Botox – What Really Happens to Our Facial Muscles When We Stop Using Them?

In recent years, Botox injections have become a very common aesthetic treatment. Women and men begin using it at younger ages, sometimes even before significant wrinkles have appeared, thinking that this way they can prevent their appearance in the future.

But there is a question that interests me especially.

What happens to our facial muscles when we reduce their activity again and again, for years?

To understand this, we first need to understand what Botox is and how it works.

What is Botox?

Botox is a trade name of a preparation containing Botulinum Toxin type A, a protein originating from the bacterium Clostridium botulinum.

There are other preparations based on botulinum toxin, such as Dysport, Xeomin, Jeuveau, and Daxxify.

Although they are sometimes referred to as anesthetics, they are not anesthetics at all.

A local anesthetic acts mainly on the transmission of nerve signals related to sensation. In contrast, botulinum toxin acts on the communication between the nerve and the muscle.

How does it work?

In a normal state, when we want to activate a muscle, the nerve releases a substance called acetylcholine.

The acetylcholine transmits to the muscle the signal to contract.

Botulinum toxin inhibits the release of acetylcholine at the nerve endings it reaches, and thus temporarily reduces the muscle's ability to contract.

In the face, this effect is used to reduce the movement that creates expression lines, mainly in the forehead, between the brows, and at the sides of the eyes.

The skin above the muscle moves less, and therefore the dynamic wrinkles become less prominent.

But it is important to understand that the substance does not fill wrinkles, does not directly produce collagen, and does not give the skin back the structure it had at a young age.

What are the advantages of Botox?

1. Reduction of expression lines

Botox is especially effective in reducing wrinkles created following repeated movements of the facial muscles, such as frown lines and crow's feet.

2. A relatively quick treatment

The injection usually takes place within minutes, without surgery, and in most cases one can return to regular activity a short time afterwards.

3. A temporary effect

The effect usually wears off gradually, and therefore it is not a permanent paralysis of the muscle.

4. Additional medical uses

Botulinum toxin is also used in medicine to treat conditions such as chronic migraine, excessive sweating, certain muscle spasms, and additional neurological disorders.

These are established medical uses, but they are different from an aesthetic injection whose purpose is to reduce wrinkles.

And what happens to a muscle that doesn't contract?

Here we arrive at an interesting point.

Muscles are tissues that respond to their level of activity.

When a muscle's activity is reduced over time, it may undergo a process of decrease in volume, called atrophy.

Studies have shown that repeated injections of botulinum toxin can cause a decrease in the thickness or volume of certain muscles.

This is not necessarily a dangerous result, and sometimes it is even part of the therapeutic goal, for example in reducing the volume of the chewing muscle in certain cases.

But it is a reminder that the treatment does not affect only the wrinkle we see in the mirror, but also the activity of the muscle beneath it.

Do the muscles atrophy permanently?

It is not correct to state this across the board.

The effect of botulinum toxin is usually temporary, and in most aesthetic treatments it lasts about three to four months, although the duration of the effect varies by preparation, dosage, and the person.

Over time, new nerve communication is created that allows the muscle to return to activity.

However, after repeated and prolonged treatments, changes may occur in the muscle's volume and in its movement patterns.

There are still not enough long-term studies to determine precisely what the significance of decades of repeated injections is for all the facial expression muscles.

Does Botox really prevent wrinkles?

Botox can reduce wrinkles created following repeated muscle movement, and therefore there is logic in that reducing movement may slow the deepening of some expression lines.

But there is a difference between slowing the appearance of certain wrinkles and preventing skin aging.

Our skin continues to change even when the muscles do not contract.

Over the years, changes occur in collagen, elastin, subcutaneous fat, and bone structure.

Sun radiation, smoking, and other factors also affect the skin's appearance.

Therefore Botox does not stop facial aging, and there is currently no strong proof that starting injections at a very young age provides a long-term advantage for every person.

Can repeated injections change facial expression?

Yes.

The facial muscles work together to create expressions such as a smile, anger, surprise, and sadness.

When the activity of some of the muscles is reduced, the face's movement can change.

At suitable doses and with precise treatment, the change may be very subtle.

