Women in their 20s want to erase wrinkles now.
At 28, Sayeh Hamzehzadeh is the picture of elegant, youthful beauty. She is tall and thin, with dark, shiny hair cut in a trendy bob and porcelain skin seemingly untouched by even the earliest signs of aging.
Her beauty secret: Botox, which has been injected into the fine lines on her forehead and her barely formed crow’s- feet every three to four months for the past four years.
Area dermatologists and plastic surgeons say Hamzehzadeh, who lives in Bethesda and is an anesthesiology resident at The Johns Hopkins Hospital in Baltimore, is one of many 20-somethings turning to injectable wrinkle zappers like Botox at the first signs of aging, aiming not only to nix fine lines, but also to prevent deeper ones from forming.
“I personally think patients with fine lines are the best candidates for Botox,” says Dr. Pantea Tamjidi, 37, a Chevy Chase dermatologist who started using Botox herself at 29. “The truth is, the sooner you get started, the better off you’ll be in the long run, because you’re slowing down the aging process before it even really starts.”
Botox, a purified form of botulinum toxin, a nerve poison produced by the bacteria that can cause botulism, works by temporarily paralyzing the injected muscles, blocking the nerve signals that cause those muscles to contract. It first hit the market for a variety of medical uses in 1989. The Food and Drug Administration (FDA) officially approved its cosmetic use for frown lines between the eyebrows in 2002, though it also is used “off label” for other wrinkles, such as crow’s-feet.
For years, its wrinkle-reducing was limited mostly to women in their 40s or 50s, area doctors say. Increasingly, younger women are seeking the procedure, too, says Chevy Chase dermatologist and laser surgeon Dr. Eliot Battle.
“When I started, my Botox and filler patients were 40 and older,” Battle says. “Four or five years ago, patients were starting in their mid-30s. And in the past two years, I have seen a substantial increase in patients in their 20s and early 30s.”
Chevy Chase dermatologist Dr. Margaret Sommerville says younger women also are seeking fillers such as Juvéderm and Restylane, which plump the skin to smooth wrinkles or replace lost volume.
“These used to be common for women in their late 40s and early 50s, and now women are asking about them in their late 30s and early 40s,” Sommerville says. “It’s as if everything downshifted by a decade.”
Though 35- to 50-year-olds accounted for 44 percent of nonsurgical cosmetic procedures like Botox and fillers nationally in 2009, 19- to 34-year-olds accounted for 20 percent of those treatments, according to The American Society for Aesthetic Plastic Surgery. Ninety percent of cosmetic-procedure patients are women, according to the organization.
Doctors say a number of factors could be leading younger women to seek anti-aging injections: a glut of information about the procedures in women’s magazines and on online message boards, for one; and a society increasingly comfortable with cosmetic procedures.
“Now that Botox is seen as tried-and- true, younger women are saying, ‘If it works for my mom, maybe it will work for me, too,’ ” says Dr. Mark Mausner, a Bethesda plastic surgeon.
In Hamzehzadeh’s case, the impetus to get Botox came while she was dating her husband, Chevy Chase facial plastic surgeon Dr. Shervin Naderi, who suggested Hamzehzadeh’s extremely expressive face might turn her fine lines into deep wrinkles down the road.
Hamzehzadeh resisted, saying she was too young to consider it—until she looked at family photos and saw that the “elevens” starting to form between her own eyebrows were etched deeply into her mother’s face.
“For me, it’s like trying to prevent the breakout by using the acne medication before you get the pimples,” says Ham- zehzadeh, who now appears in print ads for her husband’s practice. “You can do it once you already have the breakout, but the results would not be as profound.”
Naderi says patients with “wrinkles at rest,” or wrinkles that stay etched in the face after years of making the same expression, are good candidates for Botox, no matter how fine the lines are. He says people with more expressive faces may start to see those wrinkles sooner than others.
Dana Burgess, 27, an Ashburn, Va., pharmaceutical sales representative, says she first visited Naderi for Botox at age 22, when she noticed a deep line forming in her forehead that “just didn’t make sense” for her age.
Two years later she started getting Botox for her crow’s-feet, a preventative measure aimed at avoiding “horrible wrinkles when I’m 40 or 50.”
“Once you see the results you can get on your deeper wrinkles, you get addicted,” Burgess says. “You realize you don’t have to look older.”
Botox treatments last roughly three to six months and can cost anywhere from $300 to $900 per visit, depending on the severity of the lines and the number of areas being treated. There’s no requirement that patients continue getting Botox after the first dose wears off, but the lines will return.
“I always tell people, ‘If you don’t like it, don’t do it again,’ ” Mausner says. “Most people want to do it again.”
Battle says he often uses Botox to “retrain” patients’ muscles: After two to three years of being unable to make an expression, patients will find they no longer make that expression at all.
“Starting Botox doesn’t mean you’re on it for life,” he says.
Dr. Thomas Le, director of facial plastic surgery at the University of Maryland Medical Center, says using Botox to prevent fine lines from turning into deep lines is a viable strategy without any known long-term side effects.
“You’re basically delaying aging for [up to] six months, because you’re not making the expressions that led to those wrinkles in the first place,” Le says.
Not all doctors endorse the preventative use of Botox for fine lines, and some say the trend of women seeking anti-aging injections at younger ages is troublesome.
“If a woman, regardless of her age, has unusually noticeable crow’s-feet or wrinkles between her eyebrows and doesn’t like them, then I’d say she could be temporarily benefited by Botox,” says Chevy Chase dermatologist Dr. Richard Castiello. “But frankly, if some girl in her 20s came to me with some infinitesimal little wrinkle, I would tell her she’s too young. That doesn’t mean she couldn’t find someone to do it, but I would try to talk her out of it.”
At any age, Botox comes with risks. Common side effects include temporary headaches, swelling or bruising. Less common is eyelid drooping, which can last a day to several weeks. And in 2009, following reports of hospitalization and death in children who had used the drug for “off-label” treatment of muscle spasms, the FDA warned patients that Botox can cause weakness or death if it spreads from the injection site to other muscles. Doctors note that the amount of Botox used in cosmetic procedures is tiny and that the temporary nature of the treatment makes it unlikely that long-term side effects will occur. Still, they acknowledge that with only two decades of use on the books, it’s impossible to know what patients starting Botox at 25 now will look like at 70.
“It was only approved for cosmetic use in 2002, and we don’t have a crystal ball,” Mausner says. “What we know is that Botox is very safe, and that in a few months it’s gone from your system.”
As for the undesirable “frozen” look sometimes associated with Botox, Tamjidi says it’s “completely avoidable.”
“You can freeze the heck out of someone, or you can put in just enough to limit mobility,” she says. “It’s all in the hands of the injector, and in what patients want out of their treatment.”
Hamzehzadeh says her only worry was that “if I started this now, I would be doing it forever. It’s sort of like coloring your hair in that once you start, you’re kind of committed,” she says. “Now I just look at it like a haircut, or something else you need every couple months.”
Burgess, too, says she views the $300 she spends on her forehead and the $200 she spends on her crow’s-feet every three to six months as just another maintenance cost, like the $80 per month she spends on her gym membership or the $140 she spends every six to eight weeks for highlights in her hair.
“It means a lot to have confidence in the way you look,” Burgess says. “If I gained 20 pounds, I wouldn’t be happy with the way I look. And skipping Botox would make me feel the same way. To me, every single cent is worth it.”
Amy Reinink’s work has appeared in The Washington Post, Entrepreneur and Women’s Running. She lives in Silver Spring.