Will Getting Botox Cause Skin to Sag?

Question

I'd like to get Botox but have read some discerning articles reporting that paralyzing facial muscles could cause the skin to later become loose and thus, sag. I suppose in some cases, the skin may have sagged either way, but my question is, could it cause sagging in skin that otherwise may have retained its firmness? I don't want to sign myself up for a facelift due to sagging skin. I'd rather have a little bit of wrinkles.

Jennifer Reichel, MD · Answer

Botox will not cause your skin to sag or become loose later in life. In fact, it should have the opposite effect. Using botox as you start to get wrinkles will help you to look younger longer.

	Botox works by binding to the nerve/muscle complex. When botox is bound, the nerve can not tell the muscle to contract. So, you can't make wrinkles. It is possible to get temporary drooping of the eyebrows if too much botox is injected into the muscle that raises the forehead (frontalis muscle), or if it is injected too far down on the forehead. However, this is always temporary.

	When you make wrinkles on your face, you are stretching out the skin (think of a fan that is closed and then opened. When it is closed, it is compact. When it is opened, it is wide. Making wrinkles is like opening the fan).

	Botox won't keep you from needing a face-lift later in life (if you decide to get one), but it may allow you to wait more years until you need one.

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. Botox relaxes muscle and can prevent lines and wrinkles from getting deeper and creased in. Sagging skin is due to natural aging and collagen depletion. Be sure to get treated under the supervision of a board certified dermatologist or plastic surgeon for best and safest results. I hope this helps.

Kenneth Hughes, MD · Answer

Botox will not cause sagging skin.  Quite the opposite, Botox should prevent the muscle from moving the skin and prevent the skin from loosening.

Paul S. Nassif, MD · Answer

Botox acts by paralyzing the muscles in a given area, causing wrinkles to smooth. Once the effects of the Botox wear off, the patient will appear the same as they did prior to the treatment. Prolonged treatments will not cause sagging of the skin. From here, I would recommend a consult with a physician who has a great deal of experience performing Botox injections. He/she will be able to best assess your needs and provide you with advice. Thank you and best of luck!

Harold J. Kaplan, MD · Answer

Hi Natural. The only affect that Botox will have on your skin is reducing or eliminating the muscle activity that causes fine lines and wrinkles. Botox will not cause saggy skin or aging. As soon as it wears off you will look just as you would have 3-4 months earlier before you did it.

Scott Trimas, MD · Answer

There is no evidence that botox can cause loose skin later in life. To the contrary, frequent botox injections might even improve the skin texture by lessening the deep creases that become present over time.

Donald B. Yoo, MD, FACS · Answer

Botox will not cause your skin to become loose or sag.  It will however, improve the appearance of your skin by eliminating and softening wrinkles.

Michael I. Echavez, MD · Answer

Botox will not cause the skin to sag. It is a temporary treatment and once it's worn off, your face should look like it did before the treatment. Botox treatments will definitely not lead to the need for a facelift, but aging can.

Sam Naficy, MD, FACS · Answer

Botox does not cause saggy skin - it works on the muscles to stop them from doing what they normally do. You can put too much Botox under your eyes, as an example, and cause the muscle to hang, thus saggy skin. Our skin changes as we age and isn't as firm as it was from one year to the next. Regular treatments of Botox don't necessarily expedite that process.

Hratch Karamanoukian, MD, FACS · Answer

Altogether 2 different things - wrinkling from muscles and skin laxity due to loss of elastin and collagen as we age. As we age, we have less elasticity to the skin with less collage and elastin content and this may require, in some people, face tightening procedures (surgical or non surgical). Non surgical options are Ultherapy. Surgical options are face lift. Having Botox now is not going to make you more likely to need a face lift.

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