What Are the Long-Term Effects of Botox?

Botox injections are currently the most popular cosmetic procedures in the world and have been FDA-approved for decades. Botox contains botulinum toxin type A, a neurotoxin that temporarily paralyzes facial muscles. This inactivation of muscle contraction can soften facial lines and wrinkles. 

The immediate effects of Botox only last for 3–6 months. That means that people who wish to maintain their results need to receive injections on a regular basis–and sometimes continue to do so for decades. So, what are the long-term effects of Botox? Here, we’re exploring both the positive and negative outcomes of prolonged Botox use.

Botox 101: Cosmetic Uses & Medical Applications

Botox Cosmetic (onabotulinumtoxinA) is primarily used to treat dynamic wrinkles, which are lines that form from repetitive muscle movements like smiling or frowning. 

Botox is specifically FDA-approved for forehead lines, frown lines, and crow’s feet. It’s also used off-label for platysmal banding (vertical neck bands), jawline slimming, subtle lip enhancement, and treatment of a gummy smile.

It also has multiple medical applications, including the treatment of chronic migraine and spasticity, often caused by conditions like cerebral palsy. The drug is also used to treat hyperhidrosis (excessive sweating) and overactive bladder, providing relief to individuals who have not found success with other treatments.

Positive Long-Term Effects of Botox

Botox is renowned for its ability to temporarily alleviate fine lines and wrinkles, offering a more youthful appearance. Over time, the use of Botox can result in prolonged skin smoothness, as the continual relaxation of targeted muscles can mitigate the development of new lines and wrinkles. Furthermore, several studies suggest that Botox may improve skin elasticity and texture.

In addition to cosmetic applications, Botox has been effective in managing chronic conditions, providing long-term relief for many patients. For those who use Botox to treat medical conditions, long-term use under a healthcare provider’s supervision can significantly improve quality of life.

Long-Term Side Effects of Botox

In addition to its benefits, Botox has a few potential drawbacks. Though Botox has been in use for many years for a range of medical and cosmetic treatments, the complete spectrum of its long-term adverse effects remains an active area of research. Some concerns are well-established, while others are currently being explored.

1. Muscle atrophy

Muscle atrophy refers to the gradual wasting away of muscle tissue. The botulinum toxin works by blocking the release of acetylcholine, a neurotransmitter responsible for muscle contraction. With repeated treatments over time, the affected muscles can become significantly weaker. In some instances, this weakening may lead to muscle atrophy.

This issue is particularly relevant for individuals who receive Botox injections in the same muscle groups consistently over an extended period. While some might argue that smaller, weakened muscles may be advantageous in achieving a smooth appearance, it can have detrimental effects if the weakening impacts essential muscles or excessively limits facial expressions.

2. Resistance to botulinum toxin

There is a possibility of developing antibodies to the botulinum toxin, making the treatment less effective over time. To address this problem, multiple pharmaceutical companies have developed new, more purified versions of botulinum toxin type A that may reduce the risk of building up a tolerance and effectively treat people who no longer get good results from Botox Cosmetic.

3. Neurological effects 

Given that Botox is a neurotoxin, there is ongoing research on its long-term effects on the nervous system, although current studies have not yet established any significant risk.

4. Psychological dependence

While not a physical side effect, the need for ongoing treatments to maintain results could potentially result in psychological dependence on the procedure for self-esteem or body image.

Botox Alternatives and Their Long-Term Effects

Botox Cosmetic isn’t the only neurotoxin used for cosmetic and medical purposes. Several other versions of the botulinum toxin are now FDA-approved. While their long-term effects are generally similar to Botox, there are some slight differences. 

Dysport

Dysport (abobotulinumtoxinA) is an FDA-approved injectable neuromodulator used for treating fine lines and wrinkles. Its long-term effects are generally similar to those of Botox, with patients experiencing sustained reduction in the appearance of wrinkles and fine lines with repeated treatments. 

One of the advantages of Dysport is its potential for a faster onset of action compared to Botox, allowing patients to see results more quickly. Some users also report that Dysport tends to spread to a wider area after injection, which can be advantageous for treating larger areas but also requires skillful application to avoid affecting unintended muscles.

When comparing the long-term effects of Dysport and Botox, both products offer a high level of efficacy and safety when administered correctly. However, some patients develop resistance to Botox over time due to the formation of antibodies against the botulinum toxin. While less common, this issue can also occur with Dysport but is considered rarer due to the lower protein load in its formulation.

