Will Botox and Restylane make my face look much older once it wears off?

Many patients want a quick "pick-me-up" before an important social event like a wedding or other celebration.  Others are simply curious about what Botox or an injectable filler like Restylane or Juvederm can do for them, but these same patients don't want to "get started" on life-long treatments.

There is nothing wrong with trying Botox or a filler injection on a one-time or short-term basis.  The beauty of these treatments is that when they wear off, your face reverts to the previous appearance with no evidence that the treatments were ever done.

However, patients must realize that while these non-invasive treatments can "turn back the clock", they do not "stop the clock", and the aging process marches on.  In my practice, I tell patients that these non-invasive treatments are "maintenance of beauty" treatments, similar to the need to wax and detail your car periodically to keep it looking good.  Cosmetic surgery is then held in reserve until the washing and waxing (fillers and Botox) are no longer enough, and the face is in need of more comprehensive "body and fender" repairs.

Don't worry about becoming "addicted" to the effects of Botox and fillers.  They are not "habit-forming" drugs.  But, if you like what you see after these treatments, they can and should become a part of your beauty maintenance program, in moderation.

Dear Nikki,

Be assured you are not alone in your concern. In my practice I am often asked this by many first-time patients who are interested in trying Botox, and or, Fillers (such as Restylane).  

First of all, neither of these products you mentioned are designed to be permanent.  They usually lose their effectiveness over several months from treatment.  

In most cases, unless an untoward complication has occured, they also leave no residual effect to the area(s) treated.  The cases you hear of patients receiving treatments "for years" is mainly because they are not permanent treatments, and the patient likes the effect they achieve.

I hope this helps?

Best wishes,

S.P. Maggi, MD, FACS 

You are not alone in your questions regarding the ongoing use of Botox and Restylane.  Both Botox and Restylane offer temporary results and any use can be discontinued at your discretion. There is some evidence that Restylane and other dermal fillers can increase your own collagen to some degree and this may give a longer duration of wrinkle softening.

However, many patients find that they really like the softening of wrinkles and  the refreshed appearance resulting from Botox and dermal fillers such as Restylane, that they choose to continue getting them with some degree of regularity.

We always recommend that patients don't have their injectables done just prior to an important event due to the possiblity of bruising, or in rare circumstances an undesired result.   If you are considering Botox and Restylane prior to your wedding, you should probably be treated at least 1 month prior.

Always choose your provider with proper credentials in mind.  You can visit www.surgery.org for information on members of the American Society of Aesthetic Plastic Surgeons. The American Society for Aesthetic Plastic Surgery (ASAPS) is the leading organization of board-certified plastic surgeons specializing in cosmetic plastic surgery. ASAPS Active-Member plastic surgeons are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.

You can use Botox and fillers at whatever interval you choose with really no potential downside. The advantage of keeping up with the treatments, however, is a more consistently young look and the fact that it often takes much less filler to maintain your result if you don't let it all dissolve away.

The majority of people do not continuously use Botox and/or restylane. They, like you, will have it for special occasions. Afterward, you go back to exactly where you started. Botox and/or restalyne was never meant to be a permanent solution.

I agree with the other responses on this thread that stated you will need to continue using these products to keep up with the results. Furthermore, you also need to consider that your face continues to age independent of the fillers you are using.

That being said, there are some notable plastic surgeons who have begun to ask the same questions you asked. Does a filler cause the skin to age quicker? Is there any atrophy caused BY the filler? What happens to skin filled artificially over time? The true answer is that some of us believe that the fillers may indeed contribute to long term skin changes and that there simply is no data to indicate yes or no. What happens after using these products for 20 years? Nobody knows, and to simply say that there will be no consequence of the injections is likely simplistic.

I do not believe that fillers used in the short term will cause any significant long term skin changes but nobody truly knows what happens after using any of these relatively new products for 20, 30, or 40 years...

No, you do not have to continue using Botox/Restylane once you start it.  You should not see any incease in the amount or depth of wrinkles after the products have worn off.  In fact, there are studies that have shown an increase in collagen in areas injected with Restylane after the product has dissipated. This means you could have some positive longer-term results .  In regards to Botox, long-term studies of extended use of Botox have show and improvement in skin texture and tone.  Now, you may not see these positive "side effects" after just one injection, but you should defintiely not look older from the treatment.

Well, that depends:

When we were in our teens and early 20's almost all of us had perfect skin with no wrinkles or lines. As you start to get a little bit older, skin loses its elastic properties, and you start to get the external appearance of aging. In areas where you have very strong muscular activity, you start to see “active” lines. With time, the constant wrinkling of these active lines can “iron in” and make the permanent or static lines of facial expression. These go by many names – crow’s feet, smile lines, bunny lines, nasolabial folds, etc…

If you decide to try out injectables like Botox or Restylane, and only use them for one treatment, you will notice reduction / correction of the line(s) that bother you, and if you stop using the injectable, you will return back to yourself after a period of time (typically 4 months for Botox, and 4 to 8 months for Restylane, depending where you used it.)

However, if you LOVED the effect of the injectable, and used it routinely for 5 or 10 years, and THEN stopped, suddenly you would look much older (5 or 10 years older…) These interventions can cover aging very effectively, and you can maintain your appearance for a number of years before you really need surgical intervention, but you keep aging underneath the cover of the injectable. Your injector will likely have increased / redistributed how the injections were done to keep you looking the way you wanted, but in your mind’s eye, you remember the age of your face when you started using the injectable. So it is a natural reaction to blame the injectable for making you age, but really--they were doing a great job, and it is just time to blame.

I hope this helps!