S03E46 WTF IS "PREJUVENATION TOX?"

One of the latest Botox trends is called "Prejuvenation TOX." WTF is this? Let's talk about it.

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S03E46 WTF IS PREJUVENATION TOX

[00:00:00] Sam Rhee: What kind of podcast would Botox and Burpees be if I didn't actually talk about Botox? I mean, it's in the name after all, isn't it? And as a plastic surgeon, I administer a lot of Botox. I like Botox as a cosmetic treatment. It works. And a lot of patients love the results. Some patients even tell me they'd rather go without makeup than Botox.

So let's talk about one use of Botox that I saw a couple days ago called "Prejuvenation TOX." It's been hitting social media and it's gaining momentum as it becomes more popular. When I read about Prejuvenation TOX, it's one of those things that caused an instant reaction in me both as a plastic surgeon, but also as an older person in general as well.

I was actually surprised how strongly I felt about it. So let's talk about Prejuvenation TOX.

So Prejuvenation TOX is from an article in the Wall Street Journal a couple days ago written by Alex Janin titled "People are Getting Prejuvenation Botox Shots." Subtitled, " More people in their twenties and thirties are seeking what's called preventative Botox in the hopes of keeping wrinkles from developing."

And the lead sentence goes, "At the age of 27, Addie Eslinger (and if you're watching the video, you can see her picture next to me. Otherwise, if you're listening, just think of a picture of a very young person with absolutely no lines on her face) is a veteran Botox user. She's been getting the cosmetic skin injections since the age of 22.

So if you're someone older than 30 something, you may have a couple reactions that were similar to mine. Let's go through what I initially felt reading this article.

My first emotional reaction is someone no longer in their twenties or thirties was, how dare you?

You have no wrinkles, so you have no business getting Botox treatments. This takes youthful vanity to a whole new level. I mean, I knew Generation Z kids were self-entitled, but this is nuts. Earn those wrinkles like our generation did, the old fashioned way by suffering in life and getting old, and then treat them afterwards once you get old like us.

But then after I got over my jealous rant, my next thought was if I was 25 or 30 years old and someone offered me a treatment to prevent wrinkles when I was older, why wouldn't I do it?

After all, if I see my parents and old wrinkled people around me getting Botox all the time, why wouldn't I wanna look better than those old coots after I age?

And a lot of medical professionals are marketing this Prejuvenation trend. Wall Street Journal quotes a recent survey in which 27% of Botox users in 2022 were under the age of 34, compared to 21% just eight years ago.

Now I personally see patients as young as their early twenties for Botox treatment. But my patients so far have all been treatment for the jaw muscles, which is called the masseter. It's that muscle that bulges on each side of the jaw when you clench your teeth.

My patients mostly do Botox treatment of the masseter muscle because they like the slimming effect on their lower face. Treating the master muscle can also help relieve symptoms of TMJ pain, or also bruxism where patients will constantly grind their teeth often at night. The masseter is one of the strongest muscles in the body generating up to 200 pounds of force on the molars.

So Botox treatment manages to weaken the masseter muscle somewhat, but it is certainly not significantly paralyzed since you need the masseter muscle to eat and chew.

But I have never treated a patient that young yet who wanted it done to prevent wrinkles in the forehead or between their eyebrows or their crow's feet, which is what this article's describing. So the question is, would getting Botox for 10 or 20 years, starting in your twenties actually prevent wrinkling in these areas? And the best answer I could find is maybe.

Botox, or the actual name Botulinum toxin, works by blocking a neurotransmitter that causes muscles to contract.

So when you inject Botox into an area, the muscle no longer moves, even though the nerve is still trying to activate the muscle. Now, if you think about it, not moving any muscle for a really long time will cause it to atrophy, meaning get weaker and smaller. Think about your arm in a cast for six weeks after you break it.

So the skin over the forehead muscle is no longer repeatedly folding into a wrinkle. And that prevents the permanent skin creases that happen over many years of facial movement.

However, no one's done any real long-term research on patients who've received Botox for cosmetic wrinkle reduction. The longest study I saw looked for about four years, which is much shorter than the 10 or 20 years that we're talking about in this article. Whether you would actually prevent wrinkle formation with just a few years of treatment when you're younger is not known.

So the answer, whether Prejuvenation TOX works is that the jury's still out and we really don't know. And anyone who says for sure otherwise is either guessing, lying, or ignorant.

But let's suppose that long-term Botox treatment when you're younger does permanently reduce these wrinkles. Remember, Botox works in the forehead, crow's feet at the side of the eyes and between the eyebrows, what about the rest of the face?

Under the eyes, around the mouth, jowling. What if your upper face looked 20 and your lower face looked 50? That would stink to find out that you only kept half your face looking young all this time. And just speculating, but maybe a permanently Botoxed appearance is not the best look to have.

It's possible that the facial muscles would atrophy so much after decades of Botox that they might not actually ever recover full function. What if you wanted to raise your eyebrows and you found out that you no longer could?

There's some evidence that facial expressions provide feedback and reinforce our feelings. Forcing yourself to smile can actually lift mood and frowning can do the opposite. We naturally associate smiling generally with happiness, so it does seem reasonable that the very act of smiling can make us feel better.

There are studies that report Botox users feel less depth of emotion because their facial expressions are muted, therefore their emotions in some users can also become less intense.

It's one thing when you're in your forties or fifties and you start using Botox. But what happens when you spend your entire young adult life with dampened facial expressions?

