Botox injections. Wrinkle fillers. Line-reducing light therapy. They're known to some as anti-aging treatments. But old age sometimes seems to have little to do with their use. New figures, in fact, suggest that women younger than 35 account for a significant portion of the growing demand for these cosmetic procedures.
According to the latest statistics from the American Society for Aesthetic Plastic Surgery, released last month, people ages 19 to 34—the vast majority of them women—had more than 208,000 wrinkle-filling injections of hyaluronic acid (sold as Restylane) in 2007, compared with barely 23,000 in 2003. Botox treatments also rose, though less dramatically. And while some of these treatments may be used by young women to correct acne scarring or abnormal skin pigmentation, hiding the signs of aging is clearly the end goal for most users, says Alan Gold, president-elect of ASAPS.
"Botox injections in the brow in particular are very popular among young women right now," says dermatologist David Goldberg, who runs a practice in New York and New Jersey and is a professor of dermatology at the Mount Sinai School of Medicine.
He and other doctors who provide such treatments to young women express confidence that the trend has no downsides, although they acknowledge that it could lead some women to use cosmetic procedures for many years longer than the procedures have been around. "Botox has been used for over 20 years," says dermatologist Ken Beer, director of Palm Beach Esthetic Dermatology & Laser Center in Palm Beach, Fla. "To date, there have been no significant [safety] issues." The plastic surgery society agrees. "From a safety perspective, I don't believe there are any issues regardless of how long these treatments are used," says Gold. "Of course," he adds, "we don't have 40 or 50 years of follow-up."
Goldberg suggests that starting young may even reduce the need for future treatment as these women age. "Increasingly, we are seeing evidence that starting early may actually slow the aging process, so you'll need less treatment than if you waited until you were much older to start," says Goldberg.
Other experts, however, remain skeptical of some of the treatments used by young women, particularly light-based facial rejuvenation procedures such as lasers and the technique called intense pulsed light. At least some research suggests there may be more to learn about starting these treatments so young. A study published in March 2007 in the Archives of Dermatology, for example, showed that IPL generates oxidative stress in skin similar to that generated by the ultraviolet-A rays of the sun. UVA rays can cause cancer and accelerate age-related cosmetic changes. Some 101,000 people age 19 to 34 received IPL last year.
But treatment dangers aside, there may be another, even greater cause for concern—namely, the psychological implications of seeking to eradicate wrinkles on a face that has barely begun to fill out. Yearning for everlasting youth may amount to a "new anorexia," suggests Virginia Sadock, professor of psychiatry at the New York University School of Medicine. "While it's not going to kill you the way anorexia can, still, there are similarities in that this may, in some women, be representative of a distortion in self-perception, along with a striving for perfection that is both unnecessary and unrealistic," she says. Much like anorexia, she says, this new pursuit of physical perfection may have roots in profound psychological problems.
To some extent, Beer agrees. He suggests that young women who seek cosmetic anti-aging treatments may have a higher prevalence of body dysmorphic disorder—or distorted view of self. This may be particularly true, he says, if "the perception of their need for treatment does not match their outward appearance." When this is the case, Beer says, doctors—and even parents—should seize the opportunity to open helpful dialogue.
In such a discussion, says Sadock, "be nonjudgmental, but try to uncover if the drive for treatment is linked to peer pressure, cultural influence, or if it's an outgrowth of negative feelings the young woman is harboring about herself." If the latter appears to be the case, the experts agree, professional mental-health care and a shot of self-esteem may well help these young women more than a shot of Botox.