Long-term Botox Could Affect More Than Your Forehead

Whispers about celebrities having the deadliest neurotoxin on earth injected into their faces to make wrinkles go away: this eyebrow-raising gossip was how many of us first heard of a thing called Botox. Now, getting Botox treatment is common and accepted, and even comes with occasional media teasers that it could have additional positive side effects, like reduction in headaches or depression. There’s been a backlash, too, often stemming from the idea that aging is natural and not something we need to hide.

Botox: Youthful Promises Without Surgery

There’s more to the history of Botox and its active ingredient than most of us know. Where did Botox come from, and who figured out to inject it under the skin, setting it off on its current trajectory?

What if there were troubling and potentially serious side effects from putting a toxin into our foreheads? A quick look online will find stories about lasting paralysis, issues with mood, or even feeling the sickness of a genuine poisoning, but nearly anything can be found out “on the interwebs”. Medical research has our back, thankfully. In the last 10 years, studies have shown  some unwanted effects of Botox treatment. At Cardiff University, a psychologist found an association with the use of Botox for crow’s feet (“laugh lines”) and increased feelings of depression. At the University of Wisconsin Madison, a researcher is looking into peripheral side effects with nerves in other parts of the body.

What’s the truth about Botox Cosmetic? Is it beneficial, potentially harmful, or a bit of both? Many of us want to know if there are other options available to adults who would like to look a bit more youthful. The real truth behind the Botox story is fascinating, and it uncovers a few of the myths about Botox and points a way to some alternatives.

Botox: Old Truths About An Old Toxin

Botox has become well-known in our culture since FDA approval in 2002 as “that injection to make your forehead smooth”, used by the famous as well as a good number of people you know (and possibly you, too). Much of the media coverage about Botox says that it is perfectly safe and might even have some other benefits beyond the promised reduction in wrinkles and lines. One study, described in Nature, links a reduction in depressive symptoms with Botox treatment—but only when the treatment is in the forehead muscles. 

Uncovering the truth about Botox—the history, uses, side effects, and alternatives—is critical to understanding your options if you’ve considered the therapy yourself.

From Botulism to Botox: Origin Stories

Before Botox was a household word, many people knew the word behind it: botulism. Prior to the 2000s, hearing that someone had an encounter with botulism was cause for serious concern, and for good reason: botulism poisoning often came with harsh outcomes from muscle paralysis all the way to death, often from certain foods gone bad in preservation. Botulism works by inhibiting muscle signaling at the nerve level, paralyzing the affected muscles.

But the medical use of Botulinum toxin A goes back nearly a century, mostly to treat disorders that involve uncontrollable muscle spasms. For patients with spasms after stroke or spinal cord injuries, this use of the neurotoxin was a lifesaver. 

In 1989 the first cosmetic use of Botulinum toxin A happened in Sacramento. A plastic surgeon, working with a patient with one-sided forehead paralysis, injected it into the healthy side hoping to make both sides match. It worked.

Since 2002 Botox Cosmetic has been a brand name for Botulinum toxin A by the company Allergan. It has other brand names with other companies, such as Jeuveau, Xeomin, and Dysport. According to a medical review study in the journal Dermatologic Surgery, the brand of Botulinum toxin A does not matter: under the hood they all work the same way. Tiny amounts of the formula are injected into targeted facial muscles (usually forehead or next to the eyes), paralyzing them for several months by inhibiting nerve signaling. When the effects wear off, the process can be repeated.

From Botox to Backlash, and Beyond

Over time, Botox went from eye-rolling celebrity “hack” to something that was just accepted in the mainstream. For years after 2002, Botox Cosmetic gained a loyal following, and was touted as one of the best ways to “reverse” the signs of aging without invasive and expensive cosmetic surgery. By 2018, 7.4 million procedures were performed annually, three times as many as the runner-up (collagen injections).

The backlash about Botox didn’t necessarily start to address side effects, but rather to criticize the culture around the pressure to look young at all costs. Injecting a toxin into one’s skin was an easy target for such criticism. But when a few studies associated the use of Botox in certain muscles with negative effects (including a fascinating study from the University of Zurich that linked the treatments to a rewiring of the brain’s mapping of nerves in the hands), the momentum grew. In addition, there is an uncommon but potential side effect from Botox injections close to the eyes, called Ptosis, which leaves eyelids droopy while the Botox is in effect. 

