A set of identical twins have shared their results after one of them underwent frequent Botox injections while the other kept things more natural over the course of nearly 20 years.
Initial results of the study were published in 2006 by author William J. Binder, who had followed the then-38-year-old identical twin sisters for 13 years as one of them received Botox in the forehead and glabellar region (between the eyebrows) approximately two to three times each year.
The other twin had only received Botox twice in her life in the same regions, once in 1999 and once in 2003.
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In 2012, Binder followed up the study to gain further insight of the impacts of Botox by the time the twins had reached 44-years-old.
How does Botox work?
Botulinum toxin, or Botox to you and me, is delivered in injections which are intended to block certain chemical signals from nerves that cause muscles to contract.
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The toxin prevents the muscle from moving for a limited time, so they're most commonly used to relax the facial muscles that cause frown lines on the forehead, 'crows feet' around the eyes, and other wrinkles.
Botox can also be used to treat issues like neck spasms and sweating, as well as preventing migraines.
What differences did the twins notice after 13 years?
Before-and-after pictures of the twins documented noticeable differences in their faces, which they positioned into a resting pose for the photos.
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By 2006, one of the twins - Twin 2 - had undergone at least 26 Botox injections since she was 21.
In the images, Twin 2 (right) had noticeably smoother skin and more shallow wrinkles on her forehead, while Twin 1 (left), who had only received a couple of Botox shots in her life, had deeper forehead lines, as well as 'crow's feet' lines which became visible when she smiled.
What differences did they notice after 19 years?
The follow-up to the original study took place almost two decades after Twin 2 began her regular Botox injections, and revealed even more differences between the sisters.
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By the time they reached 44 years old, Twin 2 (left) had developed wrinkles around her eyes and mouth, though they were still noticeably less pronounced than her sister's.
Twin 1 (right) also appeared to have a fuller jaw, though it's unclear whether Botox was a factor in this outcome.
Were there any other factors?
In terms of differences between the sisters, Twin 1 lived in Munich, Germany, while Twin 2 lived in Los Angeles. However, in the follow-up study, the twins confirmed they both worked indoors, but led active outdoor lifestyles and used sunblock on a daily basis to protect their skin.
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Neither twin smoked or had any laser, light, or skin-tightening procedures, with the study adding: "Regarding the aesthetic quality of their skin, consistent long-term treatment with onabotulinumtoxinA [Botox] seems to be the only major difference in the lives of these twins.”
What did the results show?
After assessing the findings, Binder suggested that long-term treatment with Botox may help to prevent the development of imprinted lines both through targeting the muscle, but also by modifying behavior.
He wrote: "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."
Emily Brown