I’m often asked if I recommend Botox. My answer? It can be great, if used judiciously.

What is it?
Botulinum toxin was first harnessed by scientists in the ’70s to treat strabismus (crossed eyes) and, in the ’80s, blepharospasm (uncontrollable blinking) and was approved by the FDA in 1989. It is a versatile agent and is now used to “treat” many types of wrinkles, from crow’s feet to smile or frown lines. FDA-approved brands include Botox Cosmetic, Dysport, Jeuveau, Daxxify and Xeomin.

Botox is used to “treat” wrinkles
Botox is used to “treat” wrinkles © Kasia Bobula

How it works
Deep lines are caused by muscle wear and tear, not the skin (think of your skin as a shrink-wrap on top of the muscle). Botox is administered as an injection that temporarily “paralyses” the wrinkle-causing muscle: it blocks the neurotransmitter signals from nerves that cause muscles to contract. This prevents expression lines from transitioning from dynamic (present only when the muscles contract, and then go) to static (ever-present). The most common areas to treat are the expressive sites on the upper part of the face – including frown, forehead, those vertical “11s” between brows, and crow’s feet. There’s also the “Nefertiti Lift”, which consists of Botox across the platysma (neck) muscles and jawline to reduce sagging jowls, and can be followed by dermal fillers along the jawline to add volume and definition.

Don’t want Botox? Here are five over-the-counter alternatives

At-home devices such as the GloPRO Microneedling Regeneration Tool by Beauty Bio create controlled micro-trauma to the skin, whose healing process kickstarts collagen and elastin synthesis in the dermis. This gives strength, support and resilience to the skin. £199, harrods.com

Night-time retinol use with La Roche-Posay 0.3% Retinol + Vitamin B3 Serum will repair the skin barrier over time to soften the appearance of wrinkles. £45 for 30ml

Bioeffect EGF Power Serum harnesses barley-derived EGF (epidermal growth factor), a protein that plays a part in the production of collagen and elastin. Over time the use of EGF makes dermal tissue more dense, to reduce the look of fine lines and wrinkles. £165 for 15ml

Because collagen decline plays a big role in wrinkle formation, collagen supplements can help. Artah Skin Clinic daily capsules are packed with pro-collagen factors like glycine, lysine, and proline. Results are effective, although cumulative over time rather than fast-acting. £45 for 90 capsules

111Skin Meso Infusion Overnight Micro Mask has “intelligent” micro-dart patches enriched with hyaluronic acid and Vitamin C micro cones, which dissolve inside the skin when placed under the eyes, or on crow’s feet, smile and frown lines while you sleep. A great quick-fix line diminisher for a special event. £120 for four

How long does it last?
Effects wear off over time, usually three to six months. After initially blocking the nerve’s communication “keyhole”, the nerve ends sprout or regenerate, opening a new keyhole – and muscle movement is restored.

How much and often?
Not every person’s experience is the same with Botox – it depends on your age, wrinkle depth, genetic predisposition and facial expressions. As a facialist, I estimate that three out of five of my clients have had Botox. On film sets, I see actors keen to preserve their facial expressions, and agents keen to preserve their clients’ careers; the pressure to conform to expectations is immense and it’s a tug of war between how much to go for and how to retain one’s natural radiance. The ultimate aim is not to look too “done”. I’m always baffled when patients don’t know how much is being injected. My advice: ask your practitioner about the number of units, so you don’t veer too far from Point A as you continue with Botox over the years. Also, give your face a break from Botox: your muscles may atrophy from lack of use if it is used long term.

Where to get it?
I always recommend choosing a board-certified plastic surgeon, well-versed in craniofacial anatomy. Tales of Botox fails are rife among poorly trained providers: injecting too close to the brow bone can lead to ptosis (eyelid drooping); too close to mid-brow can lead to “Mephisto Effect” aka “Spock brows”. Understanding Botox’s placement, depth and dose – and its impact on surrounding muscle groups – is critical for proper results and long-term effectiveness. Though pricier, a board-certified practitioner is worth it. In the UK, you can check for a practitioner’s qualifications at the Professional Standards Authority (professionalstandards.org.uk) and for cosmetic surgeons, the British Association of Aesthetic Plastic Surgeons (BAAPS). 

Is there a halfway house?
Dr Edouard Manassa, a plastic surgeon with practices in Munich and Dusseldorf, has seen a steady increase in both male and female patients requesting “Baby Botox” to take the edge off the signs of fatigue and work stress. “Baby Botox is a good preventative approach,” he says, “or for those dipping their toes in. At low dosage the ‘barely there’ injections soften the wrinkle footprint but retain a level of movement.” Placed between the skin and muscle, at about 25 per cent of a regular dose, the results usually last for up to three months. If you are in your early 30s, it’s a good place to start if you are looking to stop fine wrinkles from becoming ingrained. If you are older, it’s a subtler option. 

What the difference between Botox and fillers?
I often see patients confusing Botox with fillers. Of the two, Botox is reversible and the effect wears off, whereas recent studies have shown that some fillers may not always fully dissolve, as marketed, and may also lead to stacking (layering) and inflammatory-response-led scar tissue development, causing the face and expressions to morph over time. 

What are the pitfalls?
The trend of having a visibly enhanced and frozen, waxy look – Botox Face – isn’t particularly youthful. A completely lineless face creates what I call a “Botox paradox” – a contradictory appearance of looking both young and old. Added to this, long-term users often have foreheads that look like freshly waxed car bonnets. But I don’t like to judge, and if someone feels better for injecting their brow, then I say do what makes you feel happy. With strategically injected units it’s possible to smooth away some lines and look refreshed, without wiping away one’s personality. 

Ask Adeela

Do you need advice on spot solutions, make-up or a skin emergency? Send your questions to askadeela@ft.com and she will address your concerns in an upcoming column

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Pursuit of beauty can have serious repercussions / From Anna Goodman, London N6, UK

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