Disney Marathon Week - Knee Wraps are $30 OFF! Applied in Cart!

Beauty 911: Red Light Anti-Aging Therapy

The anti-aging industry is big business. Like REALLY big business. The global anti-aging market, which includes facial anti-aging skin care products, was worth around 63 billion USD in 2021, and is projected to grow by close to 7% to reach 93 billion USD by 2027. Other anti-aging therapies are also increasingly lucrative, with the Botox market valued at 7.23 billion and the dermal filler market valued at 5.01 billion in 2022.

Older women (50 years and older) are considered a “gold mine” for the beauty industry, as they  seek ways to retain a youthful appearance. But it’s not just older women that are using anti-aging products. Advertisers now target women in their 20’s, with claims like “…it’s never too early to start looking after your skin”. Women aged 30-39 made up 18% of Botox procedures and 11% of dermal filler procedures in 2020, with women aged 40-59 making up the majority (57% and 49% respectively). These practices are so common that they are now described as being “a really good and essential thing” that is “ongoing” throughout life. 

The anti-aging business is being driven by our societal interest in youthful appearance, and whether this is helpful or harmful is certainly up for debate. Regardless of where you stand on this issue, the truth is that the widespread use of anti-aging therapies is now a well-established fact of modern life. Along with this normalization, there has been a general acceptance of the inherent value of these interventions, as evidenced by consumer spending. What has been lost, however, is the consideration of associated risks, both short and long term. 

Anti-aging therapies span a wide range of risk. Products such as lotions and creams are very different than injectable treatments or therapies that ablate the skin. It is the latter that carry risks that should be considered along with the potential benefit of improved appearance. While many of these are medical procedures that require specific training to be legally administered, practitioners have a wide range of expertise that influences the risk of adverse outcomes. And unfortunately, there are an increasing number of unqualified technicians taking advantage of unsuspecting consumers. “Botox Parties” are a real thing, where people gather in an informal setting and get Botox as a group, which can reduce the cost of going to a medical center or spa. 

In this article, I will describe the risks of some of the most used anti-aging therapies (including Botox, dermal fillers, chemical and laser peels, and microdermabrasion and dermabrasion) so that consumers can be educated and informed about the real, but rare, potential risks.

Botox

Botox, more formally known as Botulinum Toxin, is an FDA approved medication used cosmetically to reduce the appearance of wrinkles. It can also be used in higher concentrations to treat medical conditions including migraines, bladder issues, and excessive sweating. Botox is a neurotoxin produced by the bacterium Clostridium botulinum that causes muscle paralysis by blocking the signals from nerves to muscles. There are other botulinum toxin FDA approved medications that work in the same way, including Xeomin, Dysport, Daxxify, Jeuveau, and Myobloc.

By blocking the signals from nerves to muscles in the face, the muscles relax, leading to a lessening of wrinkles in certain areas such as the forehead, outer eyes, nasolabial folds, and between the eyebrows. Basically, the muscles are being temporarily inactivated, with the contraction being blocked for as long as the toxin is active. It usually lasts for 3 to 6 months. Rather than complete paralysis of the facial muscles, it is now recommended to use a “neuromodulatory” approach, where the activity of the muscles is reduced but not fully inactive.

Botox has a high rate of effectiveness and patient satisfaction. A comprehensive review of 65 randomized clinical trials, with nearly 15,000 subjects, found that Botox decreases wrinkles within four weeks following treatment. It has also been found that up to 90% of people getting Botox are satisfied with treatment outcomes, which improves how they perceive their appearance and their psychological well-being. 

Despite these clear benefits, there are some recognized risks to the use of Botox, ranging from minor to severe. Concerningly, although only a small number of adverse events are formally reported to medical regulators, recent research shows that up to 16% of Botox users have “complications”, which suggests that problems are underreported and underrecognized. The following is a list of potential adverse outcomes that should be considered by Botox users:

Injection Site Injury – Since a needle is puncturing the skin, there is trauma that can result in injuries including bruising, tenderness, pain, and swelling. These are minor concerns that usually resolve quickly. 

Infection – Infection can occur at the injection site due to contamination, which can cause a local reaction or a more serious abscess. Antibiotic treatment may be needed for resolution. 

