Botulinum toxin relaxes muscles and smooths wrinkles, but it also has less-discussed negative effects.
Botox injections are among the most widely used procedures in aesthetic medicine, with relatively few short-term complications. Its mechanism is neuromodulation: it weakens the activity of the injected muscles. Once the effect wears off—usually after 4–5 months—muscle activity generally returns close to baseline. However, not all tissues fully recover, depending on how frequently those muscles are used, their anatomical features, and their functional role.
Recent studies show that repeated injections into the same muscles induce histological changes: muscle fibers become atrophic and infiltrated with lipids. This process can even extend to surrounding tissues, leading to subcutaneous tissue atrophy and in some cases bone resorption.
Since atrophy is the hallmark of aging, repeated Botox treatments may actually accelerate tissue aging. For instance, frequent injections to reduce forehead wrinkles may initially be effective, but over time the forehead skin becomes thinner, less elastic, and more flaccid—resulting in more visible wrinkles and faster aging.
In some areas of the face or body, selective muscle atrophy may provide aesthetic benefits. But patients should be fully informed that repeated Botox treatments carry long-term consequences.
Morphodynamic Cosmetic Surgery offers alternative strategies to Botox in selected cases, focusing on preserving tissue vitality while modulating expression dynamics.
