Prevention is better than cure

Given their impact on the ever-expanding aesthetic medicine industry and the associated demand towards cosmetic enhancement, it is vital for cosmetic practitioners to fully understand their motivations and perspectives. One of the main reasons I find that millennials wish to access cosmetic procedures is to not just pause ageing, but prevent it. To this end I have seen a 200% increase in patients under the age of 25 requesting anti-wrinkle injections to prevent fine line and wrinkles since the start of the pandemic.

As a generation that has been reshaping the culture of healthcare delivery and encouraging the innovation of products and procedures with their unique values and perspectives, accounting for the beliefs of our younger patients and fostering a better understanding of their experiences will promote an elevation in the quality of their care.

Starting young

“Preventative toxin” is a term we hear a lot in medical aesthetics, but there are different schools of thought as to whether treating patients from a younger age – before they have developed visible lines and wrinkles – is of any cosmetic benefit.

Toxin essentially reduces muscle activity, resulting in the prevention of static lines, or, if lines are already present, the prevention of these lines deepening. This means that in order to benefit from treatment, it could be argued that patients needs to start having toxin treatment – reducing the muscle activity – before deep, static lines have set in in the first place. This is the reason that botulinum toxin is often referred to as a “preventative” treatment.

In my opinion, anyone under 21 doesn’t need toxin treatment, unless they’re having it to treat one of the non-cosmetic indications, such as migraines or bruxism. When a younger patient visits me for treatment with toxin, I need to find out what has brought them into clinic, especially if they have no obvious signs of ageing. We need to decide their motivations for the treatment and rule out BDD and suchlike.

Usually, they have some knowledge about toxin being used preventatively, but I do occasionally see some young women who think that they have wrinkles when they don’t. If we both decide to go ahead with treatment, I would then carry out the same medical consultation I always do before any procedure.

Light touch

When administering toxin in a preventative way, I don’t necessarily use less product than I would in an older patient just because of age – it all depends on the muscle mass and how deep the lines are, regardless of age. However, when a patient is younger, they don’t usually have such noticeable lines when you get them to animate before marking the face, and normally I would go lighter in a younger person, especially on the forehead so as not to make the brow heavy.

The injection protocol is no different to with an older patient in that the placement is dependent on the individual person’s muscles. It is of course still imperative to comply with the manufacturer’s administration instructions relating to certain areas of the face, but the amount used should be judged on the individual’s muscle mass.

Even if a patient doesn’t yet have visible lines or wrinkles, they will still see visible results from treatment with toxin because everyone will have creasing on expression and animation, no matter how subtle. So, this will be inhibited. The difference might be very small but both patient and practitioner will still be able to see it. There is no evidence to suggest toxin starts to become less effective more quickly if a patient begins having treatment at a younger age.

It is imperative to remember that botulinum toxin cannot be used to prevent other signs of ageing such as dry skin, pigmentation disorders and vascular abnormalities. To this end I would say that it cannot be used in isolation and it is paramount that an effective, medical-grade skincare regime is utilised from the early twenties alongside any botulinum toxin injections. Other nonsurgical treatments such as laser therapy and medical-grade facials can also help to ensure good skin health and thus see less requirement for botulinum toxin injections at an early age.

Patients requesting toxin in their early twenties as a preventative treatment must receive the appropriate patient care and their motives must be fully vetted to ensure that there is no underlying body dysmorphia or intense lack of self-esteem due to social pressures from celebrities, influencer culture or social media.

Unrealistic ideas of beauty ideals perpetuated by these platforms and the associated heavily-filtered images are fuelling pressure for women of all ages to have injectable treatments. There is absolutely a “look” that many women – especially young women – feel they must adhere to, and it is paramount that we are aware of this when treating younger patients.