Short answer
No age has been shown to be the right one to start Botox. The FDA label trials treated adults aged 18 to 75, and a surgeon survey released in 2026 puts the core patient group at 35 to 55. Research has not shown that starting in your 20s prevents wrinkles, and ASPS surgeons point to the line rather than the age: a movement-related line that is starting to linger and that bothers you.
What age should you start Botox?
No age is proven to be the right one. A survey of facial plastic surgeons released in 2026 found that ages 35 to 55 form the core of neurotoxin patients, while 57% of surgeons also reported more patients under 30 asking for injectables. Research has not settled whether starting early prevents lines, and two plastic surgeons interviewed by ASPS in 2026 disagreed about it.
The survey polled a select group of American Academy of Facial Plastic and Reconstructive Surgery members online in December 2025. It describes who is walking in the door, not who benefits. On prevention, Cleveland Clinic's 2024 article says there is not much evidence that it works, and quotes plastic surgeon James Zins, MD, saying he has no hard data to support it. The support it points to is a 2006 case report on one set of identical twins, in which the regularly treated twin had less noticeable crow's feet than her sister. A 2025 systematic review of nine studies called early treatment promising but found the data heterogeneous and long-term safety and efficacy not yet fully established.
ASPS's May 2026 article put two member surgeons side by side. One described early treatment as softening repetitive movement before lines are etched in. The other does not support treating a young patient with no wrinkles or creasing at baseline, but does treat people in their late 20s who already have significant forehead creasing. ASPS's summary: there is no surefire consensus, and timing should follow what the face is doing, not age.
Is 25 too early, is 40 too late, and is Botox worth it in your 30s?
Neither age is a cutoff. The FDA label trials enrolled adults up to age 75 for frown lines and 77 for forehead lines, and the average age in the frown-line trials was 46. Botox Cosmetic is labeled for adults, with safety and effectiveness not established in pediatric patients. Whether it is worth it depends on whether a movement-related line bothers you.
In the frown-line trials, an investigator rated 83% of treated participants under 65 as having none or mild lines at day 30 (316 of 382), against 39% of those 65 and older (9 of 23). With only 23 older participants, treat that as rough. The label does not report results for people in their 40s or 50s separately, so it gives no reason to call 40 too late.
ASPS's 2023 statistics report lists an average fee of $435 per neuromodulator session in the United States ($528 in 2022). Cost varies by case and location, and the report does not say how many areas a session covers. The label puts the effect for frown lines at about 3 to 4 months. As a rough calculation, not an ASPS figure, retreating each time it wore off would mean 3 to 4 sessions a year, or about $1,305 to $1,740 at that average.
- Points toward treating, per ASPS surgeons: early lines that are beginning to linger after the expression relaxes.
- Points toward waiting, per one ASPS surgeon: no wrinkles or creasing at baseline.
- Points elsewhere: jowls and deep nasolabial folds, which an ASPS surgeon says Botox will not help. Our guide to Botox versus dermal fillers covers what treats volume loss instead.
What can Botox do in each area of the face?
Botox Cosmetic is FDA-labeled for frown lines, crow's feet, forehead lines and neck bands, and those uses are backed by randomized, placebo-controlled label trials. Brow shaping, gummy smile and lip flip are off-label and rest on smaller, more varied studies. The percentages below come from different tests, so they show what was measured, not a ranking of areas.
The frown-line trials counted a participant as a responder when an investigator rated the lines none or mild at maximum frown. The crow's feet and forehead trials used a stricter test: a two-grade improvement judged by both investigator and participant. Do not rank the areas by these percentages. Label figures are for Botox Cosmetic; other botulinum toxin products have their own labels and trials.
Off-label means a clinician is using an approved product for a purpose that is not on its label, and the label itself says safety and effectiveness for unapproved uses have not been established. Ask any injector how often they treat the area and what they do if the result is off.
| Area | On the FDA label? | What was measured | Reported result |
|---|---|---|---|
| Frown lines | Yes | Lines none or mild at maximum frown | 80% vs 3% placebo (day 30) |
| Crow's feet | Yes | Two-grade improvement, rated by both | 20% to 26% vs 0% to 1% (day 30) |
| Forehead lines (with frown lines) | Yes | Same two-grade test | 46% to 61% vs 0% to 1% (day 30) |
| Brow shaping | No | Brow height | Outer brow up 0.4 to 4.8 mm (11 studies) |
| Gummy smile | No | Gum showing | About 3 mm less at 2 weeks |
| Lip flip | No | Upper lip eversion | Eversion reported; 7 studies reviewed |
Does Botox really work for crow's feet?
