As beauty treatments go, very few have received the kind of rock star status of Botox. It enjoys the same single name recognition as the likes of Cher and Beyoncé — it needs no other introduction, and has come to stand for an entire category of excellence. It’s the little neurotoxin that could. In fact, the American Society of Plastic Surgeons reported that it was the number one minimally invasive cosmetic procedure in the U.S. with 4.4 million procedures performed in 2020 alone — and that’s accounting for the fact that the country was shut down for almost half the year. But what if you are unable, or unwilling, to try Botox, but would still enjoy its myriad benefits (more on that in a bit)? Luckily, there are still a few alternative options for you.
But first, in case you somehow have managed to dodge countless mentions of it by, oh, everyone, a little recap: Botox is an injectable neuromodulator called botulinum toxin that temporarily paralyzes your muscles to smooth the appearance of fine lines and wrinkles. There are other variations on the market called Dysport, Xeomin, and Jeuveau, but Botox is far and away the most popular and well known of the bunch.
“Botox is a protein that attaches to the muscle and lasts for a period of three to four months, but for some people it can last up to six months,” says Dr. Jeanine Downie, a board-certified dermatologist and founder of Image Dermatology in Montclair, New Jersey. “It’s best for people in their 30s, 40s, and 50s who are just beginning to show age and don’t have any lines or wrinkles that are too deep. However, I do use it on patients in their 60s, 70s, and even 80s, but they won’t see as appreciable of a difference.”
Why Botox Has Surged In Popularity
Botox has made plenty of fanboys and girls out of dermatologists and plastic surgeons during its almost two decades of use as a cosmetic treatment. “There is no question why Botox is one of the most successful therapeutics ever in medical history,” says Dr. David Shafer, a board-certified plastic surgeon and founder of Shafer Clinic Fifth Avenue in NYC. “Botox weakens the underlying muscle which reduces the overlying dynamic wrinkles. Over time, the reduction of dynamic wrinkle treatment also improves the static wrinkles in the same area. For this reason, the use of Botox helps prevent static wrinkles from forming as we age.”
For those not up on their derm speak, static wrinkles are those that are age-related and caused by things like collagen loss and environmental factors, while dynamic wrinkles are caused by muscle movement. Static wrinkles are always visible once they show up, while dynamic wrinkles only appear when you move those muscles or make that expression; however, with repetitive movement, dynamic wrinkles will eventually become static wrinkles.
Botox’s reputation as a cosmetic magic wand extends past just wrinkle smoothing and prevention — it also has a few other less well known uses that might surprise you. “We can do a ‘Botox Brow Lift’,” says Dr. Sarmela Sunder, a double-board certified facial plastic surgeon in Beverly Hills, “wherein the side of the brows can be lifted.” This technique can also be used around the mouth to pull up the corners of a downturned mouth, says Dr. Paul Jarrod Frank, a celebrity cosmetic dermatologist in New York. “We can alter the way we smile by using neuromodulators underneath the tip of the nose and around the mouth. We can change the shape and the border and prominence of the lip line, by using neuromodulators on the lip border, commonly known as a lip flip.”
But, that’s not all, says Dr. Frank. “We can alter the shape of the nose and we also use it for slimming of the face in people who have overgrown masseter or chewing muscles. We can also help with the shape and tightness of the jawline and the neck by using it in that area as well.” Another use people may not be aware of, according to Dr. Bruce Katz, a board-certified dermatologist and founder of Juva Skin and Laser Center in New York, is Botox’s use on the neck. “By injecting Botox into the platysmal bands — those little vertical cords that develop under the neck as people get older — we can get that to go away temporarily in about 80% of patients.”
The Root Of Botox Hesitancy
With that kind of pedigree and laundry list of benefits, you might be asking yourself why anybody wouldn’t want to get Botox. Well, there are some people who still aren’t all that jazzed about injecting a toxin into their system, despite the FDA approval and rigorous safety standards. Then there are a small percentage of people who can’t either due to their career (some actors and comedians who rely on their facial expressions for their work), a physical inability, or a medical issue.
“For the most part, there aren’t a lot of medical contraindications,” notes Dr Katz. He cites a few medical conditions, like dystonias or multiple sclerosis, as reasons a potential patient wouldn’t be able to receive Botox (although it depends on the individual and should involve a discussion with their doctor). And, of course, there are the people with needle phobias. Adds Dr. Sunder, “The main reason that patients report for not wanting Botox is a fear of ‘looking frozen or unnatural.’ In those situations, I spend some time educating patients that Botox can look quite natural if performed with the right dose and using artful placement.”
