Neurotoxins such as Xeomin or Botox Cosmetic are among the most effective ways to look refreshed, but what worked at 35 doesn’t always translate at 55. Houston dermatologist Jennifer Segal, MD, explains that “as we age, the skin naturally thins and loses elasticity,” which means traditional areas like the forehead require more finesse to lift and brighten the eyes.
Omaha dermatologist Joel Schlessinger, MD, points to changes deeper in the face, too. “Our muscles generally lose strength over time and can lead to differences in facial expression,” he says. To avoid a flat result or a heavy, dropped brow, he often dials the dose down.
Ahead, dermatologists break down where to pull back, which areas still deliver the best results and the mistakes that can work against mature skin.
Neurotoxin and Mature Skin: Why Less Is More
Neurotoxin on mature skin isn’t about more product. It’s about placement and dosing that follow the face as it changes. Dr. 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 calls for restraint, too. “Chasing crow’s feet can create an unnatural smile or a deer-in-headlights appearance,” Dr. Segal says. To keep results soft and refreshed, she treats mature patients “more frequently with lower doses.”
Delray Beach, FL dermatologist Dr. Janet Allenby, 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 sees 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.
Verona, NJ dermatologist Avnee Shah, MD, says the forehead is where treatment changes the most with age. “I think the forehead is where I take my foot off the gas for more mature patients,” she says. “It’s easy to create too heavy of a brow in this age group, and many need the frontalis to be working so they can lift their eyebrows, especially when the infra-brow skin gets heavier and potentially obstructs vision.” Rather than chasing every forehead line, she preserves movement to keep the face looking rested and natural.
Where Neurotoxin Makes the Biggest Difference With Mature Skin
Fort Lauderdale, FL dermatologist Matthew J. Elias, MD, says one area delivers reliably at every age: the glabella. He explains that “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 dermatologist Daniel Schlessinger, MD, sees standout results in the neck and jawline—areas that show aging earlier and respond well 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.”
According to Vienna, VA dermatologist Brenda Dintiman, MD, it’s never too late to benefit from neurotoxin when it’s used strategically. “I love the lower face to relax the pull creating jowls and soften the neck,” she says. “I treat the DAO region and often along the jawline and bands to keep the platysma neck muscles from pulling down.”
Miami Beach dermatologist Melissa Lazarus, MD, says education is one of the most important parts of treating mature patients. “It’s all about lifting up and not down, so we want to relax the ‘down’ muscles so the ‘up’ muscles are unopposed,” she explains. “Sometimes this means we have to keep some wrinkles to actually look more youthful.”
Neurotoxin and Mature Skin: What Not to Do
Overcorrecting is the most common mistake dermatologists see. Dr. Segal warns that trying to erase every line “always results in an unnatural appearance,” especially as facial tissues become more delicate with age. Dr. Elias agrees, adding that overtreatment often ages patients more quickly than the lines they were trying to fix.
“Personally speaking at 53, I would look completely different if I didn’t maintain my DAO, platysmal bands, Nefertiti, lip flip and chin,” says Louisville, KY dermatologist Tami Buss Cassis, MD. Rather than making dramatic changes all at once, she encourages patients to build gradually. “Start slowly with neurotoxins and fillers…go in more often and gradually add as needed. There’s no need to dramatically change the way you look.”
But less doesn’t mean too little. Dr. Allenby says another mistake is assuming every neurotoxin works the same—or that if one treatment disappoints, neurotoxins simply don’t work. “People come in and say a toxin doesn’t work for them, and I come to find out they don’t know what toxin they had and they were given a ridiculously low price for the treatment,” she says. In many cases, she explains, patients were simply under-treated. In others, longtime neurotoxin users may develop resistance to a particular product and benefit from switching formulations.
