Societal pressure and social media comparison have catapulted neurotoxin treatments to another level, with more people seeking treatments younger and younger. Data shows that although the FDA has not approved neurotoxin use for anyone under 18 for cosmetic purposes, the rate at which these patients are getting injections is growing. We asked experts what they think of this trend and how they handle teens seeking neurotoxin treatment in their practices.
Featured Experts
Teenage Patients Are Toxin Curious
New York dermatologist Julie Russak, MD, notes that most young patients come in because they’re curious or influenced by social media, but once they’re in her office, she redirects the conversation to prevention through skin care and lifestyle choices. She notes many patients also leave with a personalized plan to revisit in their mid-20s, when we can start preventative microdosing.
The Concerns
“Neuromodulators are very safe and well-studied in patients, but using them in teenagers raises developmental and clinical concerns,” says Dr. Russak. “Facial musculature, bone structure and dermal thickness are still evolving well into the early twenties. If you weaken certain muscle groups too early, you can alter natural animation patterns or create compensatory movement in ways that aren’t predictable long term.”
Muscle atrophy is also a potential concern when using neurotoxins long-term. “When you are older and your muscles are bulky, this works to your advantage, but when you are young, the muscles are typically not bulky. Muscles get thinner when they are not permitted to contract, and this can lead to muscle wasting and too-thin faces that do not look youthful,” says New York facial plastic surgeon Lee Ann Klausner, MD. She also worries about young people seeking toxin treatments at lower costs, which raises concerns about injector experience, quality of product used and injector technique.
Dr. Russak notes that there are also behavioral factors to consider. “Teens often react to trends, filter culture and peer comparison rather than true clinical indications. Without fully formed emotional maturity, the risk of chasing ‘micro-optimizations’ is higher, and that can set unhealthy expectations for future cosmetic care,” she says. Additionally, impaired emotional expression and restricted facial movement have the potential to result in young people being unable to fully learn how to express emotions using their facial muscles, says Dr. Klausner. “The biofeedback that doesn’t come when the person doesn’t emote is also a potential hazard to creating negative feelings within.”
The Exceptions
While Botox is not FDA-approved for cosmetic use on people younger than 18, it is approved for ages 12 and older for certain medical uses like hyperhidrosis, eyelid spasms, migraines, TMJ and strabismus, notes Fresno, CA dermatologist Kathleen Behr, MD. Some of the experts feel there are certain cases where it’s acceptable to use neurotoxins cosmetically in teens. Dr. Klausner points to deep, hereditary glabellar lines as an example, but if there are no rhytids, there’s no need to treat, she says. Dr. Behr agrees, noting that “Neurotoxins for frown lines can change interactions patients have with other individuals, and has even been shown to help depression.” When presented with a case like this, Dr. Behr says she’s very comfortable treating a younger patient.
What Young Patients Should Be Doing for Their Skin
The appropriate focus for teenagers is controlling inflammation, optimizing the barrier, regulating oil production and protecting collagen, says Dr. Russak. “Neuromodulators can be incredibly effective, but they should be introduced when there’s a true clinical indication, not as a response to social pressure.” For teenage patients, true prevention involves clinical skin care, sun protection and acne management, not neurotoxins, says Dr. Russak. “Their collagen production is naturally high, so neuromodulators offer little meaningful long-term benefit at that stage of development.” She says education tends to be more impactful than treatment. For teen patients, she emphasizes “preventive measures like consistent SPF use, gentle retinoids and considering lifestyle factors such as sleep and nutrition to optimize the gut-skin axis.”
