News & Features

Restylane & Botox

New Accessories for 20-Somethings Staff Report Medically reviewed by Alexander Rivkin, M.D.

CONSUMER BRIEF: As many as half a million people in their 20s and early 30s are opting for non-surgical cosmetic treatments to maintain their good looks. Many are asking for Botox and Restylane in an effort to train their facial muscles against future aging. Some plastic surgeons say it may work. Others aren't so sure.

A 14-year-old hockey player in Minnesota was driving the puck hard and fast down the ice when he fell. Another player skated across his nose, leaving a large slice that healed unevenly. The lad's family could not afford reconstructive plastic surgery so the teen had no choice but to take cruel teasing and taunting about his nose for the rest of his high school years.

When he was 20, the hockey player became another statistic: one of half a million younger people who are turning to the hyaluronic acid filler Restylane or Botox, in many cases, years before they actually need it.


"I filled the hockey player's deep nasal scar with Restylane," says Charles E. Crutchfield III, M.D., a board certified dermatologist and clinical associate professor of dermatology at the University of Minnesota Medical School. "The injury required several vials of Restylane to fill so the patient must return in eight to 12 months because the body absorbs Restylane over time. But, compared to nose surgery, the treatment is affordable.".

Of course, the younger generation's fondness for Restylane and other facial injectables like Botox goes far beyond accident victims.

According to the American Society of Aesthetic Plastic Surgeons, (ASAPS) 505,000 people aged 19 to 34 accounted for 20 percent of the nonsurgical 11.5 million cosmetic procedures performed in 2006, the most recent year for which statistics have been compiled. The figures show younger patients having 317,000 doses of some injectable facial filler, including fat transfer. 261,000 younger patients alone opted for Restylane.


The ASAPS additionally recorded 8000 cases of the wrinkle remover Botox being used on people 18 and under.

"The trend is sure to continue," says Julius W. Few, M.D., an assistant professor of plastic surgery at Northwestern University's Feinberg School of Medicine in Chicago. "The popular idea is to stop facial aging before it begins."

Plastic Surgery

Many experts are saying 20-somethings believe that getting Botox or Restylane injections before they really need it will "train" their faces to remain younger, longer. Will we become a nation of people who get cosmetic surgery procedures as often as we get haircuts? Will a surgeon's office appear on every city block?

When K.G., a pediatric therapist in Long Beach, N.Y. was 26, she went to see Andrew Jacono, M.D. for Botox. K.G. -- who asked to be anonymous -- thought she too was heading down the same path as her wrinkled mother so she returns to Dr. Jacono periodically to make sure her forehead is smooth, the eye area is unwrinkled and her nasolabial folds remain plumped up with Restylane. K.G. also has periodic laser treatments under her eyes to keep the eye trough from getting too dark and hollow.

French Lip Augmentation Before Photo French Lip Augmentation After Photo

A 20-something patient shows the results, right, after having “French lips” enhancement. Her before picture is on the left.
(Photos, courtesy of Andrew A. Jacono, M.D.)

"My friends tell me I look more like I'm 28 rather than 32," K.G. told

Plastic Surgeons

Says New York City plastic surgeon Andrew Klapper, M.D.: "I see a large number of 20-somethings for Restylane, but it is usually for correction of existing defects and for plumping up lips. I must gently turn away young people who want Botox but don't have any wrinkles or expression lines yet. Basically, there is no scientific data to show that early use of Botox will prevent wrinkles, later on in life."

Jessica H., a 24-year-old New York City receptionist noticed new worry lines in her forehead, thanks to watching after her two small children. "Plus, I think my hormones added something and the doctor tells me I have strong facial muscles."

To stop the wrinkling, Jessica saw New York City plastic surgeon Allison Pontius, M.D. and received Botox injections at five places in her forehead and between her eyes. "I love the smooth look and plan on keeping the injections up every three to six months if that's what it takes as the cost of happiness."

Jessica, too, is hopeful she will enter her 30s with softer worry lines.

"I have some younger patients who have been teased all their lives about pencil thin lips -- or no lips -- and are just over the moon when the lips are plumped up," says Dr. Crutchfield. "I'm often asked why there has been such a dramatic increase in minimally invasive cosmetic procedures. It's simple. We have stuff that works! And the results show immediately."


According to Brent Moelleken, M.D. a board certified plastic surgeon in Los Angeles, Botox is so popular because it does something -- the quick removal of forehead lines, crow's feet and frown lines -- that surgery can't provide.

"I applaud patients wanting to be proactive and I do see a lot of patients in their 20s and early 30s asking for facial injectables," Dr. Moelleken says. "Most have early signs of aging and want either Restylane or Juvederm and then Botox as a preventive for future wrinkling. But when a patent's radar is, shall we say more finely tuned than mine, and I see no actual wrinkles in the skin, I must turn her down because I don't have anything to work with."

Can 20-something patients really rely on Botox to train their faces to remain younger looking? Perhaps.


"While there is no data to support the claim, you could argue that, by using Botox early in life, one can slow down the natural process of wrinkle formation on the face," says Elan Singer, M.D., a plastic surgeon in Montclair, New Jersey. "Wrinkles are formed by years and years of muscle activity that causes permanent indentations in the skin. Thus, if you decrease muscle activity with Botox before those wrinkles form, they will appear much later in life than if no Botox had been used. That's only a theory but it makes sense."

Henri P. Gaboriau, M.D. a facial plastic and reconstructive surgeon is the director of the Sammamish Center for Facial Plastic and Reconstructive Surgery in Seattle.

"The 20s and early 30s age group in my practice is growing rapidly; they all want to avoid surgery later on," Dr. Gaboriau says. "Botox relaxes the muscles by stopping the electrical input from the brain. After about four to six injections, three months apart, the muscles atrophy and leave little movement that can cause wrinkles."

However, not every surgeon is a true believer.

"Occasionally, patients in their early 20s get Botox," says Paul S. Nassif, M.D., F.A.C.S., a facial plastic and reconstructive plastic surgeon in Beverly Hills. Usually, they are in show business and use it to prevent facial wrinkling."

"Botox for 20 year olds? No," says Michael Ciano, M.D., an attending surgeon at the University of California, Los Angeles, Medical Center and plastic surgery advisor to the state of California. "I've never seen somebody that young with expression lines that make the eyebrows droop or the corners of the mouth turn down. In addition, Botox and almost all the popular facial injectables like Juvederm and Restylane are temporary solutions because they wear off."

EDITOR'S NOTE: Our medical reviewer, Alexander Rivkin, M.D., specializes in non-invasive cosmetic treatments like the Non-Surgical Nose Job™ which is technically known as an injection rhinoplasty.

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