Jeuveau

Jeuveau (prabotulinumtoxinA) is a relatively newer neuromodulator that has been FDA-approved for cosmetic use, specifically for the treatment of moderate to severe glabellar lines, commonly known as frown lines. Just like Botox, long-term use of Jeuveau can result in sustained wrinkle reduction and a smoother, more youthful appearance. 

Jeuveau’s formulation is designed to act in a similar manner to Botox, providing temporary paralysis of targeted facial muscles, thereby reducing the appearance of wrinkles. Although it’s newer to the market, initial reports suggest that Jeuveau is safe and effective for long-term use, with outcomes similar to those achieved with Botox.

Comparing Jeuveau to Botox in terms of long-term effects, both have been shown to offer consistent results with periodic treatments. However, as Jeuveau is newer, there is less long-term data available for it compared to Botox, which has been extensively studied. Therefore, while both are effective, Botox has the advantage of a longer track record, which may offer some patients greater peace of mind when considering long-term treatment. 

Xeomin

Xeomin (incobotulinumtoxinA) has been formulated to offer both cosmetic and therapeutic benefits similar to Botox. Long-term use can lead to a reduction in the appearance of facial wrinkles and fine lines, as well as potential relief from various medical conditions like cervical dystonia. 

One feature that sets Xeomin apart is its “naked” formula, devoid of accessory proteins, which some speculate may lessen the chances of developing resistance over time. Although research is ongoing, Xeomin has a strong safety profile and has been effective in offering lasting benefits when used in a regimen of periodic treatments.

In comparison to Botox, the two have shown similar safety and efficacy profiles for both cosmetic and medical uses. However, Botox has a longer history and more extensive research supporting its long-term effects, given its earlier entry into the market. This could make Botox a more familiar choice for those cautious about long-term use. 

Daxxify

Daxxify (daxibotulinumtoxinA-lanm) is a brand-new Botox alternative first FDA approved for treatment of glabellar lines in August 2022. It’s unique in that it does not contain human or animal byproducts, instead using a novel peptide as a stabilizer. 

Daxxify’s main selling point is that it can last up to twice as long as Botox, or 6–9 months. Despite its long-acting abilities, Daxxify isn’t associated with more prolonged side effects than other neurotoxins, and its long-term effects are predicted to be similar. However, because it is so new, it’s not possible to know if there are any unexpected long-term side effects. 

Dermal fillers

While not a botulinum toxin, dermal fillers are common wrinkle reducers that you may consider instead of or to complement your Botox treatment.

Fillers are substances injected into the skin to restore volume and fullness, and they often contain hyaluronic acid, collagen, or other materials. Unlike neurotoxins, which target muscle activity to smooth out wrinkles, fillers work by physically filling in lines and spaces. Some popular filler brands include Juvederm and Restylane.

The long-term positive effects of dermal fillers are significant and can extend beyond the immediate goal of adding volume or smoothing wrinkles. Regular treatments with dermal fillers like hyaluronic acid can encourage the skin to produce more of its own collagen over time, which contributes to a more youthful appearance even as the filler itself is absorbed by the body. This can result in prolonged effects that make future treatments less frequent or even unnecessary for some individuals. Additionally, many patients experience increased satisfaction and self-confidence after receiving dermal fillers, benefits that can be impactful over the long term.

However, the long-term use of dermal fillers is not without risks or potential negative outcomes. One concern is the possibility of developing granulomas, which are lumps that form around the filler material. Though rare, these can be permanent and may require surgical removal. Furthermore, repeated treatments with dermal fillers can sometimes lead to a “stiff” or “overfilled” appearance if not administered carefully.

There’s also a small risk of infection, scarring, or filler migration, where the filler moves from the initial injection site over time. 

Final Thoughts

There’s a lot to consider when it comes to the long-term effects of Botox. However, as far as FDA-approved uses are concerned, Botox remains a relatively safe option for both cosmetic and medical use. 

While the landscape of cosmetic treatment and medical applications of Botox continues to evolve, what remains consistent is the necessity for professional guidance and thorough research. To reduce your risk of adverse events caused by poor injection technique or inappropriate dosing, be sure to visit an experienced professional such as a board-certified dermatologist, medical aesthetician, or plastic surgeon at a reputable med spa.