Is muscle atrophy a significant issue when getting Botox?

Question

I’m 33, and have dynamic lines to my forehead that bother me and are more visible when my skin is dehydrated. I booked in for Botox, however, my BF has warned me that getting Botox before the dynamic lines are more permanent increases the risk of muscle atrophy. He made comparisons to atrophy in patients post CVA. He’s an SpR in plastics and has carried out botox but only in non cosmetic procedures. Is this something to be concerned about or is he trying to put me off?

Monica Boen, MD · Answer

Botox works by relaxing dynamic muscles that cause wrinkles, so that they stop contracting and folding your skin. Without constant contraction, the muscle does atrophy over time, just as your biceps would atrophy if you didn’t exercise them regularly. However, long term studies have shown that the muscle atrophy is not permanent and when you stop your Botox treatments, the muscle activity returns in 3-4 months! Please consult a board-certified dermatologist who is an expert injector and has experience working with younger patients.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Your boyfriend is correct in that Botox leads to muscle atrophy given its consistent use.  For aesthetic purposes of dynamic wrinkles to the forehead this is a desired effect.  Remember too that the overall starting muscle bulk is minimal.  Hope this helps.

Christopher R. Macdonald, FRCS(Plast) · Answer

Thanks for your question and photos.
You are correct that BOTOX can cause a disuse atrophy however as the cause is completely different from a CVA you can always expect it to return back to normal. Botulinum toxin works at the pre-synaptic nerve ending and blocks the release of Acetylcholine which would normally activate a muscle. The cleaving of Snap-25 proteins is permanent and irreversible but over the following weeks/months your body regenerates fresh SNARE proteins and so the synapse starts to function again. 
Some people have used BOTOX for years and years for cosmetic reasons and still find that it predictably wears off and that their muscles return to normal.
Good luck!
Dr Chris Macdonald
CRM Aesthetics

Monika Soni, MD · Answer

Your boyfriend is correct in that Botox leads to muscle atrophy given its consistent use.  For aesthetic purposes of dynamic wrinkles to the forehead this is a desired effect.  Remember too that the overall starting muscle bulk is minimal.

Craig Harrison, MD · Answer

I have a large group of patients who have been consistent Botox users for 15 years and I have never seen anyone with atrophy of their foreheads.Best wishes

Is muscle atrophy a significant issue when getting Botox?

Answers (6)

Answer: Botox leads to muscle atrophy given its consistent use.

Answer: Botox leads to muscle atrophy given its consistent use.

Answer: Is muscle atrophy a significant issue when getting Botox?

Answer: Is muscle atrophy a significant issue when getting Botox?

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Is muscle atrophy a significant issue when getting Botox?

Answers (6)

Answer: Botox leads to muscle atrophy given its consistent use.

Answer: Botox leads to muscle atrophy given its consistent use.

Answer: Is muscle atrophy a significant issue when getting Botox?

Answer: Is muscle atrophy a significant issue when getting Botox?

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.