Trains Your Muscles

After using Botox continuously for years, your muscles will become trained not to make wrinkle-forming expressions as aggressively. “Once you are used to the feeling of having less movement in the forehead after neurotoxin, you will be more aware of making the movement when the toxin wears off,” says dermatologist Mara Weinstein, MD.

Weakens the Muscles

If you didn’t move your legs for 20 years, eventually those muscles would shrink and become quite weak. The same thing can happen to the muscles in your face: “If used regularly, over a prolonged period, without interruption, eventually the muscle will atrophy from lack of use,” says the legendary dermatological surgeon Patricia Wexler, MD. That’s not to say your entire face will atrophy. “As the Botox is injected in discrete locations on the face, eventually only those treated muscles will atrophy, leaving other muscles to maintain full volume,” Wexler notes.

So, no, your face isn’t going to look stone-cold, according to Michele Farber, MD, of Schweiger Dermatology Group in New York City. “There are plenty of muscles that are working full time to allow for normal facial expression.” She adds, “If given a break from Botox, muscles will regain strength.” she says.

Can Change Your Face

A 2020 study found that long-term Botox use can trigger permanent changes in a person’s face, giving them an expressionless appearance. This could lead to a lack of animation and an inability to show facial expressions. The study says that to avoid this, it’s best to ask for fewer units than recommended.

Might Make Skin Visibly Thinner

Wexler says that some patients complain of a visible thinning of the skin after many years of Botox use. This might mean exposure of subdermal veins between areas of normal thickness. This isn’t common, but Wexler says that patients who start Botox “too early,” like in their early 20s, can be at risk for this side effect. In these cases, “The skin of the forehead [can] get prematurely thinner, and the muscles weaker,” she says. Sometimes, after many years of use, this can even result in the look of heavier brows and eyelids, “making the toxin more difficult to continue using.”

“Discussing a proper skin regimen and integrating daily sunscreen can reduce this risk,” Farber says.

Fewer Wrinkles Form

You can turn that frown upside down (quite literally) with Botox. This ties back into training your muscles, mentioned previously and emphasizes that not all long-term effect of Botox are negative. If you have an ‘expressive’ face, as mentioned by double board-certified plastic surgeon Dr. Konstantin Vasyukevich, then you’re an ideal candidate for Botox as a preventative measure. The long-term effect here is never having wrinkles form in the first place.

Could Result in Mild Discoloration or Texture

Again, atypical, but Wexler says that with the skin thinning, some patients notice “a visible waviness of the skin overlying the muscles treated,” as well as discoloration. “On expression, the forehead may even appear like hills and valleys,” she says.

Luckily, this side effect is preventable: “[It] can be avoided by changing the pattern of injection to give smaller amounts of toxin in a more uniform distribution to get an identical effect without this problem, or stopping the toxin for an extended period,” Wexler says.

You May Need Less Over Time

Years of Botox use may mean you’ll need less and less for maintenance over time. “With appropriate frequency and amount, your muscles become less strong and you may not need as much Botox or need it as frequently,” Farber says. “When your muscles are ‘trained’ not to move, it helps with the aging process and preventing wrinkles.” 

The Effects Will Last After You Stop

“Many people fear that their faces will become dramatically wrinkled when they stop Botox. If you choose not to continue, those muscles staying out of use while Botox is active can delay the aging process; it reduces movement when injected, slowing the formation of wrinkles,” Farber explains. In other words, your skin won’t develop lines overnight to make up for lost time—you’ll still enjoy looking years younger relative to your age, depending on how long you kept a Botox regimen.

Brightens Skin and Decreases Wrinkles Long-Term

Aside from what can happen after long-term use of Botox, one thing is for sure: “If you continuously get Botox for 10-plus years you will certainly look much younger and have fewer wrinkles,” promises Debra Jaliman, MD, a New York City-based dermatologist and author of Skin Rules: Trade Secrets from a Top New York Dermatologist. “Your skin will look much smoother and the appearance of fine lines and deep wrinkles will be greatly diminished.”

Weinstein agrees, adding, “You can age gracefully without having any wrinkles on the forehead, glabella, or around the eyes, when you may have had the propensity to develop them. That’s the beauty of Botox.” (FYI, the glabella is on your forehead above and between your eyebrows).

Baby Botox Is Always an Option

If commitment is keeping you from taking the first plunge into traditional botox, you could opt for a more natural alternative. Baby Botox, or Botox for newbies, is simply Botox injections administered in smaller doses. You’ll come away with a more natural appearance after each session compared to a traditional dose with the same benefits. Cost-wise, there’s not much difference, but you’ll experience fewer side effects and the recovery time is minimal. The bottom line: Your best bet is to consult a board-certified dermatologist before taking the full plunge.