How young is too young for Botox?

Between society’s growing interest in tiny appearance tweaks, and accessible information everywhere, it’s not surprising we’re all a little curious about appearance medicine and plastic surgery. If you’ve ever taken a scroll through Dr Simon Ourian’s Instagram (you know, he who sculpted Kylie Jenner’s lips and smoothed Kim K’s stretch marks) You can probably skip ahead. Ourian is so forthcoming and detailed with his posts, there is little left to wonder. But are young women having the same types of treatments here? 

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We spoke to an Dr Sarah Hart, appearance medicine expert from The Skin Institute, to break down what to know when it comes to considering preventative skincare and treatments that help smooth, lift, fill and maintain our appearance.

We’ve heard of the term ‘pre-juvenation’ what does this mean in terms of skin care?

“Pre-juvenation” describes starting cosmetic medicine treatments before the signs of skin ageing appear, to keep your skin in optimal health. There are a huge number of treatments that can powerfully affect the way your skin ages. In NZ, the mainstay of ‘prejuvenation’ is to wear daily SPF and avoid excess sun exposure. Our harsh UV levels cause earlier skin ageing than other countries. Recent studies show Australian women notice skin ageing 20 years earlier than women matched for skin type in the USA and UK.

So how can you pre-juvenate?

1. Wear a zinc based SPF 30+ cream every day.

2. Use a medical-grade skin cream containing a retinoid (Vitamin A) like retinol. There is excellent proof that retinoids improve skin cell function in many ways, including boosting collagen production. If you have sensitive, irritable skin, build your skin barrier with Vitamin B (niacinamide) and hyaluranon (hyaluronic acid) first.

3. New generation “peels” are now a way to deliver high concentration, targeted ingredients to the skin, rather than just exfoliants aimed at causing skin flaking. Prescribed according to your specific concerns, there are specialised ‘peels’ to address pigment, acne or sensitive skin that can fast track the results you get from skin care creams and serums.

4. Micro-needling treatments like Dermapen or Dermastamp induce new collagen as a “collagen bank” before skin levels start to drop at 1-2% a year from age 30.

5. LED light treatments like Omnilux or Gentlewaves activate the energy powerhouses inside skin cells, called mitochondria, to boost skin metabolism.

6. Gun treatments inject moisturising hyaluranon gel, made with the same technology as dermal filler, into the skin’s surface to enhance skin hydration and improve collagen production and skin elasticity.

7. IPL (Intense Pulsed Light) treatments reduce red veins and fade brown pigmentation, improving these signs of sun damage as they appear. Multiple treatments stimulate collagen production, helping smooth the skin. Yearly IPL treatments can be very beneficial for skin colour and collagen levels.

What age is it appropriate to consider Botox?

I’d advise against starting botulinum toxin (Botox) before you see lines. Don’t be tempted into starting it too soon – although it a very effective way to relax lines caused by muscles, it won’t magically prevent all facial ageing. For best results start Botox when a faint line first appears, and not before. Botox is perfectly capable of smoothing out wrinkles when they form.

What are the most common requests from women in their 20s?

Our team of doctors and nurses most often get requests for peels, microdermabrasion, micro-needling with Dermapen, and IPL for permanent hair reduction. We also get asked for lip and cheek enhancement with dermal fillers, and brow lifting and arching with botulinum injections.

Young women are increasingly wanting Botox and or fillers – in your opinion, how should it be approached?

Women in their 20s are usually looking for enhancement or transformation, compared to women in their 40s who want to stay the same. Younger women have bolder goals and are more comfortable with the idea of bigger lips or more dramatic cheekbones, which we can create with dermal fillers like Restylane and Juvederm. Celebrities like Kylie Jenner, who had her lips gradually transformed with Juvederm, have revealed the possibilities of dermal fillers to the world. Rather than restoring lost curves, we are creating brand new contours. This takes careful thought and a good aesthetic eye. Patients with early frown lines often have inherited strong frown muscles that run in the family, and want to ensure the family frown line doesn’t ever appear on their face. While I would not treat wrinkles with Botox if there’s no line when your face is relaxed, if you have a visible line, I am very happy to “Botox” it. The key with Botox and fillers is not go too far, especially with fillers. I will say no when I think treatment has gone far enough. It’s just as important for women in their 20s to look natural as it is for older women.