Beyond the physically intensive Botox alternatives, a wealth of lifestyle changes are also available, which will affect the appearance of your skin but also potentially change your whole attitude around health and aging. Let’s go through just a few of them.

The first alternatives to Botulinum toxin A are the most simple and apply to your whole body health across the spectrum: water and sleep. First, hydration: fighting the dominant pressure to be constantly dehydrated will do wonders for your skin, from feet to forehead and everything in between. Drinking about eight glasses per day has been touted as an ideal, but start from where you are: just drink MORE, and see how you feel. If your only fluid consumption is 4 cups of coffee and a can of fizzy water, swap out half of the coffee for decaf and add a glass of water before or after your fizzy. Try that for a few days or a week, then add another glass of water, and so on. Increment in a way that makes you feel better, not deprived. 

Topical treatments: there are absolutely things you can apply to your skin to help with signs of aging. There are many options that will not break the bank and might even make you feel literally more in touch with your body. One of the topical options is Retinol-A, found in many beauty creams and oils. The effects are tied into the presence of Vitamin A, which can also be found in rosehip oil if you’d like to choose something even more natural than a beauty cream with Retinol.

Next, there’s actual touch: massage to the whole face is one of the most relaxing things imaginable, and if a massage oil with Vitamin A is used, the effects can compound! A well-trained massage therapist can deliver an amazing experience for you, or you can learn facial self-massage through the wonders of online resources. Best of all: the latter option is free!

Over the counter night creams, plumping gels, and more are also a great option if you are looking for a gentle effect and already have a good skin routine that you can add to. Sunscreen to prevent long-term damage is always recommended, of course. 

One unsung potential for preventing the need for Botox is to directly, deliberately, consciously DO what Botox does: learn how to not over contract the muscles in your forehead that will cause wrinkles. Just like teaching yourself how to raise one eyebrow alone, you can teach yourself to not “scrinch” up your forehead. Yes, you can: this article convincingly shows you how to unlearn the face-wrinkling habits, thereby making the desire or need for Botox never appear.  

Finally, a diet full of anti-inflammatory and natural foods will never let you down and can help your skin keep its vigor. Healthy fats and good sources of collagen are a great place to start your research. 

Lifestyle and diet are fantastic. And, at the end of the day, if you are interested in some of the alternative and more medically intensive treatments to bring out your inner beauty without Botox, you have options worth considering. Let’s address a few of them.

Beyond Botox: Active Alternatives

If you’ve decided to avoid Botox altogether or put it off as long as possible, you have options. The most popular (but still invasive) alternative to Botox is Juvederm, which is a hyaluronic acid injection to fill in wrinkles and other skin creases. Healthline has a good comparison of the two, including costs and how long each lasts. Juvederm is different in that it physically fills in existing wrinkles, while Botox prevents muscles from contracting that create wrinkles. Long-term side effects of Juvederm are rare, and some prefer it to injecting a toxin in their skin.

Another option is known as PRP, or platelet rich plasma, which is a filler injection similar to Juvederm but the filler used is the person’s own plasma. Nothing foreign is added to the body, which is more appealing to some patients. The usual risks are similar to any other injectable: bruising and some pain at the site. 

Compared to the injectables we have discussed, laser treatments are outside the body and can temporarily rejuvenate the skin. They act in a similar way to a chemical peel: by abrading the skin, it is forced to bump up healing and production of collagen. Lasers do not affect muscles under the skin.

Several other external or aggressive options are available, too: micro-needling, cosmetic acupuncture, heat treatment, electric stimulation of the skin, and even “traditional” chemical peels. Most of these options have been well-tested and are safe, but effects and longevity vary. Research is key, along with finding a qualified practitioner.

Now: Own Your Radiance

As we’ve seen, there are a good number of alternatives to Botox that allow one’s skin to show fewer signs of aging. But there’s more, too, as noted. Mindset around what aging can be, and how outward signs of age often depict a rich inner life and many stories to tell are both amazing tools to feel like a healthy human, no matter the number on the birthday cake.

Understanding that you are a creature worthy of care might very well be the most important part of whole-human health. Believe that, and everything falls into place so much easier.

And it’s that kind of “manifesting” that signals true health: acceptance of growth and our shared humanity.

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