Yes, it works better than placebo, but the improvement is graded rather than erased. In the two FDA label trials, 26.1% and 20.3% of treated participants reached a two-grade improvement rated by both the investigator and themselves at day 30, compared with 1.3% and 0% on placebo. The test was demanding and was judged at maximum smile.
Those were randomized, double-blind, placebo-controlled studies in healthy adults with moderate to severe lines at maximum smile. In the safety data, the only reaction the label lists as reaching 1% and beating placebo was eyelid edema (5 of 526 treated people versus 0 of 530). The label also notes reports of dry eye after injections near the muscle that circles the eye, and suggests an eye specialist if irritation, light sensitivity or visual changes persist.
Botox works on muscle movement. An ASPS surgeon notes the lines have to be caused by repetitive movement, and ANEWU's Botox page says uneven tone, sun damage and texture point toward laser resurfacing instead. If your crow's feet look more like skin texture than squint lines, ask which of the two fits before you pay for either.
Does Botox work for frown lines, and why does it sometimes not?
The effect on frown lines is clear but temporary. In the two FDA label trials, an investigator rated 80% of 405 treated people as having none or mild lines at maximum frown by day 30, versus 3% on placebo, falling to 25% by day 120. When it falls short, the cause ranges from the line itself to handling, timing and antibodies.
The label's numbers show the arc: 74% at day 7, 80% at day 30, 70% at day 60, 48% at day 90 and 25% at day 120. Muscle effects begin one to two days after injection and strengthen over the first week, so a result judged at day 3 can look incomplete. Because it fades over about 3 to 4 months, it is a recurring commitment, covered in our post on how long Botox lasts.
- Deeply set lines. The label trials excluded people who could not substantially lessen their frown lines even by physically spreading them apart, so the label has no results for them.
- Handling or injection problems, which a 2025 narrative review lists among the triggers of losing an initial response.
- Retreating too soon: the review lists injections less than 3 months apart and boosters within 3 weeks as risk factors.
- Antibodies: in the label's crow's feet trials, 14 of 916 tested participants (1.5%) developed binding antibodies and none developed neutralizing antibodies. The review found limited data on how common nonresponse is in cosmetic use, and the label says the lowest effective dose at the longest feasible intervals may minimize antibody formation.
Why not get Botox on the forehead, and can it lift eyebrows?
Forehead injections can pull the brows lower, so the label says to treat forehead lines together with frown lines. In the label's forehead trials, 2% of treated people had brow ptosis (13 of 665) and none on placebo. Botox can raise the outer brow a little, 0.4 to 4.8 mm in a systematic review, but brow shaping is off-label.
A 2018 randomized trial of 45 patients compared three forehead injection patterns, each combined with treatment of the muscles that pull the brows down. At two weeks the brow sat lower at every measured point except its outer edge, and injecting the middle of the forehead lowered it more than injecting the upper forehead. The upper-forehead pattern was less effective on forehead lines but prevented brow ptosis, so a forehead plan trades smoother lines against a heavier brow.
Botox brow lifting relaxes the muscles that pull the brows down, so the outer brow rises slightly. A 2017 systematic review of 11 studies and 585 patients measured outer brow elevation of 0.4 to 4.8 mm, with bruising and headache the most common complications and 5 cases of eyelid ptosis. The authors called for more randomized trials. A surgical brow lift is a separate operation.
Can you get Botox to fix a gummy smile?
It can help if an overactive upper lip is the cause. A 2023 meta-analysis found about 3.2 mm less gum showing two weeks after injection (9 pooled studies) and 2.7 mm less at three months (5 pooled studies). It is off-label, the authors call the evidence scarce and of low scientific quality, and gum or bone causes call for other treatment.
