Expert Insights on Neurotoxins for Mature Skin

Neurotoxins are still one of the most effective ways to look refreshed, but experts agree the technique should evolve as the face matures. Houston dermatologist Jennifer Segal, MD, explains that “as we age, the skin naturally thins and loses elasticity,” meaning traditional areas like the forehead may require more finesse to lift and brighten the eyes.

Omaha dermatologist Joel Schlessinger, MD, notes changes deeper in the facial structure as well. “Our muscles generally lose strength over time and can lead to differences in facial expression,” he says. To prevent a flat look or dropped brow, he often lowers dosing to match what the face actually needs.

As anatomy shifts, so should technique. Ahead, clinicians break down why less is often more, which areas still give the best results and the mistakes that can work against mature skin.

Featured Experts

• Joel and Daniel Schlessinger, MD, are board-certified dermatologists in Omaha, NE
• Jennifer Segal, MD, is a board-certified dermatologist in Houston
• Janet Allenby, DO, is a board-certified dermatologist in Delray Beach, FL
• Matthew Elias, DO, FAAD, is a board-certified dermatologist in Fort Lauderdale, FL

Why Less Is Sometimes More With Mature Skin

As the underlying support of the face shifts with age, those deeper changes affect how neurotoxin behaves. Segal says too much toxin in the forehead can quickly create heaviness. “Neurotoxin is a wonderful tool for lifting the brow and opening the eyes. However, too much toxin in the forehead can easily drop the brow and worsen eyelid ptosis,” she explains. The eye area also requires restraint, since “chasing crow’s feet can create an unnatural smile or a deer-in-headlights appearance.” To keep results soft and refreshed, she treats mature patients “more frequently with lower doses.”

Delray Beach, FL dermatologist Janet Allenby, DO, sees a similar need for precision. She finds that older muscles are smaller and more spread out, which changes how evenly they respond. “I tend to use a little bit less because their muscles are smaller in my older individuals and actually more spread out. This gives a little more natural look and a more even outcome,” she says.

She also encounters patients who assume toxin has “stopped working” when the real shift is in their facial anatomy. “Sometimes their eyebrows actually go too high, and instead of trying to raise them as most people think of using toxin, we actually want to bring them down to a more proportional look, which makes them look younger and healthier,” she explains. In mature faces, balance—not height—is often what looks most refreshed.

Where Neurotoxin Makes the Biggest Difference With Mature Skin

Fort Lauderdale, FL dermatologist Matthew J. Elias, MD, says one area continues to deliver reliable results at every age. “The glabella is always a win in all age groups,” he notes. He adds that mature foreheads require extra expertise since “foreheads in older women are trickier, so it’s imperative you see an expert board-certified dermatologist or plastic surgeon for this area, as this is where we see the most complications like dropped brows, lids, etc.”

Some of the most impactful improvements, however, happen outside the upper face. Omaha, NE dermatologist Daniel Schlessinger, MD, sees standout results in the neck and jawline—areas that tend to show aging earlier and respond beautifully to strategic dosing. “We have had great results with the platysma band in the neck. Using Botox in this area, especially when it is used along the jawline for the Nefertiti Lift, helps to smooth the neck lines and also provides a subtle lift for the lower cheek,” he explains. “My patients also love treating the depressor anguli oris (DAO) muscle to help reverse a frowny face, as well as the mentalis muscle that is responsible for a dimpled, pruny chin.”

What Not to Do

Overcorrecting is one of the most common mistakes dermatologists see. Segal warns that trying to erase every line “always results in an unnatural appearance,” especially as facial tissues become more delicate with age. Elias agrees and believes overtreatment often ages patients more quickly than the lines they were trying to fix.

Timing matters too. Schlessinger says many patients wait longer than they should. “I think of preventative Botox like getting your car serviced regularly,” he says. “Staying healthy and up to date helps prevent future issues down the line.”

[This article was originally posted by our sister publication, New Beauty]