What are the effects of long term Botox injections?

22 June 2022


What happens if you use Botox in the long term? What are the effects or side effects? Here’s what you need to know if you’re a fan of cheating ageing with this anti-wrinkle treatment.


It’s been 30 years since Botulinum toxin received US FDA approval and became commercially available for treating wrinkles. Since then, the record for Botulinum toxin injections to remove wrinkles or lift the skin has been shown to an effective, low risk treatment with a good safety record, especially in the hands of an experienced doctor.


That said, do you know that Botox is not actually Botulinum toxin? Botox is actually one of the brands of Botulinum toxin, the neurotoxin that’s responsible for relaxing wrinkles and hypertrophic muscles. When injected into muscles, Botulinum toxin modulates neurotransmission to these muscles to relax them and soften wrinkles. Because Botox was the first brand of Botulinum toxin to be made commercially available, its name has become synonymous with the ingredient.


Despite the long safety record of Botox injections; Botulinum toxin has had its share of skeptics. Complications such as deaths are very rare; and you can learn more about this is Is Botox Deadly? Instead, frozen faces from excessive Botox injections are the more common scenarios of Botulinum toxin gone rogue. (Pro-tip: switch to Baby Botox to keep your facial expressions intact)


Related blogposts:

Too Much Botox: Botox Gone Wrong

Baby Botox and Preventative Botox in Your 20’s Is Real


One of the FAQs I get about Botox in my clinic in Singapore from my patients is: What are the long term effects of Botox? Will I look worse than I did if I get regular Botox?


Although there are many studies to allay our fears about the short term use of Botox; studies that looked at repeated use of Botox for years are fewer, mostly because of its impracticality. However, there’s one very interesting study published in the Archives of Plastic Surgery in 2006. This study, conducted by a plastic surgeon in California looked at the results of repeated Botox injections over years in identical twins. One of the twins received regular Botox injections to her forehead wrinkles and glabella lines for 13 years. The other twin did not receive regular Botox. Here are the results published in the journal:

Left: twin without regular botox; Right: twin with regular botox injections to her forehead and glabella regions. Image credit: Binder.


The results of these studies are reassuring to fans of Botox (like me!). In the before and after photos shared by the plastic surgeon- the results are obvious. The twin who received regular Botox injections to her forehead and glabella wrinkles- had barely visible wrinkles. Predictably, in her twin sister who did not receive regular Botox, her forehead and glabella wrinkles were very obvious, even at rest. The dynamic wrinkles that appeared on her face when she frowned had progressed to fixed lines at rest called static wrinkles.


The fine lines and static lines are more obvious in the twin who did not receive regular botox (left). Image credit: Binder.


When injected into the facial muscles; Botox relaxes the precise muscle to reduce wrinkles. This treatment also reduces the facial muscles on the skin; which can help to prevent the skin creases at rest, called static wrinkles. Once static wrinkles are formed, additional treatments are required to address the skin wrinkles. Some examples are skin resurfacing lasers such as fractional CO2 lasers; and dermal fillers.


Related blogposts:

Botox VS Fillers

How to Get Rid of Neck Lines and Wrinkles


In the lower half of the face, the nasolabial folds were similar in both twin sisters. This suggests that both identical twin sisters aged similarly; and the improvements in the upper face seen in the twin who was regularly treated with Botox was due to Botulinum toxin. The twin sister who received regular Botox for 13 years did not suffer from any side effects or adverse events from Botulinum toxin.


Based on this study, we can see that Botox injections can help to delay signs of ageing and even prevent static wrinkles in the long term and are generally safe and well tolerated. If you enjoyed this blogpost, you may also enjoy these Botox related reviews:

How to Make Your Botox & Filler Injections Last Longer

Too Much Botox: Botox Gone Wrong

More Than Wrinkles: 5 Surprising Uses for Botox

Shoulder Contouring with Trapezius Botox Injections

Baby Botox and Preventative Botox

Is Botox Deadly?

Jaw Reduction Botox for a Slimmer V Face




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