The studies started with 3.5 to 7.2 mm of gum showing, and the pooled studies differed widely from one another (heterogeneity above 95%). Those with six-month follow-up reported a tendency toward recurrence, and those at eight and nine months found gum exposure similar to before treatment. The authors call Botox a conservative option for moderate cases or people who decline surgery, if they understand it is temporary and not the gold standard. Gum overgrowth and bone excess call for gum contouring (gingivectomy) or, in severe cases, jaw surgery.
A lip flip is a different off-label use. A 2025 systematic review found 48 articles, 7 of which described injection sites and doses, and reported consistent upper lip eversion and improved contour, with mild, transient side effects such as difficulty whistling or drinking through a straw that resolved within weeks. ANEWU's Botox page mentions a subtle lip flip as a lighter alternative to filler for some people, and its lip treatments page covers shape and definition around the mouth.
Are some areas riskier for Botox, and who should skip it?
No source identified for this article ranks areas by risk. The problems described involve the eyes and brows, the smile and the muscles used for swallowing. In the label trials, eyelid ptosis affected 3% of frown-line patients and brow ptosis 2% of forehead patients. The boxed warning applies everywhere: toxin effects can spread, and trouble swallowing, speaking or breathing needs immediate medical care.
Eyelid droop happens when toxin reaches the muscle that lifts the lid. A 2021 review reports a mean onset of 3 to 14 days after injection, eventual resolution as the effect wanes, and partial reversal in some cases with eye drops used by clinicians. It calls the problem rare but more frequent among inexperienced injectors, and the label tells injectors to avoid the lid-lifting muscle and keep the dose accurate. Our guide to who can legally inject Botox and fillers covers what to ask about training.
Around the mouth, the risk is a change in your smile: the 2023 gummy smile review says finding the right point has a long learning curve so that smile symmetry is not altered. The label also warns that weakening swallowing or breathing muscles can cause swallowing or breathing difficulties, though it notes no definitive serious reports of distant spread at the labeled cosmetic doses.
The label lists two contraindications: known allergy to any botulinum toxin product or its ingredients, and infection at the planned injection site. It advises caution with neuromuscular disorders such as ALS, myasthenia gravis and Lambert-Eaton syndrome, existing eyelid ptosis and heart disease, and it reports no adequate data in pregnancy. ANEWU's Botox page says Botox is not used during pregnancy or while nursing, and Dr. Arshia Payman reviews your health history and medications first. To talk it through, book a free consultation.
Sources and further reading
- BOTOX Cosmetic (onabotulinumtoxinA) prescribing information DailyMed, U.S. National Library of Medicine, label version published January 2026 (content revised October 2024)
- AAFPRS reveals the trends defining facial plastic surgery (2025 Annual Survey) American Academy of Facial Plastic and Reconstructive Surgery, February 24, 2026
- Fact or myth: Does preventative Botox actually work? American Society of Plastic Surgeons, May 26, 2026
- Does Preventative Botox Really Work? Cleveland Clinic, March 12, 2024
- Proactive Aesthetic Strategies: Evaluating the Preventive Role of Botulinum Toxin in Facial Aging Muscles, 2025
- 2023 Plastic Surgery Statistics Report (Procedural Statistics Release, including average surgeon and physician fees) American Society of Plastic Surgeons, 2023 (archived copy)
- Botulinum Toxin for Eyebrow Shaping: A Systematic Review Dermatologic Surgery, 2017
- The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines Plastic and Reconstructive Surgery, 2018
- Non-Surgical Management of the Gingival Smile with Botulinum Toxin A: A Systematic Review and Meta-Analysis Journal of Clinical Medicine, 2023
- The lip flip: a systematic review of botulinum toxin lip augmentation Archives of Dermatological Research, 2025
- Botulinum toxin-induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options Journal of Cosmetic Dermatology, 2021
- Exploring Nonresponse to Botulinum Toxin in Aesthetics: Narrative Review of Key Trigger Factors and Effective Management Strategies JMIR Dermatology, 2025
This article is general information about dental and facial procedures, not a diagnosis or medical advice. Every jaw and every health history is different, so the right plan for you can only be set after an exam and imaging with a surgeon.