(CNN) – It has been over 20 years since Botox was approved for cosmetic use by the US Food and Drug Administration. The minimally invasive procedure has offered millions of Americans with wrinkled foreheads the chance to regain a more youthful appearance.
Although most Botox recipients are middle-aged, dermatologists and plastic surgeons say they’re now targeting a new group of patients: Gen Z.
Dr. Shereene Idriss, a dermatologist who works in New York, says the median age of her clientele is getting younger every year. Some patients have come to her office looking for Botox for wrinkles that don’t exist.
“They come in with no lines or embedded marks on their skin,” he said. “And they come with a fear of aging.”
A growing number of people under the age of 30 in the US are spending thousands of dollars on cosmetic procedures, including fillers, skin resurfacing treatments and injections of neuromodulators such as Botox, according to the American Society of Plastic Surgeons.
This focus on looking “perfect” is even reaching elementary and middle school-aged children on social media, experts say, as “Sephora kids” gain a reputation for buying skin care products designed for older people.
“Social media is incredibly powerful and has really worked its way into everyone’s consciousness, but especially younger women,” said Dr. Steven Williams, a plastic surgeon in California and president of the American Society of Plastic Surgeons.
There’s nothing wrong with cosmetic procedures and using preventative skin care, Williams says, but knowing the risks associated with them can help people use them more responsibly.
“It’s important to realize that we’re being sold something,” he said. “We’re being used a bit.”
Rise of ‘preventive’ Botox
Neuroregulatory injections such as Botox, Dysport, Xeomin, and Jeuveau contain botulinum toxin, a neurotoxin often called a “miracle poison” for its wrinkle-relaxing properties. It can deal with two kinds of wrinkles: static and dynamic.
Static wrinkles remain visible on the skin while the face is at rest and result from the loss of elasticity and collagen in the skin. Dynamic wrinkles are those that appear on the face due to expressions such as frowning or smiling.
Over time, dynamic wrinkles can turn into static wrinkles due to repetitive motion and loss of elasticity.
People ages 40 to 54 accounted for the largest share of those injecting neuromodulators in 2022, at 57 percent, with nearly 5 million people in that age group injecting, according to procedural statistics from the American Society of Plastic Surgeons. They represent procedures performed by surgeons who are members of the society and certified by the American Board of Plastic Surgery.
But between 2019 and 2022, the number of people aged 19 and under who received injections of neuromodulators increased by 75%, the data show. Their use increased by 71% among adults aged 20 to 29.
Williams says the increase is mainly due to preventative or “baby” Botox: injecting Botox into an area of the face that doesn’t have defined wrinkles, with the goal of preventing them from forming.
Although Botox is approved by the FDA for use in people 18 years of age and older, Idriss does not recommend injections in people under 21 years of age who do not have visible wrinkles.
Her advice for younger people? “Save your money and go to Europe,” he said. “Come back when your first signs of aging are printed on your face and don’t disappear when you calm down.”
The average cost of Botox injections is about $530, according to statistics from the American Society of Plastic Surgeons.
A botulinum toxin unit costs between $15 and $20 on average, Idriss says. The number of units used on a person depends on how significant their wrinkles are and how aggressively they want to treat the area. For example, someone getting “baby Botox” might get 10 points per area. For standard Botox, 20 to 40 units are usually used per area.
On average, injection results last three to four months, so further injections are needed to keep wrinkles and fine lines at bay, Idriss says. These costs add up.
Williams agrees that some young adults seeking preventative procedures are potentially throwing money at a problem that doesn’t exist.
“You assume where you’re going to have wrinkles, and maybe you are, but maybe you’re not,” she said. “Sometimes it takes a little maturity to think about that too, instead of saying ‘I don’t ever want to have a wrinkle.’ It’s a complicated area.”
“Preventive” Botox may be a waste of money for some young adults, Idriss says, but there are exceptions for people who have had wrinkles set at a young age, simply to help with their confidence.
“I’ve had 19- or 20-year-olds put on me who look much older than their age,” he said. “They’re very emotional about their foreheads, and the lines on their foreheads are deeper than they should be at 19 or 20.”
Too much Botox can age you
Botox injections are generally safe, but Williams says that receiving injections over a prolonged period can lead to atrophy, in which a muscle shrinks in size and wastes from lack of use.
If someone gets Botox every three to four months for decades, their facial muscles can start to look thinner and looser at a younger age, Idriss said.
This is the body’s natural response to neuromodulator injections, Williams notes.
“The science is clear: If you block muscle action and the muscle doesn’t work, it atrophies and gets smaller over time,” he said. “Whether that’s a good thing or not is a whole different conversation.”
Idriss tells her patients to take breaks between injections to give their muscles a chance to strengthen.
“Your bone structure also changes as you age, so if the Botox lasted forever and you’re aging around it, you’re going to fall and fall in places you didn’t anticipate.”
That said, if a patient stops the injections, normal muscle function should return to the face over time as they build back strength. This can take weeks or months depending on how often they inject.
Other risks associated with neuromodulator injections include bruising, pain, and redness at the injection site as well as flu-like symptoms, headache, nausea, and temporary facial weakness.
Social media drives the trends
The anti-aging craze is not unique to young adults. Minors called “Sephora kids” can be found running the aisles of cosmetics stores looking for trendy skin care products they’ve seen online.
The reason why some tweens are obsessed with beauty products isn’t simple, but Dr. Mitch Prinstein, chief scientific officer of the American Psychological Association, says social media definitely fuels it.
Many pre-teens consume large amounts of content as a part of their brain called the prefrontal cortex begins to develop and mature more rapidly.
“It’s an area that creates more dopamine and oxytocin receptors in the social areas of the brain, and suddenly we’re very interested in attention and positive feedback from peers,” he said. “We’ve taken a normal biological process and put it on steroids.”
Tweens desperate to fit in can inadvertently damage their skin’s barrier by using skincare products that aren’t meant for them.
The skin’s barrier — the outermost layer — is meant to protect against irritants like pollution, dust mites and fragrances in skin care products, according to the American Academy of Dermatology. At the age of 9 or 10, the skin barrier is not fully formed and is easily damaged by products with active ingredients such as vitamins A and C.
“When your skin barrier is damaged, it doesn’t work well,” said Dr. Brooke Jeffery, an Arizona dermatologist who specializes in teen skin care.
Plus, when the skin’s barrier is damaged, it can’t hold water, Jeffy says, which often leads to skin inflammation and collagen breakdown in the face.
“So these products that are marketed for antiaging, but when younger kids use them, they get this low-level irritation,” he said. “That does the exact opposite of what they’re trying to do.”
Jeffy says this breakdown of collagen can lead to wrinkles earlier in life—and a desire for cosmetic procedures like neuromodulator injections.
Prevention of aging in adulthood
Young people interested in looking older should invest in a simple skin care routine, dermatologists say: a facial cleanser, a moisturizer and a daily sunscreen.
Eating a healthy diet rich in antioxidants such as fruits and vegetables can improve collagen production, as can minimizing processed foods and sugar.
When it comes to skin care, Idriss says adults should start using vitamin C and AHA serums in their mid-to-late 20s. However, vitamin A derivatives like retinol should be avoided until at least 30.
“If you don’t feel like you can manage your biggest skin problem with just your skin care routine after giving it a solid chance, then go and seek professional help,” Idriss said.
Ultimately, embracing the skin you’re in is probably the best advice for young people.
“I don’t think we should fear the aging process. If anything, it’s really a blessing if you can grow old,” Idriss said. “The aging process should be approached with eyes wide open.”
