Bonnie Tyler at 69: Are You Ever Too Old For Anti-Wrinkle Treatment?

Hi Dr Ana! You’ve probably seen Bonnie Tyler in the news, recently, talking about how Botox apparently keeps her looking young, and how she’s been getting it every six months for years. Is it ever too late to start getting aesthetic treatments like anti-wrinkle injections?

No, not really. It’s more of a question of whether you’re just starting out or whether you’re maintaining. But, personally, I think that, as long as it’s safe to go ahead, is not going to affect any other medical issues and is still appropriate for the psychological benefit you’re looking for, I try not to focus too much on the age of the patient but rather what I see and what they are telling me.

When it comes to having anti-wrinkle treatments for many years - as Bonnie Tyler has - and then continuing it past the age of 65, it’s not particularly problematic or complicated. It’s usually just a case of continuing with the treatment as normal. But, occasionally, we do get patients who are over that age, who have never had it before and want to start. This is generally still ok. The only thing with Botox is that it isn’t licensed for use over the age of 65 - the research, efficacy and safety hasn’t been tested on this age group or above. We do use it on an off-license basis when we think it’s appropriate, but always take extra caution.

When it comes to patients over 65, there are a couple of things to bear in mind before recommending botulinum toxin treatment. The first is that sometimes the effects can be a little bit more unpredictable - especially if they are new to it - because anatomy changes when we mature, and sometimes our muscles weaken as part of the ageing process, which means that if you’re intending to treat someone who’s 70 the same as you would with someone who’s 40, you could cause a problem with overtreating them if you haven’t accounted for the fact that their muscles have started to weaken or atrophy. This could then lead to complications like ptosis, like a brow drop or lid drop. However, if you do account for this and you select your patients carefully, and appropriately lower the dose, this will eliminate the increased risk. But I do still warn patients that I’m using the product on an off-license basis and will start by just using a small amount and topping up if necessary.

There are also another couple of things to think about in terms of safety, such as the fact that they may already be at risk for other reasons. I.e. they might have excess skin above the eyelid or a droopy brow, or they might already have elasticity issues around the area. All of these things are an added risk towards causing ptosis, so it’s really important to check for them. In some cases, it may be necessary to avoid injecting the forehead and just treat, say, the crow’s feet instead.

If you’ve been having anti-wrinkle treatment for years and years and you just happen to cross over the age of 65, it’s not going to be as much of an issue. Especially if you’ve been going to the same practitioner for a long time. They know your doses and they know your face, and they’ll know when, if necessary, to start changing the dose.

Also, if you’ve been getting anti-wrinkle injections for years and have been keeping on top of this, your muscles will continue to shrink anyway, so that’s why Bonnie Tyler can probably get away with having the treatment just once every six months. For me, that’s a bonus in terms of affordability and effort, and it means the patient gets more out of the product because they’ve maintained it.

I’ve been getting Botox for around five years and have kept on top of it. At the beginning I was having it every three months, and then I noticed my muscles were shrinking, so I’ve been able to reduce the dose and can now get away with spacing the appointments further apart. So, it’s not just necessarily an age thing.

Ok, so what would be an ideal age to start getting anti-wrinkle treatments?

You have to be a minimum of 18 years old to get anti-wrinkle injections, though I have never injected anyone that young from an ethical point of view. Regardless of that, it’s not really about age. It’s about what signs you can see and what the patient is feeling. Sometimes there are signs of premature ageing; sometimes not. This can depend on lifestyle and the quality of your skin, and can come down to the amount of UV damage you have. For some people, the first signs of ageing appear at 25, whereas for others it’s 35 or even later.

What I usually say is, the earliest I’d recommend anti-wrinkle treatment like Botox - apart from the legal age - is when you can first see fine lines at rest, and only if this bothers you. That’s when it’s an appropriate time to start.

So, skincare and protecting our skin from the sun also play a huge part when it comes to looking younger for longer!

Yes, so apart from the muscles moving and crinkling the skin, it’s all to do with the elastic recoil of the skin and how much you’re protecting yourself from UV damage - because that’s about 90% of the ageing process. I don’t treat anyone with anti-wrinkle injections unless they promise me they’re going to use an SPF everyday because, otherwise, they’re just wasting their money and won’t get enough out of their treatment.

If you don’t start getting anti-wrinkle treatment until later in life, do you need to lower your expectations in terms of what it will do for your appearance?

It depends on the clinical picture, but, first of all, I always use too little than too much because of safety reasons. So, I’d much rather airbrush and soften a line than try to eliminate a line. At that age, if someone has deep set static lines, it’s not going to be realistic to eliminate them - even if you over treat them. A good way to test this is to stretch the skin, and if you can still see an etched line, that’s the maximum result you can achieve.

It’s all about softening lines. We’re making them less visible but we’re not freezing them - not only for safety reasons but because it’s more tasteful that way. You want the results to be age appropriate and you want the patient’s face to match the rest of their body. The last thing you want is a 40 year old’s forehead on a 60 year old’s neck. It should all look in harmony.

If someone does start anti-wrinkle injections later on, would you then suggest other treatments as well to help keep this harmony?

Yes. The most common scenario would be someone who has barcode lines - AKA smoker’s lines - and deep set upper face lines. The first step would be to talk about lifestyle, then active skincare, and we’d then look at some cautious toxin injections in the upper face. But then, what sometimes happens is that the patient starts to notice that their barcode lines have begun to bother them more than usual. So then it’s always good to holistically take a look at the entire face - not just the upper face - and suggest options that will help. There’s toxin, filler, CO2 laser resurfacing...just to match everything up. An in-depth consultation will help ensure a patients gets the treatments that are right for them.

I know you’re a huge fan of "Baby Botox". Would this be something that would work on someone over the age of 65?

It depends on the individual’s anatomy, really. The argument for Baby Botox is that because it’s a lesser dose, there’s less risk of a side effect or a droop. Another reason for it is that because the patient already has weaker musculature, it generally means they won’t need to get Baby Botox as often as someone younger. Baby Botox isn’t as effective at softening deeper set lines, though, so you’d be looking at a less dramatic result. For my older patients, I usually start off with Baby Botox but then we could slowly work our way up to a higher dosage in small increments. But then everyone’s different. Sometimes I see patients who are 70 years old and have really strong musculature and I would treat them based on that.

What do you think about Bonnie Tyler talking openly about getting anti-wrinkle injections? And do you think she’s had any other aesthetic treatments?

I find it really refreshing when people in the public eye have the courage and confidence to talk about their own aesthetic treatments. Otherwise, it can be quite damaging and discouraging to the public if they expect to be able to maintain such a look without getting the extra help most of us end up ‘needing’.

Bonnie looks really good. I can definitely tell she’s had anti-wrinkle injections, and in terms of her lower face - I can never say for sure but - it looks like she’s also had cheek fillers, as she has nice, plump cheeks for someone her age. Unless she’s been extremely genetically blessed, I would say cheek fillers are likely. She might have had some volumising in the mid and lower face too. There are all kinds of skin tightening treatments like radiofrequency, ultrasound, etc, that are so undetectable, so I wouldn’t be surprised if she’s also had some collagen stimulation on top of that as well.

If a treatment supports your psychological well being, as long as you keep it safe and sensible, there’s so much we can do now to look younger for longer. However, it’s always easier to start earlier and try to maintain it rather than start later in life.

Thanks, Dr Ana. That’s really insightful. We totally agree that she looks brilliant! And it’s great to know there are options whatever your age.

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