What should people considering these types of updates to know?

Not long ago, I saw two new patients aged 46 on the same day. One had been having treatment with Botox, filler, IPL and medical skin care since her late twenties. The other had never had treatment. They looked like two different generations. I was blown away by how good the patient with close to 20 years of treatment looked. So yes, these treatments can provide a lot of benefit, but don’t forget they are medical procedures with risks. In good hands, the risks are very small, but picking the right practitioner is crucial. For example, there is a tiny risk of blindness with dermal fillers, especially with nose treatments. Don’t have treatment on a whim, or because there’s a special on a daily deals site. Spend time finding the right person to trust your face with.

There is one condition where you should be cautious. If you have melasma, a hormonal skin condition with patches of brown pigment on the skin, see a dermatologist for advice before having skin treatments. Although it is tempting to be aggressive, melasma is a long-term skin condition needing creams and sun protection as priority. Treatments causing heat or redness can aggravate melasma, so don’t jump into having procedures.

You don’t have to spend a lot of money. The most important “prejuvenation” step is very simple - protecting your skin daily with SPF 30, as this prevents ageing changes and lowers your risk of skin cancer.

Add in a medical grade skin care regime with good levels of retinol and that’s a great start.

 What’s the best way to find someone that can carry out these procedures in a safe and considered manner?

It’s getting harder to find a reputable practitioner, as under-regulation is allowing poorly trained and unsupervised practitioners to take advantage of a growing demand for these procedures. Be very careful in choosing your practitioner.

There’s two things to consider – safety and artistry. Safety is most important, as cosmetic medicine treatments have a very small, but very real, risk. Seek out trained doctors and nurses working from accredited medical clinics, not a back room or beauty parlour. Check if you doctor is a member of NZSCM, the NZ Society of Cosmetic Medicine, which trains and regulates cosmetic doctors. Currently there is no accredited training program for cosmetic nurses, so you are safest to stick with nurses who work closely with expert cosmetic doctors – typically NZSCM doctors, dermatologists or plastic surgeons. Be wary of new places – it takes years to build the experience delivering these treatments safely. On the artistry side, word of mouth is important. Practitioners vary in their style, especially with injectable treatments like Botox and dermal fillers. Some practitioners favour a very natural result while others are more extreme. Ask to see before and after photos of a doctor or nurse’s work, to see if their style is in line with your goals. Or, like a good hairdresser, if a friend has a result you like, ask who did it.

 What’s the upkeep like?

Both dermal filler and botulinum toxin treatments fade away gradually, leaving your face to return to its original state. There’s no commitment to repeating treatment, unless you like the result and want to maintain it. For maintenance, you’ll need Botox 2-3 times a year and dermal filler once or twice a year. Typically, the longer you have treatment, the less often you’ll need it.

 What are recovery times like?

 Botulinum toxin (“Botox”) treatment is a true walk-in, walk-out lunchtime treatment. Dermal filler can cause a little swelling and there is a chance of a bruise, which can last up to two weeks.

It takes 2 weeks after IPL for skin to look its best as brown pigment flakes off and marks fade.

Microneedling can cause 3-4 days of redness and swelling, but can be covered by makeup. You skin will exfoliate over two weeks following. If you’re skilled at covering small bruises or marks on the skin, most of these treatments have very little down time.

 What does Botox and filler cost?

Consultations where pricing is discussed based on the area recommended are essential as every person is different. Botulinum toxin starts from as little as $80-$100 for a treatment to soften lip lines to about $400 for a full-dose frown treatment, usually lasting 4 months. Dermal fillers are priced at $600-$900 per syringe depending on thickness and lasting ability. Usually you’d need one syringe for lip enhancement and at least two syringes for cheeks. *

* Prices are an estimate only