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March 10, 2026
We all know the short-term effects of Botox: muscles are temporarily frozen, facial expressions are limited and you appear younger. But what happens when Botox is used for many years?
Botox has been used in medicine for about forty years, yet we still know surprisingly little about its long-term effects. New studies, mostly conducted in the 2020s, suggest that long-term Botox use has certain benefits, but also point to some important drawbacks.
Research shows that repeated injections can gradually weaken the muscles into which Botox is injected, making them smaller and less active over time. In some cases, changes in the structure of muscle tissue may also occur, which can affect the way the face moves. Because of this, some researchers mention the possibility of permanently reduced facial expressiveness, meaning less pronounced facial movements.
Less commonly discussed is the possibility of thinning skin in treated areas, as well as the development of resistance to Botox, which may cause the treatment to become less effective for a small number of people.
On the other hand, reduced muscle activity is also the reason Botox provides its most noticeable aesthetic benefits. When certain facial expressions occur less frequently, wrinkles form more slowly and existing lines become less visible. Long-term users often notice that they require smaller amounts of Botox to maintain results, because their muscles gradually “learn” to contract less.
The result can be a face that retains a smoother and more rested appearance even after many years of use.
If you use Botox continuously for years, your muscles gradually adapt and stop producing certain facial expressions. This can be beneficial if your goal is to reduce wrinkles.
However, Botox also does something else at the same time: it can change the structure of your muscles. These changes may include alterations in muscle tissue composition, increased collagen within the muscle and permanently reduced muscle strength.
If you did not move your legs for 20 years, your muscles would gradually lose volume until they eventually wasted away. A similar process can occur in facial muscles after more than ten years of Botox use.
This does not mean the entire face will atrophy. Botox is injected into specific muscles, so only those muscles may weaken while others continue to function normally.
A review of studies published in 2023 warns that repeated Botox injections may cause long-term chemical denervation — a condition in which nerves lose the ability to activate a muscle.
This is a rare side effect, but it is mentioned as a potential risk in cases of very long-term use.
A study published in 2020 found that long-term Botox use may lead to lasting changes in facial appearance, making the face appear less expressive. This may result in reduced facial animation and a decreased ability to display emotions.
According to the research, this risk can be reduced by using smaller doses rather than the maximum recommended amounts.
After many years of Botox use, some patients report visible thinning of the skin. This can make underlying veins more noticeable.
This is not a common effect, but the risk may be higher in people who begin using Botox very early — for example, in their early twenties. In such cases, the skin of the forehead may become thinner prematurely while the muscles weaken.
After many years, this can sometimes lead to a heavier or slightly drooping appearance of the eyebrows and eyelids, which may make further Botox treatments more difficult.
Botox can genuinely help prevent wrinkles. This effect is connected to muscle “training”: when facial expressions that cause wrinkles occur less frequently, wrinkles form more slowly.
Many people worry that their face will suddenly become full of wrinkles if they stop using Botox, but this is not true. While Botox is active, it reduces muscle movement and slows wrinkle formation.
As a result, the skin will not suddenly develop lines to “catch up” for lost time. In many cases, people will still look younger than their age, depending on how long they used Botox.
This is rare, but some patients notice a slightly uneven or wavy skin texture above treated muscles, often due to skin thinning. They may also observe subtle changes in skin color.
When moving their forehead, the skin may appear slightly wrinkled or rippled. Fortunately, this effect can often be prevented by adjusting injection techniques — using smaller amounts of Botox distributed more evenly — or by taking longer breaks between treatments.
Another potential long-term effect of Botox is improved facial symmetry. Because Botox relaxes specific muscles, it can help balance facial movement.
If some muscles are naturally stronger than others, relaxing them can make facial expressions appear more even and symmetrical.
Photo: Anna Shvets / Pexels.com
