Last September 18, during New York Fashion Week, Gweneth Paltrow posted a series of photos on her Instagram account that remained unnoticed. Between photos of the launch of his fashion company Gwyn (which G. Label inherited), advertising for the Goop Beauty serum and videos of front-row fashion shows, the editorial has grabbed many headlines. the reason? The 52-year-old businesswoman shows her true face, with visible skin texture and pronounced expressive wrinkles on the forehead, eyes and creases, while in her hands she supports the campaign of her new line of essential gifts. @salljanemerrett’s comment — “The first photo is so refreshing and real” — prompted responses like “It would be so much better if everyone came out like this” or “Women who choose to be themselves naturally inspire me.” For many years now, combating expression lines and tired faces has been the first goal of most cosmetic treatments, the standard for seeing flawless foreheads, smooth brows and rested faces.
The use of botulinum toxin, the commercial branding that ended up turning it into the common generic name for botulinum toxin—like mascara, tissue paper, and T-shirt—wasn’t limited to Hollywood for long. Its use has extended to all residents, and rather than hiding it, many have proudly incorporated it into their maintenance routines. According to data from the Spanish Society of Aesthetic Medicine (SEME), in 2023, 46.6% of the Spanish population underwent some aesthetic medicine treatment, and among them, botulinum toxin was the most requested (35% of all protocols). At the global level, the phenomenon is similar. According to a report from Grand View Research, in 2022, more than 7.4 million people received botulinum toxin injections in the United States, becoming the most common surgical procedure in that country.
At one time, these injections, capable of smoothing wrinkles and paralyzing facial muscles, were a privilege reserved for celebrities. Today they form part of a transverse phenomenon that extends across classes and generations. So, while actresses like Jennifer Garner, Cameron Diaz, Nicole Kidman, or Courteney Cox regret no longer expressing themselves, many of their followers are now celebrating their ability to access these thoughts so easily. How do we get here?
From status symbol to everyday gesture
Botulinum toxin, a purified form of the bacteria Clostridium botulinumIt was first approved for cosmetic use by the Food and Drug Administration (FDA) in 2002. Since then, its use has not stopped growing. “It crept into Barcelona more than 22 years ago. When it started, we had very few doctors and its costs were five times higher than today’s costs. At that moment, it was a treatment reserved for celebrities or people with high spending power. In all the clinics, it was offered and patients never knew better. Over time, the offer increased, the costs fell and it became seen as an everyday thing. The real democratization happened in the 2000s, when social networks began,” says Dr. Beatriz Beltran, founder of the clinic. Which bears its name: “New aesthetic references helped people perceive it as something natural and accessible.”
Compared to other treatments, its use is relatively affordable. Dr. Sergio Quintero, KOL Endolift plastic surgeon and founder of Elegance Medical, Apostille “Treatment of the entire upper third (forehead, buttress and chicken legs) can range between 300 and 550 euros. It needs adjustments) and the complexity of the condition, because it is not the same as treating asymmetry, hyperarticulation, bruxism or hyperhidrosis As of 2015, neuromodulator is the treatment. prevailing In urban environments for several reasons: its success on social networks allows us to see results, patients want to see with a relaxed face, they find a better relationship between price and quality for the competition between brands and centers and, without a doubt, due to the emergence of more conservative techniques such as the use of microdosing or Botox baby That the face will no longer freeze and will allow a more natural expression.
For Dr. Carlos Morales Raya, a dermatologist and medical director of the clinic that bears his name, said the pandemic was a turning point. “The normalization of aesthetic care as part of good public health, driven by the era of remote work and social networks, contributes to the elimination of stigma. The demand for quick, safe and low-social procedures means that the poison is integrated into the aesthetic routine of the general population. Advances in injection techniques as more precise, personal needles for recipients and ultra-fine, reduce the risk of secondary effects and improve the naturalness of the results. Moreover, the standardization of formulas and the improvement of their stability facilitate consultation practice.”
Homogeneous faces and aesthetic pressure
They are not all allies in the use of neuromodulators, and critical voices continue to grow. By sociologist Dana Berkowitz, author of the book Botox Nation: Changing the Face of America (New York University Press), The rise of Botox can be read not only in aesthetic terms, but as a cultural phenomenon that turns the face into a permanent maintenance project. Berkowitz criticizes that all faces correct the same points (forehead, lines, eye contour) and lead to a gradual smoothing of features. Moreover, for the author, Botox does not function as a one-time purchase, but rather as a system of continuous consumption because its effect only lasts a few months and forces its repetition indefinitely. This ephemeral character lends itself to users as consumers of maintenance, which explains why the industry seeks to attract increasingly younger customers: the earlier you start, the more years you stay in the loop and the more gains you make.
