Botox on thin skin, what are my options?

Although Botox may have been sufficient to resolve your wrinkles in the past, as we continue to age, our needs change. Botox works in patients with both thin and thick skin, but aging not only makes the skin thinner, but also atrophies the underlying muscle and bone. You are probably losing collagen and elastin in your skin, which are the building components that keep it looking plump and supported. If you want to avoid fillers, you can improve the texture of your skin with a variety of lasers including both non-invasive and no-downtime treatments with intense pulsed light (IPL) or more aggressive ablative lasers with minimal downtime that can stimulate collagen production to minimize wrinkles and enhance Botox's effects. A high-quality skin care routine, including topical antioxidants and SkinMedica’s HA5 hyaluronic acid cream are also helpful. Please consult a board-certified dermatologist who has a number of anti-aging strategies to help you move through each stage of life looking beautiful and youthful.

The indication of Botox or other neurotoxin, such as Dysport, for reducing muscle contraction creating wrinkles does not change for thick or thin skin, however, patients will thinner skin may need some building of collagen or volumizing to the face to get the best aesthetic result.  I am a proponent of combination rejuvenaton treatment, and it is common in my practice to perform Botox, Fillers and Skin rejuvenation treatments with lasers, microneedling, RF or IPL to maximize the appearance and benefits.

Botox works in the muscle, not the skin. However, because skin, muscle and bone thin with age, to look more rejuvenated you may need to begin stimulating collagen in your skin with hyaluronic-acid fillers, such as Juvederm, Restylane and Voluma. Please see a board-certified dermatologist to come up with a new strategy to rejuvenate your aging skin.

Hello, and thank you for your question.  The effects of Botox are not dependent on the thickness (or thinness) of one’s skin, so I suspect that your doctor has suggested fillers to add volume to your face, thus achieving the best overall aesthetic result. I would suggest that you speak to your doctor and ascertain exactly what he is suggesting – and the results he would expect from this – before making a decision. Best of luck! 

It is difficult to assess what is going on without a photo.  Since botox is injected into the muscle it should not matter the thickness of the skin.  It may be after all these years you have developed a tolerance to botox and changing the dose or switching to another neuromodulator would be helpful.  It may be that your provider has suggested dermal fillers to get the best results.  Dermal fillers will replace volume and lift to the face which may be what you need.  

I note that you are 58 years old and you have been having Botox for some years. During Menopause the skin loses elasticity and firmness , there is also loss of fat and bone resorption. This leads to thin sagging , wrinkled facial and neck skin. It will not be addressed by Botulinum toxin which main effect is to relax tight overworking expression facial muscles. Dermal filler is one of the tools but not the only ideal treatment. Skin care that includes retinoids, Vitamin C helps to rejuvenate the skin and reverse some of the features of ageing. I do recommend energy based treatments such as Micro-Focused Ultrasound  ( Ulthera) and Radiofrequency ( Pélleve) and get good results for collagen stimulation and smoothing fine lines. My favourite to regain skin plumpness and firmness, is using CaHA fillers which has significant and longer lasting collagen stimulating effect.  HA dermal fillers are widely used and they are very useful in correcting, enhancing facial contour and boosting skin hydration As well as being safe in the experienced hands. 
I hope this will help you in making decision or at least give you direction for further research. Regards

Thank you for your question PHEASANT 123. Botox is a purified protein used to address wrinkles associated with
facial expression. It is difficult to make an assessment without photographs. Botox relaxes the muscles that are under the skin. To stimulate collagen in the skin itself I recommend fractional CO2 laser treatment for my patients. Please consult with a doctor for specific recommendations. Good luck!