Is Your Botox Giving You Jowls?
I've been doing a bit of research into Botox recently, mainly from being nosey in all honesty. I've always been a bit of a "never say never" kind of girl with Botox and although I've never had it, I always assumed that maybe at some point in the future I would. I'd just hold off for as long as possible and then, when the wrinkles eventually got the better of me, I'd probably succumb.
Fillers have been an absolute no go for me personally for a long time. I've learnt too much about them, seen them done badly far too many times and worked on many a face that is constantly puffy after having them. Botox, however, I always looked at slightly differently, but I'm starting to realise that perhaps that was because I'd never really thought about what repeatedly weakening a muscle actually means.
I recently came across an article in Harper's Bazaar about masseter Botox and the possibility of it contributing to sagging and jowling, and of course that sent me down another rabbit hole.
'Why You Might Want to Think Twice About Botox in Your Jaw', was the name of the article if you want a nosey.
Masseter Botox has become incredibly popular over the last few years, both for people struggling with jaw clenching and grinding, and cosmetically to create a slimmer, more V-shaped lower face. The masseter is one of the large muscles we use to chew and when Botox is injected into it, the muscle can't contract as strongly. Over time, it can actually become smaller, which is precisely why it can make a wide or square jaw appear slimmer.
The bit that really peaked my interest, though, was what happens when you take away some of that muscle volume.
Studies have shown measurable reductions in masseter thickness and volume after Botox, particularly with repeated treatments. In one small study, three treatments six months apart resulted in an average 12% reduction in masseter volume that was still present a year after the final treatment. Another human study found that repeated injections produced greater reductions in masseter thickness than a single treatment.
So yes, muscle atrophy sounds like a terrifying phrase, but in the case of cosmetic masseter Botox, making the muscle smaller is essentially part of what you're trying to achieve at the end of the day.
But what happens to the skin sitting on top of it?
So, if you have a very square face with large masseter muscles, reducing some of that volume might give you exactly the result you're looking for. However, if you already have a narrower face, less facial volume, some laxity or you're simply getting older and naturally losing some of the structural support beneath your skin anyway, taking away even more volume might not necessarily be such a great idea.
There is actually a published paper looking at 27 patients who presented with facial flaccidity (very funny word I know) and sagging after masseter Botox, so this isn't something that someone has made up on TikTok to cause controversy. That doesn't mean everyone who has masseter Botox will suddenly develop jowls, of course, but it does mean it's a potential aesthetic consequence worth knowing about.
There has also been research into whether repeatedly weakening the masseter could affect the underlying jawbone. One small human study found reductions in bone volume around the mandibular angle following treatment, with greater changes in people who received two injections rather than one. There has been a study done that links masseter Botox to osteoporosis, but it was a very small study so let's not completely freak out here.
However, more recent and much larger controlled research hasn't found clinically meaningful changes to the mandible over 12 months, so I don't think we can currently say that masseter Botox definitely damages the jawbone. It is, however, something researchers are still looking at, particularly when we're talking about repeated treatment over many years. It does kind of make sense though.
And this is why my thoughts about Botox in general have changed.
I think I'm taking myself out of the race. I said it a while ago with the designer bags and material items. Now I'm saying it about ageing too.
I've worked in skincare for around twenty three years now and I've watched faces, treatments and trends change enormously during that time. When I first started, Botox wasn't something everyone openly discussed. Then gradually more of my clients started having it, fillers became huge and before we knew it, injectables became another part of the beauty routine.
Now I'm seeing some of that go the other way entirely.
Over the last few years, a large proportion of my clients have stopped having filler and quite a few have either reduced their Botox or stopped that altogether too. One of the things I hear repeatedly is simply, "I didn't like the way my face looked anymore."
For years I've almost assumed that Botox would be inevitable. I'd look after my skin for as long as I could and eventually there would come a point where skincare wasn't enough and I'd have to move onto the needles.
Except... why? Is this a societal natural progression? Like Meet someone, fall in love, get married, buy a house and have kids?? Is it the same kind of thing? Live your life up to the age of twenty nine, then start panicking about turning thirty, start spending copious amounts of money on preventative and corrective skincare, have the injectables and then what...? The grand finale is the facelift?
So I'm taking myself out of the anti-wrinkle race altogether.