Allergic/Hypersensitivity Reactions – Allergic reactions can be either localized (staying within region of the injection site) or generalized (spreading throughout the body). The latter are much more serious and require medical intervention. Local reactions can usually be managed with antihistamines. Some reactions may be due to silicone oil, which is used as a lubricant to line most syringes.

Decreased Sweat Gland Activity – The botulinum toxin can decrease the sweat gland activity in the affected area, which causes localized areas of dry skin. This is a minor side effect that can be treated with moisturizers.

Nerve Damage – If the injection causes trauma to nerves in the area it can cause changes in sensation such as tingling or abnormal sensations. This usually resolves on its own as the nerve heals.

Vision Problems – Botox injections around the eye area can cause problems including blurred vision, dry eyes, irritation of the cornea, and strabismus (which is when the eyes don’t line up properly). These are rare complications usually caused by improper injection techniques, and which may require treatment from an ophthalmologist.

Negative Aesthetic Results – A wide range of undesirable aesthetic outcomes can happen with Botox treatment, which vary depending on the area being injected. Drooping of the upper eyelid is estimated to occur with 1-5% of patients and can last for several weeks. Other undesirable outcomes include eyebrow raising, smile limitations, and asymmetry between the sides of the face. These can last until the toxin wears off. Repeated use of Botox injections over a long period of time can cause permanent changes to facial expression.  

Botulism – Botulism is a serious side effect of Botox that can be life threatening. Botulism occurs when the toxin spreads throughout the body, causing muscle weakness, difficulty swallowing, and respiratory failure. Since 2008, Botox and related products have had a black box warning from the FDA that warned of this risk, but citizen safety groups are currently lobbying for a more severe warning to be applied. 

Botox Resistance – Also known as “immunoresistance”, Botox resistance occurs when people develop antibodies against the Botox toxin. This can occur in up to 5 to 10% of people who get repeated, high dose Botox injections, although it’s much less common for people using Botox for cosmetic as compared to medical purposes. The antibodies block the response to Botox making the treatment ineffective.

Muscle Atrophy – Because Botox partially or completely paralyzes facial muscles, the muscles themselves can atrophy over time. This is especially a problem with repeated injections. Given the increasingly common practice of starting Botox at younger ages, many women may find themselves with weakened atrophied muscles as they get older, which will ultimately prove counterproductive to their pursuit of a youthful appearance.

One other concern related to the safety of Botox injections relates to the issue of autoimmune disease. Although the relationship between Botox and autoimmune diseases is unclear, there are anecdotal reports of Botox aggravating or inciting these conditions. As described by acupuncturist Dr. Megan Gray, as a foreign substance, Botox may trigger an already overreactive immune system to be even more reactive, which may create problems. Making the connection between Botox injections and aggravation of the immune system can be very difficult, but it is something people at risk of autoimmune disease should consider as a potential risk. 

Dermal Fillers

Fillers” are soft substances that have a gel-like consistency. They are injected under the skin to fill and add volume to spaces in the face and sometimes other areas, like the hands. Adding dermal fillers under the skin has the effect of reducing signs of aging, such as under eye circles, hollowed cheekbones, and wrinkles. 

There are several different types of dermal fillers, including natural and synthetic. Natural fillers include hyaluronic acid (Restylane, Juvederm), which is naturally found in the skin and helps with hydration and volume, and calcium hydroxylapatite (Radiesse), which is naturally found in bones. Natural fillers usually last for at least 6 months and then are gradually absorbed by the body. Autologous fat, which is when fat is taken from one area and injected into another, is another type of (natural) dermal filler, as is human collagen. Synthetic fillers include poly-L-lactic acid (Sculptra), which stimulates the body to produce collagen over a period of months after injection, and polymethyl methacrylate (Artefill, Bellafill), which is a semi-permanent filler.

Most people report improvement in appearance following injection of dermal fillers. In a study of people getting hyaluronic acid filler, almost 94% reported improvements at month 3 and 76% reported improvement at month 12. People receiving calcium hydroxylapatite filler also report improvements of up to 12 months, as do people receiving synthetic filler

All dermal fillers are capable of causing complications, with long-lasting synthetic fillers creating more of a risk due to their persistence. According to an analysis of side effects related to complications that have resulted in litigation, the most common are:

Swelling – Swelling in the treated area can range from mild to severe. It will usually resolve in hours to a few days but can lead to the area looking “overtreated” while it’s inflamed.