But when too large an amount is injected, or when the substance affects muscles that were not intended to be weakened, a frozen or asymmetrical appearance can result.

Sometimes temporary drooping of the brow or eyelid appears.

It is important to remember that facial expression is not created by one muscle alone, but by cooperation between groups of muscles.

And what about the connection between facial expressions and emotions?

This is a subject that interests me especially.

We are used to thinking that our emotions affect our facial expressions, but there are studies that also examine the opposite direction: can facial muscle movement affect our emotional experience?

This field is called Facial Feedback.

Some of the studies found that limiting certain facial movements may affect the processing of emotions or the way we experience them.

There are also studies that examined the effect of botulinum toxin on symptoms of depression.

But the findings are still not sufficient to determine that aesthetic injections harm the ability to feel emotions, or conversely, that they provably improve mental health.

Our face is part of our emotional communication with the world, and therefore in my view this is a field that is interesting to continue researching.

What are the risks and side effects?

As with any medical treatment, botulinum toxin injections also have risks.

Possible side effects include pain, swelling, or a bruise at the injection area, headaches, asymmetry, and temporary drooping of a brow or eyelid.

In certain cases, depending on the injection location, changes in the smile, unwanted muscle weakness, or disturbance in the function of nearby muscles may appear.

There is also a serious medical warning against the spread of the toxin's effect beyond the injection area. In rare cases, general weakness, difficulty swallowing, speaking, or breathing may appear.

Such symptoms require urgent medical treatment.

It is especially important to avoid injections performed by people who are not qualified or using preparations from an unclear source.

Can the body develop resistance to Botox?

Yes, although this is not common in regular aesthetic treatments.

In certain cases the immune system may develop antibodies that reduce the substance's effect.

The risk is influenced, among other things, by the type of preparation, the doses, and the frequency of treatment.

Therefore it is not recommended to perform injections at a higher frequency than required without medical justification.

And what happens when we stop injecting?

In most cases, muscle activity gradually returns.

Expression lines may reappear as the movement returns.

There is no proof that stopping Botox in itself causes the skin to age at a faster rate than would have occurred naturally.

However, if changes in muscle volume were created after repeated treatments, their recovery may be gradual.

Are there alternatives to Botox?

Here it is important to distinguish between treating wrinkles and treating skin health.

Sunscreens, suitable retinoids, good moisture, and avoiding smoking can help maintain skin quality and reduce some of the signs of aging.

But they do not act like botulinum toxin and do not paralyze muscles.

Facial exercises and massage are also not a proven substitute for Botox in terms of reducing expression lines.

Facial exercises may affect muscle activity, but the research regarding their aesthetic effect is still limited.

And what about injections for twenty or thirty years?

This, in my view, is one of the most important questions.

We know quite a lot about the effect of a single injection and about repeated treatments over certain periods.

But the knowledge about the effects of regular aesthetic use over decades is still limited.

Do the muscles maintain the same volume? Do movement patterns change? Is there an effect on the overall appearance of the face when certain muscle groups are weakened for years?

There are findings that point to possible changes, but not enough information to give one answer that suits everyone.

It is also important to say that there is currently no basis for determining that everyone who uses Botox for years causes herself irreversible damage.

My daily recommendation

I love our body's ability to move, change, and express emotions.

I love the fact that our face tells a story even without words.

And I certainly understand the desire to soften wrinkles and feel better in front of the mirror.

But I think that before we decide to weaken a certain muscle again and again, it is worth understanding what its role is and what the possible significance of reducing its activity over time is.

Not every wrinkle is a medical problem, and not every facial movement is something that needs to be stopped.

I am not against aesthetic treatments. I am in favor of knowledge, conscious choice, and careful use.

In my eyes, true skincare is not only the attempt to maintain a young appearance, but also to preserve the function, health, and balance of our body.

And sometimes I think we should ask not only how we can look younger, but also what we want to preserve in ourselves as we grow older.

Nurit Rozenblat

With love,
Nurit Rozenblat
OrOrgani

FOLLOW ORORGANI    Website · Blog · YouTube · Instagram · Facebook · Threads · Medium · Substack