Botox has been approved for cosmetic use since the 1980s, and curiosity about it only keeps growing as the stigma around these injections fades. Everyone knows what it does right away — but what it does to your face over years of regular use is talked about far less. So is Botox bad for you in the long run? To answer that, the article below draws on four leading dermatologists and the clinical studies they point to, looking at how these injections can shape your face and skin over time.
In this article: how Botox trains your facial muscles; why you may need less of it over time; muscle weakening and atrophy; permanent changes to your expression; thinner skin; discoloration and texture changes; wrinkles that never form; how long the benefits last after you stop; and the smaller-dose option known as Baby Botox.
Key takeaways: long-term Botox use can weaken the facial muscles, because the neurotoxin temporarily stops them from moving normally; some people notice thinner skin and mild discoloration after many years of steady treatment; and over time, you may find you need fewer injections, because your muscles become less likely to etch wrinkles into the skin.
Meet the experts: Dr. Mara Weinstein, a board-certified dermatologist in Rochester, New York; Dr. Debra Jaliman, a New York City dermatologist and the author of Skin Rules: Trade Secrets from a Top New York Dermatologist; Dr. Michele Farber, a board-certified dermatologist at Schweiger Dermatology Group in New York City; and Dr. Patricia Wexler, a board-certified dermatologist in New York City who specializes in dermatology and dermatologic surgery.
Trains Your Muscles
Use Botox steadily for years and your muscles start to learn a new habit: they stop pulling the wrinkle-forming expressions as hard. Dr. Weinstein explains the feeling behind it — once you get used to how little your forehead moves with the neurotoxin in place, you notice yourself trying to make that movement much more once it wears off. That awareness is part of the training effect, and it is one reason the results can feel like they last longer the longer you keep the routine going.
Weakens the Muscles
Think of it the way you would any other muscle in the body. Dr. Wexler puts it plainly: if you did not move your legs for 20 years, those muscles would eventually shrink and grow quite weak — and the same thing can happen to the muscles in your face. Used regularly, over a long stretch, without a break, the treated muscle can eventually waste away from lack of use. That does not mean your whole face thins out. Because Botox goes into discrete spots, only the treated muscles lose bulk, while the rest keep their full volume.
That is also why your face does not end up looking frozen, according to Dr. Farber. Plenty of muscles keep working full time to give you normal facial expressions. And if you do take a break from Botox, those muscles regain their strength.
Can Change Your Face
There is a more serious version of this story. A 2020 study found that long-term Botox use can bring about lasting changes in a person’s face, leaving them with an expressionless look — less animation, and a harder time showing what they feel. The study’s advice for avoiding that outcome is simple: ask for fewer units than the standard recommendation.
Might Make Skin Visibly Thinner
Dr. Wexler says some patients report that their skin looks visibly thinner after many years of Botox. In those cases, the fine veins under the skin can start to show through between areas of normal thickness. It is not common, she notes — but people who start Botox very early, in their early twenties, carry more of this risk. In that situation, the forehead skin can thin out prematurely and the muscles underneath weaken, and after many years that can even leave the brows and eyelids looking heavier, which makes the treatment harder to keep using.
Dr. Farber adds that the risk can be lowered: talking through a proper skincare routine and using sunscreen every day helps protect the skin against it.
Fewer Wrinkles Form
Not every long-term effect is a downside — this one follows directly from the muscle training above. Double board-certified plastic surgeon Dr. Konstantin Vasyukevich points out that if you have an expressive face, you are an ideal candidate for Botox as a preventive step. The long-term payoff, in his view, is straightforward: the lines simply never get the chance to form in the first place.
Could Result in Mild Discoloration or Texture
This one is unusual, but Dr. Wexler says it does happen: as the skin thins, some patients notice a visible waviness in the skin lying over the treated muscles, along with discoloration. When they make an expression, the forehead can even look like hills and valleys. The good news is that it can be prevented — by changing the injection pattern so that smaller amounts of toxin are spread more evenly, which gives the same result without the problem, or by stopping the toxin for an extended period.
You May Need Less Over Time
Years of Botox can mean less and less upkeep. As Dr. Farber explains it, with the right frequency and amount, your muscles grow less strong, so you may not need as much Botox, or need it as often. Once your muscles are trained not to move, that helps with the aging process and with keeping wrinkles from forming.
The Effects Will Last After You Stop
Many people worry that stopping Botox will leave their face dramatically wrinkled overnight. Dr. Farber says that fear is misplaced. While Botox is active, the muscles stay out of use, and that can slow the aging process — less movement while the injections are working means wrinkles form more slowly. Your skin will not suddenly develop lines to make up for lost time. Instead, you can still look years younger for your age, depending on how long you kept up the routine.
Brightens Skin and Decreases Wrinkles Long-Term
Then there is the payoff the dermatologists are most confident about. Dr. Jaliman puts it directly: get Botox continuously for 10-plus years and you will certainly look much younger and have fewer wrinkles — skin that looks much smoother, with fine lines and deep wrinkles greatly diminished. Dr. Weinstein agrees, adding that you can age gracefully without wrinkles on the forehead, the glabella, or around the eyes, even if you were the kind of person likely to develop them. The glabella, for reference, is the area on your forehead just above and between your eyebrows.
Baby Botox Is Always an Option
If the commitment of full-strength Botox is what is holding you back, there is a gentler way in. Baby Botox — Botox for newcomers — is simply the same injections given in smaller doses. You come away looking more natural after each session than you would with a traditional dose, while keeping the same benefits. Cost-wise, there is not much difference, and you can expect fewer side effects and a minimal recovery time. The bottom line is the same one the dermatologists keep coming back to: talk to a board-certified dermatologist before taking the full plunge.
Sources: the article’s findings draw on one peer-reviewed review — Witmanowski H, Błochowiak K, “The whole truth about botulinum toxin – a review,” Advances in Dermatology and Allergology, 2019;37(6):853-861. I have not tried Botox myself, and nothing here is my own experience; I am reporting what the dermatologists and the study say.