Infection – As with Botox, the injection associated with dermal fillers can result in infection, which can vary in severity. Another infection associated complication is the formation of biofilms, which can be difficult to treat. 

Allergic/Hypersensitivity Reactions – Allergic/hypersensitivity reactions can occur to dermal fillers but are much more common with synthetic as compared to natural fillers. There are factors that increase the risk of hypersensitivity reactions, such as exposure to viral illness or recent vaccination (such as against Shingles or COVID). Risk of some hypersensitivity reactions is increased when a person carries specific genes that drives the immune response.

Nodules – Nodules are the second most reported complaint, next to swelling. Nodules are unintended lumps that can form immediately or have a delayed onset. Delayed onset nodules can even form years after filler injection. Nodules formed from hyaluronic acid can be dissolved with the enzyme hyaluronidase (which breaks down hyaluronic acid), but nodules from synthetic filler are more difficult to treat (and more common). 

Negative Aesthetic Results – Nodules can result in negative aesthetic results, but these are not the only cause of poor outcomes. Others include asymmetry between the sides of the face and overfilling, which is most common in the lips and cheeks. Asymmetry can sometimes be fixed by adding more filler to the less filled side, while overfilling with hyaluronic acid filler can be dealt with by injecting the enzyme hyaluronidase. However, overfilling with synthetic fillers is harder to correct, and hyaluronidase breaks down not only the filler but also existing hyaluronic acid, which can be undesirable. Filler can also migrate to other locations, as discussed widely on social media (#lipfillermigration). 

Pain – Pain is the third most common reported complaint and is more likely to occur with synthetic filler. Injection of fillers uses larger cannulas, as compared to Botox which uses needles, and these can cause more injection site pain. 

Blood Vessel Complications – Dermal filler injections can result in trauma to blood vessels in the area. A rare complication is that fillers can be injected into blood vessels, which can block blood flow. This is a potentially severe outcome that must be diagnosed and treated immediately, or death of the tissue being fed by that blood vessel can occur. 

Vision Problems – Dermal fillers can cause vision loss and blindness in rare circumstances. These effects can be permanent, although some people recover fully. Vision problems are usually caused by damage to blood vessels, which allows filler to get in and block the blood vessels that feed the eye. This is mainly a risk when injecting into the eye and forehead areas.  

Nerve Damage – Damage to nerves can occur as a result of injection with a canula and can range from minor to severe. Usually, nerve damage will heal but sometimes it is permanent. 

Tyndall Effect – The Tyndall effect is when a bluish hue appears within the skin when too much hyaluronic acid filler is placed superficially. It’s caused by scattering of different wavelengths of light when they hit the filler particles. This can appear like a bruise, but it doesn’t resolve within a few days, instead lasting for as long as the filler is present. 

Like Botox, dermal filler should only be administered by a certified professional. Dermal fillers can be provided in the US by medical doctors, nurse practitioners, physician’s assistants, registered nurses, dentists (in some jurisdictions), and licensed aestheticians (in a few states). It is crucial that the provider be well trained and experienced, which will help to reduce the risk of negative outcomes. 

Chemical Peels

Chemical peels are a non-injectable anti-aging therapy in which a chemical solution is applied to the skin which removes the top layers of skin. Since the new skin that grows back is smoother, chemical peels are used to reduce the appearance of wrinkles, minimize scars, treat acne, and improve skin pigmentation. 

Chemical peels are either light, medium, or deep. Light peels remove the superficial epidermis of the skin, while medium peels remove both the epidermis and some of the dermis. Deep peels can get even deeper, which is recommended for deep wrinkles and scars. The level of risk of adverse events goes up as the chemical peel gets deeper.

Light chemical peels are most helpful for fine wrinkles, uneven pigmentation, and dry skin. The risks of light chemical peels are minor, and include redness, stinging, and skin flaking and irritation. Light peels may also cause acne flare ups, and all peels can activate latent herpes infections, trigger allergic reactions, and alter skin pigmentation. 

