Can You Be Too Old for Neurotoxin Injections?

Most of the conversation surrounding neurotoxins and age revolve around the younger end of the spectrum and prejuvenation: Questions like “How young is too young?” and “If I start young, will I look better when I’m older?” flood doctors’ offices and Google searches. But there’s a whole other group of patients—those ages 70 and up—who benefit from a bit of muscle freezing if you will, and this particular conversation focuses on them.

“I do think older people get concerned thinking they’re past an age where they can do anything, or they have to have surgery at this point, but there is a lot we can do that is nonsurgical and still get good results,” says Campbell, CA dermatologist Amelia K. Hausauer, MD. “We often end up skewing toward talking more about millennials and younger people, but there’s a whole other end of the spectrum. We don’t end up talking about some of the older patients and what they may or may not be good candidates for.” Here, we are.

Is there a recommended “age limit” for neurotoxins?

Dover, OH facial plastic surgeon David Hartman, MD says neurotoxins “work” on older people by the same mechanism that they work on younger people: by decreasing the contraction of the underlying facial muscles, which lead to the “bunching” of the overlying skin. “‘Dynamic lines’ from bunching skin comprise the majority of lines found on a younger person’s face,” he explains. “By contrast, ‘static lines’—primarily caused by decades of sun exposure—are far more prevalent in an aging face. Static lines are wrinkles that are present all the time, not just when underlying muscles are contracting. Neurotoxins only work on dynamic lines. Because many of the lines on an aging face are static lines (wrinkles), neurotoxins are not as effective at smoothing an aging face overall. However, in the appropriate aging face, neurotoxins can still be highly effective.”

Dr. Hausauer agrees, saying neurotoxins work for any age group when they’re done appropriately and with respect to the patient’s anatomy. “The difference with age is that as we get older, our muscle strength changes and the way the muscles balance one another may change, which a board-certified doctor will be aware of when using neurotoxins. I had a patient who came in last month and she said she didn’t like the lines between her eyebrows and she wanted a little lift here and there, but she wasn’t interested in surgery and didn’t think she was a candidate. I told her there were plenty of nonsurgical things we could do, and she looked great. Then I looked at her chart and she was in her 90s!”

Do neurotoxins last just as long in patients ages 75 and up as they do in younger patients?

“Neurotoxins disable the thousands of microscopic nerve endings (neuromuscular endplates), which trigger muscle contraction,” says Dr. Hartman. “The duration of the effect of neurotoxins depends on how long it takes a person to regenerate new ‘neuromuscular endplates.’ Endplates disabled by neurotoxin injections take three to five months to re-sprout and become active again. Arguably, neurotoxins last longer in seniors simply because seniors ‘regenerate’ nerve endings somewhat slower than younger people do.”

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