Which twin looks better at 38: one who had Botox for two decades or the one who didn’t?

Record numbers of Americans are gifting their significant others cosmetic surgeries for Christmas this year.

Curious about the effects of Botox on facial appearance? An intriguing study provides a clear illustration of the transformation it can bring about.

The women were followed for nearly 20 years, with one receiving Botox injections two to three times a year and the other letting nature take its course.

The case report, written by a Beverly Hills plastic surgeon, compared several images of each twin at different time intervals.

They were first pictured in 2006 at age 38 and taken as they ‘rested’ their faces. 

At that time, one of the twins had undergone at least 26 Botox injections since she was 21 and the other had received only a couple of shots.

The twin who’d received the treatments regularly had noticeably smoother skin with more shallow wrinkles on her face.

Her sister, meanwhile, had deeper forehead lines and more noticeable crow’s feet when she smiled compared to the twin who had undergone the shots.

The twin who received very few injections – image A – next to twin who got Botox regularly – image D. The twin who did not receive the injections had more pronounced lines on her forehead and between her brows 

The images show that the twin who received very few injections – images B and C – and the one who got Botox regularly – E, and F –  had significantly more forehead wrinkles

They were then followed up at age 44 in 2012 – at which point the Botox twin had been getting the injections for almost 20 years.

By this point the no-Botox twin had a noticeably puffier visage and a wider jaw – though it is not clear whether the Botox was a factor.

For the 2012 follow-up, both twins said they had used sunscreen consistently, ruling out the possibility that wrinkles could have been caused by long-term exposure to the sun’s UV rays. 

Neither used retinol for wrinkles and led mostly healthy lives.

And the twins lived on different sides of the world with significantly different levels of sunlight. 

The twin with sporadic treatments and more lines resided in Munich, where the average UV index is lower compared to Los Angeles, the location of the other twin.

Crow’s feet when smiling are more visible in the twin who let nature take its course – images A and B. The regularly treated twin – images C and D – had far less pronounced crow’s feet

Pictured are the spots that one twin had  Botox injections in the forehead, glabellar (between the brows), and crow’s feet regions

Dr William Binder, who reported the case study, claimed it ‘is likely that long-term treatment with Botox is able to prevent the development of imprinted lines not only by inhibiting the patient’s ability to contract the target muscle but also perhaps through behavioral modification.

‘With long-term treatment, the patient may become used to having little, if any, need or ability to contract the target muscle and may eventually “learn” to avoid even trying to contract it.

‘It is also thought that, by relieving the mechanical pressure of chronic muscle contraction in this way, dermal remodeling may be facilitated.’

Wrinkles form when facial muscles contract. At the same time, the production of collagen and elastin, proteins that provide structure and elasticity to the skin, decreases with age. 

The skin becomes thinner, drier, and less able to retain its shape, leading to the formation of wrinkles.

A 2015 follow up showed the Botox receiver twin had virtually no forehead wrinkles at rest 

The woman treated with Botox had more shallow wrinkles compared to her sister around her eyes and mouth

Botox injections are extremely popular. Over 8.7 million cosmetic procedures were carried out with them in the US in 2022. But the injections are not without risk. 

The shots can cause bruising, swelling, and redness where the needle was injected. And the face can take on a frozen look, while also showing droopiness by the eyebrows or eyelids. 

More serious reactions including anaphylaxis, shortness of breath, headache, and even flu-like symptoms.