Medium chemical peels are helpful for deeper wrinkles, acne scars, and uneven pigmentation. With medium chemical peels, in addition to the risks seen with light peels, the redness is more significant and can last up to several months. The effects of medium chemical peels on the skin are similar to a deep sunburn. Medium peels can rarely cause scarring.

Deep chemical peels are most helpful for deeper wrinkles, sun damaged skin, scars, and blotchy skin. Deep chemical peels are quite intense and may require a local anesthetic. There are many potential complications, including: peeling, scabbing, redness, flaking and irritation of the skin for up to several months; scarring; and loss of skin pigmentation (potentially permanent). Deep peels that use phenol can also cause heart arrythmia and atrial fibrillation.  

Laser Peels

Laser peels, also known as laser skin resurfacing, are similar to chemical peels in that the goal is to improve appearance by getting rid of older, damaged skin. While chemical peels use a chemical solution to remove skin, lasers use concentrated light beams to remove damaged skin. Laser peels can reduce the appearance of wrinkles, scars and blemishes.

Potential side effects of laser peels are similar to those of chemical peels, and include: infection, scarring, changes in pigmentation, allergic reactions, redness, acne flare ups, and reactivation of herpes infections. 

Dermabrasion

As with laser and chemical peels, the goal of dermabrasion is to resurface the skin. With dermabrasion, the top layer of the skin is removed using a high speed rotating brush. Dermabrasion can help to reduce the appearance of fine lines and minimize scars.

Potential side effects of dermabrasion include reactivation of herpes infections, changes in skin pigmentation (which can be permanent), infections, persistent redness, and thickened skin.  

My Story

As I approached my late 30’s, I decided to try using Botox and filler to slow down the signs of aging. I actually had no visible lines at the time, and I wanted to keep it that way! Using Botox to prevent lines from developing in the “active” areas of my face, like between my eyebrows and around my eyes, seemed like a good preventive measure. I also noticed that my face seemed to be a bit less plump than when I was younger, which I thought could be improved with dermal filler. 

Since this was all new to me, I did my due diligence and looked around for a reputable provider. I learned that people with different qualifications were doing injectable treatments, and I decided that if I was going to do this, I wanted the most highly credentialed therapist I could find: a dermatologist. I chose one who came highly recommended by a friend and set up a consultation.

The doctor recommended injection of a small amount of hyaluronic acid filler under my eyes and around my cheekbones, and some Botox between my eyebrows and around my eyes. The Botox was only a tiny bit uncomfortable, but I found the injection of filler (which uses a canula rather than a fine needle), to be unpleasant. It’s not so much that it was painful, but it was strange feeling a canula being moved around in such a delicate area. Since there was a small amount of filler left in the vial after doing my eye and cheekbone area, the doctor suggested that we put this into my lips. I wasn’t too keen, as my lips are already pretty full, and I’d seen enough overfilled lips to be concerned about appearing unnatural. But since I had to pay for the filler regardless, and as the doctor assured me that it was such a small amount that it would barely be visible, I agreed.

I was surprised to discover that Botox doesn’t work immediately – you have to wait a couple of days for the effects of the toxin to be seen. And filler can feel a bit hard at first, which scared me as it felt unnatural in my face. It softened within a few days, and the Botox set in, and overall, I was pretty happy with the results. It was super subtle, and I’d say that I just looked a bit more refreshed and rested. I definitely still looked exactly like “me”, just a little bit better, which was my original goal.

However, after a month or two I noticed that my eyes seemed to have bags underneath them that had never been there before. And as time went on, it got more noticeable. So much so that I returned to the doctor to discuss my concerns. It turned out that I had filler migration. I don’t recall being told that this was a potential risk, although it may have been part of the small print in the informed consent form. Migration of filler from the tear trough to the orbital area of the eye can apparently occur up to several years after injection.  

The recommended solution was to use hyaluronidase to break down the filler. Because hyaluronidase dissolves not only hyaluronic acid filler, but also the body’s own hyaluronic acid, it can reduce volume even further. According to realself.com, when hyaluronidase spreads outside of its zone of injection its outcome can be “somewhat unpredictable”. In people who have been using it for a long time, hyaluronidase reveals the signs of aging as well as the damage caused when filler stretches the skin. Thankfully, since this was my first foray into the filler world, I largely escaped unscathed. However, years later I still have some residual under eye puffiness that I attribute to this ill-fated (and costly) anti-aging experiment.

