This week I take up the challenge to loosen the debate and bring transparency on a still sensitive topic: the use in medical aesthetics of botulinum toxin on young adults aged between 22 and 30.
To do so, I have interviewed 3 doctors:
- my father, dermatologist, Dr. Luigi Polla,
- a plastic surgeon, Dr. Emanuele Bartoletti,
- a phlebologist, Dr. Andrea Alessandrini.
All three are experts in aesthetic medicine with over 20 years experience. Although they are of same age (between 50 and 60), same nationality (Italian) and share the same passion for aesthetics, they each bring interesting and personal comments to the theme: botulinum toxin on young adult patients.
Cyrille Polla : In your medical practice do you have a demand for aesthetic injections (fillers, botulinum etc.) coming from a young adult clientele between 22 and 30?
Luigi Polla : Yes, about 10% of my clientele for injections is between 22 and 30.
Emanuele Bartoletti : Not much, and never under 25-28 years old.
Andrea Alessandrini : Yes, I receive young adult patients with aesthetic expectations that have nothing to do with ageing, but more with beauty and self-confidence.
CP : What is the social and medical profile of your young adult clientele ?
LP : They are professionally active and financially independent with a good purchasing power. A third of these young women have an elder sister, mother or girlfriend as a confidant and “accomplice” with positive experiences of medical aesthetics. Another third has already come to consult my practice for other treatments such as peels and laser hair removal.
CP : Are the injection techniques, points of injections and number of botulinum toxin units injected different for a patient in her twenties as for one in her fifties ?
LP : I usually inject smaller doses on younger adults. However the features, muscle activity and other specificities of a face are more important than age when deciding how and how much botulinum I inject. Regarding frequency of injection sessions, I perform maximum 2 per year on a younger adult whereas the injections may be repeated up to 3 times per year on a woman over 40.
EB : No ; these three variables depend on the patient and her facial characteristics and have nothing to do with age. The recommended frequency is always the same (i.e. intervals of 4-6 months between two injection sessions) in order for the muscles to entirely recuperate their contraction function and to avoid risks of muscular atrophy.
CP : Do these young women come back regularly for their botulinum injections ?
LP : Usually they come once in a while, with no regular pattern. Their demand is more anecdotic.
EB : Not really. I noticed they usually come for special occasions, like before a wedding or graduation.
CP : Do you notice a taboo around the topic of botulinum injections on young adults between 22 and 30 ? Do you feel it in the media, with your patients and/or colleagues ? If so, why is that ?
LP : Yes, I feel the taboo at three levels : social, medical and in the media. This taboo is linked to the fact that botulinum is a drug and that it is associated – although wrongly – to the notion of habit and « addiction ».
EB : I notice the taboo when interacting with the media or with certain of my patients, but not when I discuss the issue with colleagues. The word « toxin » does not scare as much anymore, but there is still a fear of the « frozen » look after injections of botulinum, which means fear that the doctor injects too much or in the wrong muscles.
AA : Indeed, there clearly is a taboo, but I don’t think it is linked to patients’ age. Injections on older patients are as controversial.
One of the reasons explaining the taboo around botulinum injections on young adults is the idea that they will automatically have to continue the treatment for their whole life to maintain results. But actually, it’s the opposite; when botulinum is injected on patients in their 20s and 30s, there is a “muscle memory” effect which means that after a couple of sessions, the hypertonic (overactive) muscles will lose their habit of over contracting. The doctor may then discontinue or reduce the frequency of injection sessions, while results will continue to be visible. So previous wrinkles and lines won’t automatically reappear.
CP : Do you think that starting botulinum injections in your twenties will slow down the process of facial wrinkle formation?
LP : In a zone of muscle hyper tonicity, yes.
EB : Yes, absolutely.
AA : Yes.
CP : Apart from that benefit, do you think botulinum injections can have other effects, positive or negative, on the skin and general ageing of a face ?
LP : There are no case studies that allow me to express an informed opinion.
EB : No.
CP : What is your personal viewpoint and approach regarding the demand for botulinum injections coming from young women (22-30 years old) ?
LP : As a doctor I commit myself to answer with intelligence, ethic, and level-headedness to each demand, whatever the patient’s age; as long as the patient is adult, well-informed and fully conscious of the treatment in question. To refuse discussion amounts to keeping a certain power over younger generations, which is not something I believe in.
EB : According to me, the major quality of botulinum injections is not to erase wrinkles, but to enhance the beauty and expressions of a face. However I do not perform them on patients under 25 years old.
AA : Botulinum toxin is not an anti-age product per se. Rather, it allows improving the appearance of a face, to correct certain asymmetries and mimics. These are aesthetic preoccupations that exist also in patients under 30. So when their request is thought-through and justified, I have no reason not to perform botulinum injections.
CP : When do women start to perceive their own ageing process ?
LP : Between 30 and 35 years old ; often, that’s when the start to identify themselves to their mothers.
EB : Around 30.
AA : The demand for ageing prevention appears around 30-35. I noticed that external factors might influence the timing, like a heartbreak for example.
CP : These young women between 22 and 30, what are they aspiring to ?
a) age prevention
b) feeling more beautiful
c) taking care of themselves and their self-esteem
LP : Above all there is a desire to feel better about themselves.
EB : Feeling more beautiful and attractive.
And what about you, what do you think ?