How would an elderly person's skin take Botox?

Question

Would the skin of an 86 year old woman successfully take Botox on the frown lines to start with (then will probably want to expand). This lady is very healthy in general and very physically active with high energy aerobics, fast walking, dancing, etc. Wishes to show only the frown area but doesn't know how to crop the picture...So we'll wait. :o) Thank you very much for any ideas.

Nelson Lee Novick, MD · Answer

I have been injecting Botox for cosmetic purposes since 1991, eleven years before it even received its FDA approval for this indication. In that time, I have had the pleasure of treating persons of all ages with it. The oldest individual I ever treated with Botox for upper facial wrinkles in my Upper East Side Manhattan practice was a 92 year old woman and in my Israel satellite facility was an 86 year old woman. In an otherwise healthy person without excessive skin laxity, there is absolutely no contraindication against treatment and the results can be as gratifying as in younger individuals. So, go ahead and continue to enjoy until age 120 years.

Evan Ransom, MD, FACS · Answer

Thank you for the question. It sounds like you are having a great time! Botox is safe for older patients, though the doses sometimes need to be changed depending on the relative strength of the muscles. The only thing I would add is that lines and wrinkles which have been present for a very long time may be "permanent" (i.e., the skin crease won't really relax much with the Botox). In these cases, fillers or a surgical procedure may be required.

Jonathan Kulbersh, MD · Answer

Properly dosed Botox is safe in elderly patients that are in good health.  It can be used in the frown lines successfully.  The one caveat, if the patient has severe wrinkling in the area, it may not create a smooth area.  They must understand Botox would improve the area, but may not get rid of the wrinkles.I hope this helps.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question VeryVegan. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
Botox can work for both younger patients and more mature patients. Without an in-office exam, it is difficult to tell if it would work well on a specific individual. Often times combining Botox with topical products, fillers, and energy-based treatments provides even better results.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Benjamin Barankin, MD, FRCPC · Answer

I have treated patients as young as 20 and as old as 90 with Botox safely and effectively. There are some adjustments to be made in a more mature face, so as long as you see an expert physician injector such as a dermatologist, there shouldn't be any problems.

Michele S. Green, MD · Answer

I have patients of all ages receiving Botox.  The most important thing is (1) your general good health, and (2) the depth of the wrinkle.  If you are in good health and the wrinkles are not too deep then you are a good candidate for Botox.  If the wrinkles are very deep you will see some improvement of the lines but the wrinkles will not be completely gone.  Please find a board certified dermatologist with experience in Botox for the best results.

Parham Ganchi, PhD, MD · Answer

Botox can be safe and effective in an elderly patient who is healthy.  I have many elderly patients who use Botox very successfully.  Botox is not injected into the skin.  It is injected into the muscles under the skin.  It relaxes these muscles, preventing them from wrinkling the skin.  This prevents the muscles from damaging the skin.  However, if your skin is already damaged, Botox will not correct that.  It will only prevent further damage.  Sometimes, a filler is necessary if there is enough pre-existing damage.  Good luck!Dr. Parham Ganchi - NJ Plastic Surgeon

Stephen Weber MD, FACS · Answer

Botox is injected into the facial muscles and the age of the overlying skin doesn't affect the functioning of Botox. Frown line treatments with Botox tend to be very effective regardless of age. Seek an experienced physician injector who has treated people in their 80s to maximize the chances of a beautiful and natural result. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

How would an elderly person's skin take Botox?

Answers (8)

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