In the same critical line, journalist Jessica Divino warned in her columns about… The Guardian The “algorithmic face” look, a repetitive aesthetic optimized for online admiration, reduces facial diversity and fuels anxiety and aesthetic pressure that means having to constantly look young. To this criticism we can add the criticism of writer Ellen Atlanta, the author of the article Virtual diva (Deusto) who directly questions the rhetoric of so-called preventive Botox: “Preventive Botox does not exist: it is just Botox and is a misleading concept.” For Atlanta, offering these injections as self-care reduces the fear of aging even before wrinkles appear and makes the medical intervention feel more natural, as if it were a cosmetic product.
Dr. Mar Mira, from the Mira Cueto Clinic, warns: “In young patients we see many cases of ‘alienation’, a term that refers to similar faces with prominent cheekbones, a smooth forehead and very large lips that give the appearance of Alien Because it does not blend naturally or harmoniously with the facial skin. In older patients, we bring in people who ended up with people from years ago. Pillow face Pillow face. These are exaggerated faces that do not respect adequate anatomical proportions. Not respecting the harmony and essence of each face and treating their faces serially is a trend that is beginning to decline. According to our philosophy (f simple motive) The treatment should not be noticed or supposed to be a shadow.
Increasingly younger patients
As the use of neuromodulators increases, the lifetime of access to the toxin is reduced. The fact exists to the point that in the United Kingdom it was decided to ban its use to the majority of people due to the current high demand. In our country, legislation does not set age limits and all responsibility lies with the medical professional. According to the Spanish Society of Aesthetic Medicine (SEME), the average age of aesthetic medicine patients has decreased significantly, falling from 35 years to 20 years. Parties from 16 to 25 years old constitute 20% of the treatments performed, and 21% are between 25 and 34 years old. Neuromodulators occupy four spaces behind the IPL, filling them with hyaluronic acid and mesotherapy. Dr. Beatriz Beltran confirms this phenomenon: “Previously, patients were larger and had very pronounced wrinkles. Today, the age of onset has been reduced because it is designed as a preventive treatment that prevents the appearance of dynamic wrinkles. Therefore, it is necessary that it be performed according to medical standards, and we cannot underestimate that,” says Beatriz Beltran.
A popular treatment without risks
The use of the toxin is so widespread that it can be considered a maintenance routine similar to giving a manicure or highlight at a hair salon. Experts warn that in safe hands it is a safe treatment (and never without risks), but there are beliefs that excessive use can burn the skin or muscles, and cause resistance and permanent loss of expression. “Burning the skin is impossible because the toxin acts in the neuromuscular union, not in the superficial layer. Obviously, applying excessive and very frequent doses can lead to persistent hypoactivity in the muscles (flat appearance and temporary weakness), so we dose the treatment and space it out for four to six months. The refractory period is rare and is more associated with high, frequent doses or formulations containing more protein complexes. This risk is reduced with adequate doses and high-purity brands.
What are the most common adverse reactions? “Complications can be mild and transient, such as pain or sensitivity at the injection site, swelling, redness, mild bruising or headache. There are also more serious risks if not managed well, such as eyelid drooping, dysphagia, difficulty breathing and muscle atrophy. It is essential that treatment is carried out by qualified specialists in aesthetic medicine to reduce it,” says Miriam Sanz, Director of Registry, Pharmacovigilance and Quality at Merz Aesthetics.
The field of cosmetics does not escape from reality, and there are increasingly more centers and clinics offering low prices and a large number of attractive offers. Today, SEME notes in its report that only 10% of the population considers it “normal” to undergo aesthetic medicine treatments in their homes. When should we doubt? “There is no magic number, but a full upper third costs well under €200 which is a red flag,” says Dr. Anna Revuelta. “As warning signs, I highlight centers that do not communicate the brand you use, do not record the quantity, do not sign an approval and do not provide reviews.” Dr. Sergio Fernandez, Vice President of SEME, is clear: “We must strive to have accredited centers that have been granted, in addition to their health registration number, the Aesthetic Medicine Auxiliary Unit, which is U.48. The law in our country is very clear, that only doctors can use botulinum toxin for aesthetic purposes.”
What happens when we see such low prices? According to Dr. Carlos Morales Raya, “The poison must be a medicine approved in Spain, obtained through legal channels, preserved in a cold chain and with the availability of a batch recorded in the clinical history. When prices are abnormally low, it is because fewer units are used (diluted product) or collection promotions are offered. In the worst cases, unauthorized products are used or it is done in non-medical settings.”
How do experts see the future of neuromodulators? “I expect its use to continue to grow. Today it is the number one aesthetic treatment in the world, and I do not think this will change. The pharmaceutical industry is developing new formulas that allow more personalized treatments and precise doses adapted to the natural movement of each face. I see a future in which neuromodulators will still be the mainstay of facial rejuvenation, but integrated into global plans that include skin, volume and skin quality,” says Beatriz Beltran. Everything indicates that it will be difficult to knock him off his pedestal.