What age should you get anti-wrinkle injections?

The short answer: there is no single right age. Most people who come to me for anti-wrinkle injections are in their thirties to fifties, and the best time to start is when your lines are still there with your face at rest, not on a particular birthday. If you have no lines, there is nothing to treat. In England it is illegal to give anti-wrinkle injections for cosmetic reasons to anyone under 18.

“Am I too young?” and “Have I left it too late?” are two of the questions I hear most often, sometimes from the same person in the same consultation. Social media hasn’t helped. Some people in their early twenties have been told they need “prevention”, while some people in their sixties assume injections aren’t for them. The truth is more reassuring than either. In this article I explain how lines form, what the evidence says about starting early, what changes at each age, and how to make sure you are treated safely.

How do wrinkles form?

Most of the lines people want to treat with injections are caused by repeated movement. Every time you frown, raise your eyebrows or smile, small muscles fold the skin above them. In your twenties, the skin springs back as soon as you stop. These are dynamic lines: you only see them when you move.

Over the years, collagen and elastin in the skin decline, the skin becomes thinner, and sun exposure adds its own damage. Gradually the same creases start to stay when your face is relaxed. These are static lines, and they are the ones that make people look tired, worried or cross when they feel perfectly fine.

Anti-wrinkle injections work on the muscle, not the skin. A tiny dose of a prescription medicine called botulinum toxin is placed into the muscles that crease the skin. It temporarily reduces the signal from the nerve to the muscle, so the muscle relaxes and the skin above it isn’t folded as hard. The effect starts after a few days and lasts about three to four months.

“The best time to treat a line is when it starts to stay after the movement has stopped. That is a feature of your face, not a number on your birth certificate.”

Mr Siva Kumar, consultant plastic surgeon

Is there a best age to start anti-wrinkle injections?

There isn’t an age that suits everyone, because faces age at very different rates. Genetics, sun exposure, smoking, skin type and how expressive you are all play a part. Two 35-year-olds can have completely different foreheads.

What I look for is the point where dynamic lines start to leave a mark at rest. Treating at that stage softens them, and while the treatment is working, the crease isn’t being folded as often, so it has less chance to deepen. Once a line is deeply etched into the skin, injections still help, but they may not smooth it completely on their own.

Does “preventative” treatment in your twenties work?

This is where the online conversation often gets ahead of the evidence. What people call “preventative Botox” (Botox is one brand of botulinum toxin) means starting regular treatment before lines appear, to stop them forming.

The idea makes sense in theory, because a muscle that is moving less creases the skin less. The evidence, though, is limited. The study most often quoted is a 2006 report of a pair of identical twins, one of whom had regular injections to the forehead and frown area for 13 years while the other had very few. The treated twin had noticeably fewer lines. It’s an interesting observation, but it involves two people with different lifestyles, and it isn’t the kind of controlled trial that can prove a benefit.

There are also reasons for caution in younger people with smooth skin:

• You are treating something that isn’t there yet. Many people never develop deep lines in some areas.
• Cost adds up. Treatment every three to four months from your early twenties is a big commitment for an uncertain benefit.
• Long-term effects on the muscle. Some studies suggest that many years of regular treatment can make the treated muscles slightly thinner. This is usually not harmful, but it’s a reason to use the smallest dose that works.

My view is that in your twenties, the most effective “prevention” is boring but proven: daily broad-spectrum sun protection, not smoking, a good night’s sleep and a simple skincare routine with a retinoid at night. Those will do far more for your skin over the next 20 years than any injection.

“I’m very happy to tell someone in their twenties to come back in a few years. A consultation that ends with ‘you don’t need this yet’ is still a good consultation.”

Mr Siva Kumar

What changes in your thirties and forties?

This is when most people start, and usually for good reason. Frown lines between the eyebrows, horizontal forehead lines and crow’s feet at the sides of the eyes begin to stay at rest. Treatment at this stage tends to give the most natural-looking results, because the lines are still soft and respond quickly.

The three areas most people have treated are:

• The frown lines (the “11s” between the eyebrows), which can make you look cross or worried.
• The forehead lines, which need a careful approach, as the forehead muscle also lifts your eyebrows.
• Crow’s feet, the fan of lines at the outer corners of the eyes when you smile.

In this age group, many people find that once lines have softened with a few rounds of treatment, they can leave longer gaps between appointments.

Is it ever too late? Anti-wrinkle injections in your fifties and beyond

It’s never too late to start, but expectations matter more as we get older. Anti-wrinkle injections work on lines caused by muscle movement. They don’t:

• lift sagging skin around the jaw or neck
• restore lost volume in the cheeks or temples
• remove heavy, hooded skin from the upper eyelids
• smooth fine crepey lines caused mainly by sun damage

There is also an important safety point about the forehead. As the upper eyelids become heavier with age, many people unconsciously lift their eyebrows all day to keep their eyes open, which is why they develop deep forehead lines. If those forehead muscles are relaxed too much, the brows drop and the eyelids can feel heavier. When I see this pattern, I treat the forehead very lightly, or not at all, and we talk about whether upper eyelid surgery would address the real cause.

