger, your skin is generally very elastic. The crease appears when you frown but disappears again when the muscles relax.
That's normal.
There's nothing wrong with having facial movement.
In fact, I don't think we should try to eliminate every facial expression we make.
The problem happens when the crease stops disappearing
As we age, our skin gradually loses some of its elasticity and its ability to bounce back.
Now those repeated movements can start to leave a line behind.
It's a little like repeatedly folding a piece of paper in exactly the same place.
Eventually, even when you unfold it, the crease remains.
That's when treating excessive muscle activity can become particularly useful.
For many people this becomes increasingly noticeable from their mid-30s onwards, although there is enormous individual variation.
Genetics, sun exposure, lifestyle, skin quality and facial anatomy all play a part.
So why don't I recommend Botox to everyone in their 20s?
Because young skin is usually doing a perfectly good job of recovering from normal facial movement.
If you have good skin elasticity and your expression lines disappear completely when your face is relaxed, there may be no compelling reason to treat them.
I would much rather see a young patient investing in:
In other words, protect the skin you have before worrying about treating the ageing process.
But there are exceptions
There are some younger people who have particularly strong muscle activity in certain areas.
The frown area is probably the best example I see.
Some people naturally contract these muscles very strongly, particularly when concentrating. Others spend a lot of time frowning without even realising they're doing it.
This can sometimes be associated with muscular tension and tension-type headaches.
I've had younger patients where the muscle activity was significant enough that treatment was appropriate.
I remember one patient who had been waiting to see neurology because of persistent headaches. Following assessment, it became apparent that muscular tension was contributing to the symptoms, and treatment with botulinum toxin resulted in a very positive outcome.
Obviously, this doesn't mean Botox is a treatment for every headache. Headaches have many causes and require appropriate medical assessment.
But it does demonstrate an important point:
Age alone shouldn't determine whether someone is suitable for treatment.
Preventative Botox isn't about freezing your face
This is another misconception I would like to clear up.
Good aesthetic treatment shouldn't be about removing every movement from your face.
Your face is supposed to move.
You should be able to smile, laugh, look surprised and frown when appropriate.
The aim is generally to achieve an appropriate reduction in excessive muscle activity while maintaining natural expression.
And sometimes, the right answer is simply “not yet.”
What about skincare?
If you're younger and thinking about preventative anti-ageing treatments, I would strongly encourage you to start with your skin.
One of the biggest environmental contributors to premature skin ageing is UV exposure.
That's why sunscreen is such an important part of any long-term skin strategy.
At Nichola Maasdorp No4, we particularly like Heliocare. The range is developed by Cantabria Labs, a dermatological company with a strong focus on scientific research and photoprotection.
And good skincare doesn't have to mean spending a fortune.
A properly chosen routine that you actually use every day is far more useful than ten products sitting untouched in your bathroom cabinet!
Our skin consultations are designed to look at your individual skin, lifestyle and concerns, and help you work out what you actually need.
We can also combine this with an Express HydraFacial when you want to give your skin a little extra boost.
So… is preventative Botox worth it?
Yes — for the right person.
But I don't think “preventative Botox” should mean:
“Start Botox as young as possible so you never get wrinkles.”
I'd much rather it mean:
“Let's understand how your muscles move, what your skin is doing and what you're trying to achieve — and decide whether Botox is appropriate.”
For some people, that might be Botox.
For someone else, it might be skincare and sunscreen.
For another person, it might be a combination of treatments.
And for someone else?
Nothing yet.
There is absolutely nothing wrong with that.