Back to my lips. That little bit of filler there also turned out to be a bad idea. I was looking at a picture of myself a couple of years after the injections and noticed that my smile looked a tiny bit lopsided. Sure enough, my lips were now a little bit uneven. Although patients are told that temporary fillers dissolve, it turns out that sometimes they last for much longer – perhaps even forever. In my case, I suspect that the filler has dissolved unevenly, leaving me with a slight asymmetry between the two sides. 

This unfortunate experience let me to do two things. First, I decided to embrace aging. I will wear my life experiences with pride and recognize that happiness will never be found by forcing my body to conform to an unrealistic and ill-conceived idea of beauty. And second, I searched for alternatives to injectable and invasive anti-aging therapies that I knew I could use safely and without concern about adverse outcomes. 

Alternative Anti-Aging Therapies

Topical Products – There are loads of topical anti-aging products that can safely be used on the skin and that have anti-aging effects. While these aren’t expected to cause dramatic results, many have been shown in clinical research to reduce signs of aging, such as fine lines and uneven skin pigmentation. They include ingredients like vitamin C, niacinamide (vitamin B3), retinol, and tranexamic acid (from the amino acid lysine). Since what goes on your body goes in your body, make sure that all ingredients in your products are safe. The Environmental Working Group’s Skin Deep database is an amazing resource for this – just type in your product and they’ll give you a safety report.  

Red Light Therapy – Red light therapy (also known as photobiomodulation) is the application of red light, which is visible as the color red, and/or near infrared light, which is not visible but can be felt as heat. Red light therapy has been shown to be effective for “skin rejuvenation”, including outcomes like increased collagen synthesis, increased elastin production, extracellular matrix regeneration, regulation of oil production, and regulation of the pigment producing cells of the skin. Clinically, these manifest as reduced wrinkles, improved skin appearance, and improved skin pigmentation. Studies show results such as smoother skin; wrinkle reduction and improved skin elasticity; and normalization of skin pigmentation. Most skin rejuvenation studies use both red and near infrared light. Red light therapy has an amazing safety profile and can be used safely by most people, especially at low to moderate intensities.  

Cosmetic Acupuncture – Cosmetic acupuncture is acupuncture applied to the face, head and neck. Since acupuncture does involve piercing the skin with needles, there is a small risk of infection, which can be greatly minimized by using safe practices like using sterile needles and disinfecting the skin before treatments. Side effects are extremely rare. Cosmetic acupuncture has been found to improve facial elasticity and restore muscle tone. 


Face Yoga – Face yoga involves doing exercises to strengthen the muscles in the face. By increasing muscle mass, the facial atrophy that is associated with aging can be reduced. Although the effects are not dramatic, face yoga has been found to improve measures of facial appearance, particularly cheek fullness. This contrasts with Botox, which is known to cause muscle atrophy because the paralyzed muscle is not being used. There are no risks at all involved with doing face yoga. 

Conclusion

Author Leo Tolstoy is credited with saying “It is amazing how complete is the delusion that beauty is goodness.” Perhaps this is why the pursuit of youthful beauty goes back to humanity’s earliest civilizations. Exacerbated in the modern world through the digital spotlight of social media, the increasing normalization of altering appearance using anti-aging therapies has led to a diminished consideration of associated risks, which can be significant and life-altering. Fortunately, there are many safer alternatives that have can be used to support natural and graceful aging. 

Dr. Genevieve Newton, DC, PhD  spent close to 20 years as a researcher and educator in the field of nutritional sciences before joining Fringe as its Scientific Director. Gen’s job is to “bring the science” that supports Fringe’s products and education. She is passionate about all things Fringe, and is a deep believer in healing body, mind and spirit using the gifts of the natural world. 

The contents in this blog; such as text, content, graphics are intended for educational purposes only. The Content is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider.

For more information about Fringe light products, go to: https://fringeheals.com/shop-all-products/

Leave a Reply

Your email address will not be published. Required fields are marked *