This article discusses the rise of "baby Botox" among youth, emphasising the potential long-term risks of early use. This article also includes muscle atrophy and the influence of social media on this growing trend.

Originating on social media, the cutesy-sounding term "baby Botox" is essentially a form of preventative anti-ageing treatment using smaller-than-usual doses of botulinum toxin. The technique has become a hit among young adults in their 20s looking to tackle signs of ageing preemptively. 

Practically speaking, baby Botox allows for a more dynamic facial expression post-treatment, reducing the risk of the “frozen” look associated with regular Botox. It’s suited for those starting early on anti-ageing regimes or preferring a lighter touch to their cosmetic enhancements. 

Neurotoxin use increasing among youth

Approved by the FDA in 2002 for cosmetic use in individuals over 18, botulinum neurotoxin type A (BoNT-A) is increasingly being used off-label in younger populations.[1] 

The American Society of Plastic Surgeons' 2022 report indicates that 25,308 patients aged 19 and under received neuromodulator injections (eg, Botox, Dysport, Xeomin, and Jeaveau), marking a 75% increase from 2019.[2]

We’re talking about off-label applications for issues like forehead lines, glabellar lines, crow's feet, benign masseter hypertrophy, and subtle body contouring of the shoulder and calves.[4][5]

However, most of these kids don’t even have wrinkles yet, so they're using neurotoxins, in the form of baby Botox, at much lower doses—and preemptively—which might not always be the wisest choice.

Should we blame social media?

Our society promotes addictive behaviours, and social media eagerly plays along. In today’s world, people are quick to buy into the allure of beautifully packaged creams and serums, hoping they'll provide a quick fix for a problem that may not even exist. And if one product fails, there's always another to try—or perhaps a cosmetic procedure, like Botox.

According to a 2023 research study done in Saudi Arabia, “about 83% of the young population seeks medical information or attention over the Internet.”[6] The study also found that around a third of participants expressed a willingness to undergo facial cosmetic procedures influenced by social media, with half of them already planning a specific procedure for the future.

Why starting early is a bad idea

In a 2023 review, Swedish researchers discussed the neurophysiology of BoNT’s long-term effects.[7] BoNT-A, they explained, targets the SNAP-25 protein within nerve terminals, blocking acetylcholine release and preventing muscle contraction. This leads to a temporary paralysis of affected muscles.

Initially, nerve recovery involves the formation of new sprouts, not vesicle turnover in the original nerve terminals, which takes about 2 months post-injection to resume. A secondary phase sees these sprouts retract as the original terminals regain function, possibly taking up to 6 months.

The authors concluded that “Aesthetic botulinum toxin injections may result in atrophy of the injected facial muscles.” Furthermore, “Serial injections of botulinum toxin in the facial muscles may cause permanent chemical denervation.” Therefore, starting Botox use early, especially in the teens or early 20s, could raise the risk of muscle atrophy with repeated usage in later years.

In one study involving two men, a significant reduction in muscle volume lasted up to 1 year post-injection.

While some might argue that cosmetic Botox is just another beauty fix, as a healthcare professional encountering young patients desiring these treatments, you must always gauge their mental maturity and understand their motives.

In some cases, these desires may stem from body dysmorphia. Always involve parents if the patient is underage, and consider a psychological evaluation to fully understand the reasons behind the patient’s desire for these image-altering treatments.

Disclaimer: This story is contributed by Alpana Mohta, and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.