That doesn't mean I've suddenly decided I don't care what I look like. Quite the opposite in fact, I spend an arguably ridiculous amount of time looking after my skin and I fully intend to continue doing so. I just think my goal has changed now I'm in my forties.
I'm much more interested in skin longevity. I want my skin to function well, stay healthy, retain as much collagen as possible, remain resilient and, yes, look as good as it possibly can while doing all of that.
If I get some wrinkles along the way, I think I'm actually okay with that.
And if you love your Botox, I'm equally okay with that too. I genuinely couldn't care less what anybody else chooses to do with their own face. This is purely what I've decided I want with mine.
So what am I doing instead?
I'm concentrating on the more boring stuff that isn't actually very boring when you realise how much difference it can make over decades.
I do my bi-weekly facials at home, eat as well as I can, move my body, try to get enough sleep, manage my stress and anxiety as much as possible and yes, have regular orgasms because I've already written copious blog posts about why they're rather fabulous for us too! Read my last one here.
Then there's my skincare...
Rather than trying to freeze every line, I'm concentrating on keeping the skin itself in the best condition I possibly can.
Cleansing: I always start with my Cleansing Beauty Balm (in the evening) and follow with either Nimue Cleansing Gel or Revision Papaya Enzyme Cleanser. Cleansing sounds incredibly basic, but people massively underestimate how much the wrong cleanser can affect the health of their skin.
Serums and lotions: I alternate between Forlle'd Refining Lotion and Platinum Lotion, use the leftover serum from my Meder Beauty sheet masks and absolutely swear by SkinBetter Science LINES. I use LINES at least twice a day and, for me, this is one of the products I swear by when I want to soften the appearance of expression lines without Botox.
Moisturisers: There is always something Forlle'd on my face twice a day. For me I alternate between the AC Clear Cream, the Basing Emulsion and the Platinum Face Cream. Plus Calecim Multi Action Cream I will use at least once a day too.
Retinoids: Vitamin A is a huge part of my skin longevity routine. Because I'm acne prone I use SkinBetter Science AlphaRet Clearing Serum, but AlphaRet Overnight Cream is another brilliant option if breakouts aren't your concern.
Exfoliation: I use peel pads twice a week, SkinBetter Science AlphaRet Peel Pads on a Sunday and Nimue Rejuvenating Face Wipes on a Wednesday. I don't believe in constantly exfoliating the life out of your face, but used appropriately, exfoliating acids can be fantastic for texture, pigmentation and overall skin appearance.
Masks: Meder Beauty Masks are still some of my favourite sheet masks and I use them weekly. I also save all that lovely leftover serum and use it in my routine afterwards because I refuse to waste a drop!
SPF: This is probably the least glamorous and most important part of the whole thing. I never leave the house without it. Nimue Sun-C SPF 40 has been a favourite of mine for more than twenty years, and I also use Revision TruPhysical SPF 45 when I want something tinted with a little extra coverage.
Supplements: Skinade is still one of my go-tos and I'm becoming increasingly interested in looking after the gut as part of skin longevity too. I use ANP Skin Clear Biome alongside Decoded GS-1 Inner Foundation because the gut-skin axis is another area that I think we've massively underestimated for years. Please read my recent blog post on this as it's such an important part of our overall health.
Obviously, you don't need to go out tomorrow and buy every single thing I use. Your skin might need something completely different from mine, and chucking twelve new products at your face in the name of avoiding Botox isn't exactly the message here either.
The biggest thing for me is consistency.
I'm not expecting one serum, supplement, facial or even one lifestyle habit to stop me ageing. I'm looking at what I can consistently do over the next ten, twenty and hopefully forty plus years to keep my skin, and myself, as healthy as possible.
Will I still develop wrinkles? Absolutely. Will my face change? Of course it will. I'm 41, not frozen in time!
But I think I've finally stopped seeing injectables as the inevitable next step when skincare has taken me as far as it can.
Maybe there doesn't actually have to be a next step...??
If you're thinking more about skin longevity and would like to know what you can realistically do for your own skin without automatically heading down the injectable route, you can book an online consultation with me here or fill out my free Skin Check-In form and I'll help you put together a routine that actually suits your skin.
Thank you so much for reading,
Emmaline
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