Why millennials are flocking to Botox

Botox used to be for boomers, but not anymore. Increasingly younger women are embracing the injections that promise to smooth out wrinkles and result in a more youthful appearance.

Millennials and Gen Xers are heading to plastic surgeons or dermatologists not to undo the toll years have taken on their skin, but to prevent it.

Lauren Madden used to think of Botox was for her mother’s generation. But when a friend became a Botox injector, her opinion shifted. Her friend told her Botox would erase her fine wrinkles and ensure they did not deepen as she aged.

“You think wrinkles, you think older people. At first, I definitely thought it was just for people that were trying to look younger than what they really are,” said Madden, 30, who started using Botox a few years ago. “Some people think that if you get it at this age, it’s because you’re worried about your looks right now. That’s not necessarily the case for me. Really I’m just looking toward the future in regards to my face.”

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Although the majority of Botox users fall in the 40 to 54 age range, about 1.2 million Botox injections, 18 percent of the total, were performed in 2015 on patients in their 30s. More than 100,000 were for patients in their 20s, according to the American Society of Plastic Surgeons. And although only 19,604 injections were done in teenagers, that number represents a 2 percent increase from 2014 to 2015.

Plastic surgeon Dr. Mark Hamilton has seen the trend in his practice.

Since the Food and Drug Administration approved Botox in 2002 for cosmetic use, its popularity has skyrocketed tenfold and so has awareness, said Hamilton, who has offices in Greenwood and at IU Health North Hospital in Carmel.

“Most 20-year-olds, they say, ‘Cosmetic surgery is something that I would never consider,’ ” he said. “However as Botox has become more popular … I think it’s creeped into the 20s. Twenty-year-olds are not typical, but they definitely do occur.”                            

When Hamilton recently flipped through his patient records, he saw more born in the 1990s than he expected. Still, only about 20 to 30 patients, or less than 5 percent, of the total were so young. The numbers start climbing for women in their 30s and soar for those in middle age, he said.               

Some of those younger patients decided to opt for Botox after having other minimally invasive treatments, such as microdermabrasions and facials. Others like Madden came to him expressly for Botox.

An emergency department nurse who lives on the south side, Madden visited Hamilton not to achieve a more youthful experience, but to erase a line between her eyebrows that bothered her.

“I’m 30, but I don’t feel like I look 30,” she said. “With or without the Botox, I think I look pretty young.”               

The rise of Botox use among millennials has mirrored the spread of Botox from plastic surgeons’ offices into medical spas, dentists’ and gynecologists’ offices, said Dana Berkowitz, author of “Botox Nation: Changing the Face of America.” With all of these places offering the procedure, advertising has increased, and Botox use has become normalized.

From 2015 to 2016, Botox injections increased by 4 percent, according to the American Society of Plastic Surgeons. Last year saw 7.06 million injections, statistics show.

Made from a neurotoxin produced by a bacteria, Botox temporarily paralyzes the muscles that cause frown lines, relaxing the wrinkles. Effects typically wear off in three to six months. 

The price of Botox can range widely, depending on how much a person needs and where he or she has it done. The average cost of such injections in 2015 was $382, according to the American Society of Plastic Surgeons. 

When Berkowitz started reporting her book in 2008, she rarely found people using Botox in their 30s who lived outside of New York, Miami or Los Angeles. Now, she said, you can find people in that age range using Botox throughout the U.S. .

Regular Botox use before middle age, goes the thinking, can stave off the need for a facelift down the road, said Berkowitz, an associate sociology professor at Louisiana State University. But it may also spur the use of Botox and other cosmetic procedures.

“It’s preventative only to the extent that you keep getting it again and again,” she said. “It creates almost this psychological addiction and it’s a gateway drug into other both noninvasive procedures and invasive. The first stop is Botox, the next fillers …”

Even doctors concede that Botox early in life does not guarantee a youthful appearance later without surgery or other procedures.

Still, they think earlier Botox use may ward off the need for the most invasive procedures and result in a better appearance.

The use of Botox in millennials started with their parents. Doctors saw that the longer the drug was used, the better the results. They started wondering whether Botox might prevent wrinkles, said Dr. Arthur Perry, a plastic surgeon in New York and New Jersey and author of the book “Straight Talk About Cosmetic Surgery."                     

The theory behind the use stems from biology. From the ages of 0 to 20, our skin thickens as we grow, thanks to collagen production. From 20 to 30, collagen production halts and our skin enters a holding pattern; few wrinkles form but the skin does not continue to thicken, Perry said. In fact, from 30 on, our skin loses about 1 percent of its thickness a year and wrinkles start to deepen.

But some people may see lines creep in, especially in the forehead, a decade or two earlier, Hamilton said. Some people may naturally have a strong frown function that etches lines into their forehead. That’s where Botox injections can help. The drug will relax the muscles and smooth those lines.

Not only will Botox soften women's expressions and make their face seem more relaxed; if used over time, it will prevent deeper wrinkles from forming, Hamilton said.

People who continue using Botox may find themselves needing less Botox as they grow older, though they won't reach a point where Botox isn't needed to keep the lines at bay, he added.

Either way, they will be better off than patients who start Botox in their 40s and 50s, when a deep crease has already formed. At that point, Hamilton said, fillers or more invasive procedures will be the only remedy.

“Someone who has been doing Botox all along, they won’t develop those lines and they can delay or prevent less aggressive procedures,” he said.

Botox is cheaper for younger patients, as less of the drug is needed for the injection. A typical older Botox patient might need about 25 to 30 units, costing from $300 to $400, Hamilton said. A patient in her 20s, however, would likely need around 15 units at a cost of $200.

Over time, Perry said, regular use of Botox may kill muscle and patients may be able to go longer between injections. Still, once a person stops using Botox, the wrinkles will begin to form.

 "If you use Botox for 20 years and stop using at 50, you will get wrinkles, but they’re set back," Perry said. The longer you do Botox, the better it is.”

Users like Catherine Payne hope they see that pattern. Payne, 29, had visited Hamilton for microdermabrasions and facials. Then the Downtown resident, who works in commodities trading, noticed frown lines on her forehead.

Friends told her that starting Botox younger could prevent the frozen look that some associate with the treatment, and she figured she would try it. Just before she turned 29, she had her first injection. Her boyfriend didn’t even notice a difference until she told him.

“To me, it’s just another thing in the self care regimen. … I think you just look like a better version of yourself,” she said. “Maybe later on in life, I might be more happy to let those lines appear a little more, but at this stage I don’t want it.”

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and on Facebook. 

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