In older skin, a combined approach often works best: a small amount of anti-wrinkle treatment for movement lines, dermal fillers or skin boosters for volume and quality, and laser or energy treatments for texture.

If I start early, will I need it forever?

No. This is one of the most common worries, and it’s a myth. The effect wears off after three to four months, and the muscle gradually returns to working as it did before. If you stop treatment, your lines go back to how they would have been anyway. You don’t age faster, and your face doesn’t “collapse”.

What does happen is that people get used to looking fresher, so the return of lines can feel more noticeable than it really is.

Who shouldn’t have anti-wrinkle injections?

Treatment isn’t suitable for everyone. I won’t treat you if:

• you are pregnant or breastfeeding
• you have a nerve or muscle condition such as myasthenia gravis or Lambert-Eaton syndrome
• you have an infection or active skin problem in the area
• you have had an allergic reaction to botulinum toxin before
• your expectations can’t be met with injections

Tell me about any medicines you take, including some antibiotics and blood thinners, and any treatments you have had before. I will also ask about how you feel about your appearance. Anyone who is very distressed by small features, or wants frequent treatment for lines that others can’t see, may be better helped by a different kind of support.

Why does who injects you matter so much?

Botulinum toxin is a prescription-only medicine in the UK. By law it should be prescribed only after a face-to-face consultation with a qualified prescriber who has assessed you in person. Since 2021, it has been illegal in England to give it for cosmetic reasons to anyone under 18, and the government has announced plans for a licensing scheme for people and premises offering injectables.

Until that is in place, the injectables market remains poorly regulated. When choosing where to go, ask:

• Is the person treating me a doctor, nurse or dentist registered with a UK regulator, and can I check their registration?
• Will I have a proper consultation first, with time to think before treatment?
• Do they know facial anatomy well enough to manage a complication, and will they see me if something goes wrong?

“Good injecting is mostly about judgement: where not to inject, and how little you can use. Most people don’t want to look ‘done’. They want to look like themselves on a good day.”

Mr Siva Kumar

What happens during treatment?

• Consultation: I watch how your face moves, look at your lines at rest, and talk about what you would like to change and what you would like to keep.
• Treatment time: 15 to 30 minutes. The needle is very fine, and no anaesthetic is needed.
• When it works: you will start to notice a difference after 3 to 5 days, with the full effect at around two weeks.
• Review: I see first-time patients again at two weeks, in case a small top-up is needed.
• How long it lasts: about 3 to 4 months, sometimes longer as lines soften.
• Downtime: minimal. Small bumps settle within an hour. Avoid lying flat, rubbing the area and strenuous exercise for the rest of the day.

Side effects are usually mild: a little redness, a small bruise or a short-lived headache. Rarely, the medicine can affect a nearby muscle and cause a droopy eyebrow or eyelid for a few weeks. Careful placement makes this uncommon, and it always wears off.

Anti-wrinkle injections with me start from £300 at The Ü Clinic in Sevenoaks and Oxted. You can read more on my anti-wrinkle injections page.

Quick questions

Is 25 too young for anti-wrinkle injections?

Not if you have a line that genuinely bothers you, such as a deep frown line from strong muscles, but most people at 25 don’t need treatment. A consultation is the best way to find out, and I’m happy to tell you to wait.

Can anti-wrinkle injections stop wrinkles from forming?

They can slow lines from deepening while the treatment is working, because the muscle creases the skin less. They can’t stop your skin from ageing, which is why sun protection matters at every age.

How often will I need treatment?

Usually every three to four months to keep the effect. Many people find they can stretch this to four to six months over time.

Will I look frozen?

Not if the dose and placement are right. A natural result keeps some movement, so you can still look surprised, happy or concerned.

Is it safe to have treatment for many years?

In experienced hands, yes. Botulinum toxin has been used medically for over 30 years. Using the lowest effective dose, and leaving at least three months between treatments, keeps the risks low.

Next steps

If you’re not sure whether you are ready, a consultation is the best place to start. I’ll tell you honestly whether treatment would help, and if not, what would. You can book a consultation at The Ü Clinic in Sevenoaks or Oxted.

Sources

• Binder WJ. Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Archives of Facial Plastic Surgery 2006;8:426–31.
• Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. legislation.gov.uk
• Department of Health and Social Care. Consultation on the licensing of non-surgical cosmetic procedures in England, 2023.
• General Medical Council. Guidance for doctors who offer cosmetic interventions. 2016. gmc-uk.org