Baby Botox: Why younger women are turning to preventative injections, NC doctors say

The procedure takes less than five minutes.

Since she was young, Courtney Cochrane said she had been concerned about the appearance of dynamic lines on her forehead when she raised her eyebrows. Now, the 28-year-old marketing director at Finn Plastic Surgery in Chapel Hill, is in her seventh year of receiving Botox injections.

“Every time I stop, I think, ‘Oh, maybe I could stop for a little bit,’” said Cochrane, who receives injections in her forehead every four to six months.

“Then I see the forehead lines, and I just want to get ahead of that. Skincare can only do so much in that regard.”

Neuromodulator injections — which include the botulinum toxin commonly known as Botox — rose by 71% among ages 20 through 29 and by 75% among ages 19 and younger from 2019 to 2022, according to the American Society of Plastic Surgeons. Like Cochrane, many within this age range are seeking what’s known as preventative Botox to address the contraction of the muscles leading to wrinkles and creases.

Compared to traditional neuromodulator injections, preventative Botox uses a lower dosage to decrease significant animation over time or soften any dynamic lines, depending on the individual’s aesthetic goals.

Dr. Lynn Damitz, chief of the division of plastic surgery at UNC Hospitals, said this recent trend can be attributed to the prevalence of minimally invasive cosmetic procedures on social media and a phenomenon many plastic surgeons refer to as “the Zoom boom.”

A 2022 report by the American Society of Plastic Surgeons, which highlighted changes reported by plastic surgeons in the 18-month period immediately following the height of the COVID-19 pandemic, found that 76 percent reported seeing increased demand for cosmetic procedures compared to levels before the pandemic.

“Most of us don’t have the ability to look at our own faces all the time,” Damitz said. “But because people saw themselves every day, they started to really investigate and pursue facial aesthetic interventions.”

Stigma diminished

Damitz said she’s seen younger people in her practice than she has traditionally seen over the last three to five years.

She also said one of the possible influences behind this is the normalization of aesthetic procedures on social media, as well as other avenues to address visible aging in the face, including nutraceuticals and medical-grade skincare.

“I think certainly people are thinking about those sorts of anti-aging maneuvers, whether it’s everything from skincare to botulinum toxin to other treatments, younger and younger,” she said.

Dr. Tyler Elkins-Williams, a plastic surgeon at Finn Plastic who specializes in injectable treatments, said the increase in younger clientele seeking neuromodulator injections can also be explained by the shift in the cultural stigma around cosmetic procedures.

“Back in the old days, it was like a big secret,” Elkins-Williams said. “Nobody ever talked about it. Now, you’re seeing people talk about it with their friends and even promote it on their social media accounts. People video themselves getting treatments. Definitely, it’s become less of a stigma for this country, that’s for sure.”

Cochrane said that while her mother had received treatments, the subject of Botox was never discussed in her family. When Cochrane started interning in a plastic surgery office at 21, the accessibility of neuromodulator injections and seeing others undergo treatment influenced her decision to start.

“I think with social media and with everyone posting all the time everything that they’re doing, people are a lot more aware of what they look like on camera, so they’re able to pick out their insecurities or see themselves,” she said. “It’s just more front of mind. With being on camera and all of that, women are just being more cognizant of those things.”

Kara Alaimo, a communications professor at Fairleigh-Dickinson University, explores the consumption of social media by young girls and women. She said as adolescents undergo puberty and the developmental stage, there is an increase in preoccupation with personal appearance. With the normalization of “influencer culture” on social media, younger women can become more pressured to undergo treatments such as preventative Botox.

According to the Aesthetic Society, neuromodulator injections increased 40 percent from 2020 to 2021. However, from 2000 to 2020, there has been a 459 percent increase in neuromodulator injections.

“That really tells me that the effects of being constantly confronted with images of yourself on social networks are significant,” Alaimo said.

‘Sephora kids’

These effects can also be observed in the new phenomenon of “Sephora kids,” or children under 13 who are becoming increasingly interested in skincare that contains retinol, peptides and exfoliating acids, ingredients in many anti-aging products that can irritate young skin.

Younger and younger girls who have adapted to modern-day consumer culture because of their access to social media and influencers are targeted by advertisements for cosmetic and aesthetic procedures and treatments that might not align with their age group.

“I think you are seeing younger and younger women and patients focusing on their skincare even earlier in their early teen years,” Elkins-Williams said. “Obviously, people need to be of age and make their own decisions before they start getting actual invasive medical procedures.”

Although the Food and Drug Administration approves Botox injections for those ages 18 and up, Damitz said the general recommendation by many plastic surgeons and aesthetic positions is to receive them 21 and up. Although neuromodulator injections are generally safe drugs, there can be potential risks for consistent atrophying of the muscle at a young age.

“I think when it comes to people doing it for preventative purposes, there is a concern that by atrophying the muscle or injecting the muscle to such a degree at such a young age, that then is that going to lead to other potential issues over time, whether aesthetic or functional,” Damitz said. “If you’ve limited that muscle’s ability to ever contract, is it going to atrophy? Get smaller? Not be as functional?”

Regardless of societal influences behind this trend, both Elkins-Williams and Damitz encourage those interested in receiving neuromodulator injections — no matter the age — to conduct research beforehand and go to a reputable injector.

“What we try to do when we see a patient is really focus on how we can best help them be their best selves and treat areas that are bothering them,” Elkins-Williams said. “Make them just look the way they want to and really feel that these treatments are like a form of self-care for people and not try to focus on someone else’s standard.”

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