My next reaction about Prejuvenation TOX is about the money. I'm sure a lot of older patients are thinking, I've worked longer than these 20 something year olds have actually been alive. Botox isn't cheap. How can they even afford it?

Sure, maybe if you're super wealthy like a Mr. Beast and have millions of fans on YouTube, - if you don't know who Mr. Beast is, excuse me, but your age is showing- then you should definitely spend your money on whatever you want.

Go for the Prejuvenation TOX if you can afford it. But for the other 99%, these younger patients are probably hitting up their parents, or are they really blowing a huge amount of disposable income on Prejuvenation TOX every couple months? Treatments aren't cheap. Wall Street Journal quotes an average Botox treatment price ranging from $325 to $725 per treatment and up to above a thousand dollars in major cities.

Now I'm actually a little on the lower side of this average, and I'm starting to think I need to bump up my prices.

So not to sound like your financial advisor or your parents, but saving money when you're younger pays huge dividends. If you're a bartender like this guy from the article, and a picture of him is next to me.

If you're listening to this podcast, think Young Dude in a Bathrobe, in a bathroom, with thin scraggly facial hair and a super thick hairdo, taking a selfie with his iPhone, but not looking at the camera and not smiling, with a cool classic Gen Z expression.

Unless this guy is like a Tom Cruise bartender in that movie Cocktail making tons of money, it might be worth it if this bartender dude saved it versus spending it on Botox. For example, saving $1,500 a year for 20 years at 5% investment return would get you $50,000.

I mean, this is a Wall Street Journal article we're talking about. I'm surprised these authors aren't knocking Botox syringes out of these people's hands and telling them to go to Charles Schwab or Fidelity or whatever and plunk that money into a mutual fund or something.

Or maybe an IRA. I mean, I don't know. I mean, I don't know specifically I'm a doctor. I don't know anything about finance. But even an ignorant doctor knows to think twice or maybe even three times before blowing $1,500 every year starting at the age of 20.

Are these the choices: financially secure and wrinkly, or poor with a smooth forehead? Is this a tough choice for some people? I would suggest at least Prejuvenation TOX should probably be the last on your list as a young person for those discretionary things to buy.

And then my last reaction was, is it even medically safe to be taking Botox for 20 years? Not to be a cranky Gen Xer, but these young Gen Z types are stereotypically all about health and wellbeing, organic products and holistic care, aren't they?

Should they not want to be injected with an actual poison derived from bacteria in their bodies? Again, not to make this too much of a generational thing, but if we gen Xers survived lawn darts and riding in cars without seat belts and working the French fryer for a $3.35 an hour minimum wage, I mean, the risk of a little Botox is a walk in the park.

I mean, more seriously, there are medical uses for Botox where patients will undergo treatment for many years. Migraines, excessive sweating or hyperhydrosis, spastic muscle issues such as cervical dystonia. These are some of the conditions that Botox treats, and we know from these medical cases that Botox is generally well tolerated and safe. Serious side effects are extremely rare.

One of the known possible side effects from long-term Botox treatment is antibody development. Since Botox is a protein, the body may recognize the Botox protein as foreign and to begin to develop antibodies against it.

While this is not common, this resistance to Botox is more likely to happen after long-term treatments or higher doses. When you develop Botox resistance, it means that treatments may no longer work as well, or not at all. So other than Botox treatments not working, can Botox resistance be a problem?

Again, we really don't know. Antibody development is a complex process and there are different factors involved, such as what other proteins are attached to the Botox and what kind of antibodies are developed. So again, the jury's still out.

I can count on one hand the number of patients I've seen in my career so far where a patient may have developed Botox resistance, where the product stopped working or worked for only a very short period of time.

Switching their product to a different type of botulinum toxin maybe complexed with a different protein or no protein; for example, from Botox to Discord or Botox to Xeomin, it seemed to help. But it doesn't seem to make sense to me for patients in their twenties or thirties who don't even have wrinkles to be receiving treatments, for a possible benefit that only works on half their face, which they would see only after decades of regular treatment.

And even then, the long-term effects are not known on permanent facial expression, or the effects of developing Botox antibodies at such an early age.

So as you can tell, I'm not a fan of Prejuvenation TOX. Quite the opposite. So if I've convinced you and you're a 20 or 30 something year old and you don't want to do Prejuvenation TOX anymore, you might be asking me: what should I then do to keep myself looking youthful and wrinkle free in the future?

I bet you probably know the answers even before I say anything, but just because what I offer is common sense does not mean it isn't worthwhile and true.

So number one, healthy living, adequate sleep, good stress management, appropriate nutrition, avoiding substance abuse. Those will all help you way more than Prejuvenation TOX. I know. Ho hum. Whatever. Right? But you know what they say? Fiction is exciting. Truth is boring.

And the number two piece of advice for all you young guns out there: skincare, retinol, and sunscreens are your friends. Don't slap the baby oil on your face and body and go out for that first good sunburn of the season, like our parents did to us.

Now on the next podcast episode, we continue on the Botox topic where I talk about an even MORE egregious use of Botox, if that is possible, that's trending these days. If you think I was not a fan of Prejuvenation TOX, just wait for the next one.

So what's your experience with Botox been? Do you disagree with me and you think Prejuvenation TOX is the solution for you? Help change my mind and let me know.

DM me @BotoxAndBurpeesPodcast on Instagram. Also remember, please like and subscribe wherever you listen to or watch this podcast and thanks again.