Botox users getting younger after a year of Zoom meetings, doctors say

As cities around the world start to reopen after COVID-19 lockdowns, the effects of the pandemic are starting to show on people's faces.

Experts in cosmetic medicine say they have begun to notice an uptick in Botox treatments among younger generations. They say people, particularly women, in their early 20s -- aged from the pandemic and wearing less makeup than before -- spent so much time looking at themselves during Zoom meetings that they started to notice their "imperfections," and for the first time, turned to Botox and fillers.

"I would say that my average age of patients shifted down considerably this year, and it's now early 20s," Skinly Aesthetics founder Dr. Dmitriy Schwarzburg said. "And they're coming not just for Botox, but for all kinds of procedures that they would otherwise consider at a much later point in their lives."

Amy Shecter, the CEO of Ever/Body said, "The Zoom effect is real, and it has definitely been a catalyst for increased interest in cosmetic dermatology treatments."

According to Stacy Garrity, a nurse practitioner at Ever/Body, many of their clients over the past year have admitted that they only started to notice their fine lines because of Zoom, and now that things are opening up, they're anxious to get out of their quarantine funk and look and feel better.

The number of patients in their early to mid 20s "is a phenomenon that was not seen five years ago," Garrity said.

Schwarzburg said the pandemic accelerated what was already happening with people's interest in Botox. He said the median age of patients at his clinic has actually been declining for about four years, "and it's 100% because of social media -- especially filters." Schwarzburg said patients often come to him with photos of themselves with Instagram filters on and ask him to make them look that way. His biggest requests this year: "smooth skin, full lips, nice cheeks, sharp jawline."

Priya Patel, a physician assistant and Botox expert at Plump, agreed social media is to thank for the younger audience, and for the slow but steady de-stigmatization of Botox and cosmetic procedures in general.

"You can easily go on Instagram or TikTok and watch the procedures being done and realize like, 'Oh, it's not really what I thought it would be,'" she said. "And you can also follow those posts and see what their results look like."

But what's different about this younger population of first-time Botox users, Schwarzburg said, is that many of them are choosing to embrace wrinkle relaxers before their "dynamic lines" turn "static." In other words, it's all "preventative," whereas some years ago, it was used purely to treat an already existing "problem."

He explained that all Botox -- a protein approved by the Centers for Disease Control and Prevention and the Food and Drug Administration -- does is temporarily paralyze one's muscle receptors so that even when the brain sends the muscle a signal to move, it stays put. It takes about 12 weeks for the Botox to have full effect. Researchers also believe that the injections give the skin a chance to produce collagen to erase whatever fine lines may have developed over time. That's why those lines disappear. So, by using Botox early, millennials and Gen Zs are essentially taking control of how they age -- at least externally.

"What millennials want is for those dynamic lines to be less expressive, so they never reach the point of static lines. And they start early, so they never have to worry about developing static lines," Schwarzburg said. "That's a huge shift, I would say."

Botox clinics are adapting to this younger population

Dr. Carolyn Treasure, the co-founder of Peachy, opened the Botox clinic in New York's SoHo neighborhood at the peak of the pandemic, but has already secured a cult-like following of younger fans, including influencers, who love her services. This is not because Peachy is the only place in Manhattan to get wrinkle-relaxers -- there are hundreds -- but because clinics like hers are catering to a younger audience by making the experience of cosmetic procedures feel more trendy and casual than scary, taboo and hospital-like.

Also, Peachy uses a technology to apply Botox that was made precisely for the digital times we're living in. When a patient goes into the clinic, the nurse or doctor who will deliver the treatment first takes photos of the patient's face using an iPad. Then, Peachy's own Botox app will analyze the photos and suggest the number of Botox units that should be applied to each of the three FDA-approved points: forehead, frown lines and crow's feet. Of course, those numbers can be tweaked depending on the patient's desired look.

After the procedure -- which takes about five minutes -- the patient can sit down in the clinic's cozy, pink relaxation room, enjoy a complimentary sparkling water, ice their Botox points and take selfies on the many mirrored walls.

"Our mission at Peachy is really balancing fun and approachability with clinical excellence and scientific rigor," Treasure said. "I really try to fight against the 'Botox bar' stereotype in that we do have a clinically excellent environment and phenomenal providers and nurse practitioners who are really here to educate people on wrinkle prevention, and particularly prevention that doesn't alter or change how you naturally look. And it's a novel model of health care delivery."

Peachy, Plump, Skinly Aesthetics and Ever/Body -- with their pastel-colored decor, bright white lights ideal for photos and stylish waiting rooms -- look more like spas you want to post on Instagram than clinics where you get injected in. At the same time, many of the doctors and nurse practitioners who deliver the treatments have become social media stars, and often run in the same circles as fashion influencers or celebrities.

Treasure, who graduated from Harvard Medical School and was previously a resident at Brigham and Women's Hospital in Boston, said Peachy is like no other health care environment she's ever worked in, and that is exactly the draw. Young patients see getting Botox as a fun experience they want to brag about, whereas their parents likely believed in the myths associated with the procedure and thought it taboo.

The FDA does not recommend Botox cosmetic use in people under 18, and says any side effects are generally minor, such as redness, headache or nausea, according to the medication guide.

One common misconception is that Botox gives you a plastic or "deformed" look, but experts said that is actually the result of too much filler -- which is not the same. Another myth is that Botox is bad for the health, but Garrity said, "Neuromodulators are FDA-approved and have been used cosmetically in the U.S. since 1991. When injected judiciously and by a skilled medical provider, there is very little risk to people of any age."

Schwarzburg, at Skinly Aesthetics, said those are the exact misconceptions that caused the yearslong stigma against Botox, and which millennials and Gen Zs are helping to eliminate.

"I can tell you that most of the 40-plus patients keep it to themselves or to a very close circle of friends, while 20-year-olds could be posting it as I'm doing it and then they'll tell everyone and that will generate more traffic," Schwarzburg said. "It's a lifestyle kind of achievement."

The experts also agreed that while Zoom, Instagram and TikTok have certainly pushed younger people to try out Botox for the first time, so have they. Now that medical professionals have different platforms, health, skin care and scientifically backed cosmetic procedures have begun trending.

"People are now more interested in what is results-oriented -- what has data behind it. Because in this space there's historically been a lot of pseudo-science, and that's what we're fighting against," Treasure said.