So, are those individuals left to face the world au naturel? Not quite: While all these dermatologists reiterate that nothing compares to Botox when it comes to the treatment and prevention of those dynamic wrinkles, there are some alternatives that come pretty close on diminishing the appearance of visible fine lines and wrinkles — as well as a few that can also perform some of those ancillary Botox benefits like lifting and slimming. They all have their pros and cons, from being beaucoup bucks to multiple treatments needed before any noticeable results, but each has the MD stamp of approval as the best alternatives for those who can’t (or won’t) get Botox.
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The 6 Best Alternatives To Botox
Fractional CO2 Laser
Of all the alternatives on the list, this one bears the distinction of being “the next best thing to Botox” in terms of wrinkle reduction, according to dermatologists. “It’s a laser that resurfaces the skin to take away dark spots, scars, wrinkles, and lines,” says Dr. Katz. It’s called fractional because it only treats a fraction of the skin — it leaves microscopic columns of untreated tissue within the treated areas, which help speed up your healing time and minimize your chance of side effects. Dr. Katz notes it is one of the most popular treatments in his office and that he performs five to six per day.
While Fraxel was one of the first fractional CO2 lasers on the market, the technology has since evolved and Dr. Katz says the more popular devices now include SmartXide DOT and SmartSkin. Side effects include redness and puffiness for a few days, and there is a chance of developing herpes simplex virus around the mouth, which is why many patients are prescribed oral antivirals to fight infection prior to their treatments.
Expect to undergo multiple treatments over the course of a few months in order to see best results and to have to repeat the treatment every five years or so, depending on your age, skin type, genetics, and how good you are at staying out of the sun and taking care of your skin. Laser treatment prices will vary depending on your doctor and location, as well as the areas you have treated, but expect to pay between $1,500 and $2,000 per session.
If you’re in the needle phobic category, this one isn’t for you. For everybody else, facial fillers also came in high on the alternatives list with our derms. While fillers are typically used to fill in deep lines in the mid face area or add back lost volume, Dr. Frank says that you can somewhat mimic that “Botox Brow Lift” effect using fillers. “While we can easily lift and raise the brow using neuromodulators, every now and then we have a patient who does not want to use Botox around the eyes because of an anatomical issue. We find we can use a little bit of filler placed above the brow bone to give that natural arch, and it does a nice job of supporting it, but it does not lift enough where it will prevent those crows feet from being pronounced.”
Another Botox adjacent use for fillers is jawline slimming, which seems counterintuitive but is actually quite effective. By adding filler along the jawline, it creates structure, which in turn gives the illusion of a slimmer jaw and can even visually elongate the neck. Typically for the brow lift, you’ll want either Restylane or Voluma, while for the jawline you’ll opt for Voluma or Radiesse. Fillers can last anywhere from five to 24 months, depending on the person and the filler used. The price can range from $500 to $2,000 depending on where you live and how much is needed for your treatment.
Also known as microneedling RF, this treatment is more geared towards fine lines rather than dynamic wrinkles. It’s a combination device that uses microneedles to both create tiny injuries to the skin and promote collagen production, but also deliver radiofrequency energy into the dermis, which encourages collagen growth and has the added benefit of tightening skin tissue as well. “Vivace Microneedling RF does have added treatment benefits, such as reducing the appearance of dull and uneven texture, enlarged pores, fine lines, and loose skin,” says Dr. Frank, “but again, those deeper lines and creases aren’t going to be solved with only Vivace. We offer a treatment called ‘tech neck’ that uses Vivace Microneedling RF to address the fine lines and crepey skin in your neck from looking down at your phone.” It will run you anywhere between $700 and $2,000 per session, depending on where you live and the areas you need treated. Typically, three sessions is recommended to see the best results, spaced a few months apart, and the effects can last about a year.
For skin tightening and lifting (and, to a degree, wrinkle reduction), another option that dermatologists recommend is ultrasound technology in the form of a device called Ultherapy. It also can have an effect on those pesky neck bands. “Through ultrasound technology, Ultherapy helps to lift areas such as the neck, jawline, chin, and brow and improves lines and wrinkles,” explains Dr. Frank. “However, we do like to use it in conjunction with neuromodulators, especially if those platysma bands are starting to become too pronounced. Ultherapy will not address those platysma bands in the same way that Botox will, however we still use Ultherapy as an alternative, but prefer to use it in conjunction with Botox when the platysma bands are an issue.” Typically you can do one treatment and the results will last for a year — after that it’s recommended you do it every two years for maintenance. Depending on the areas treated, it can cost you anywhere from $2,000 to $5,000 per treatment.
On the at-home front, there are some treatments and devices on the market that have been shown to have an effect on fine lines and wrinkles, although you definitely need to manage your expectations and recognize that no product used outside of a doctor’s office is going to give you the kind of transformative effects as Botox — or even the procedures described above.
Now that that’s out of the way, one area that’s shown some promise in the anti-aging category is light-emitting diodes, aka LED technology. Specifically red lights, which, according to Dr. Katz, have been shown to have some effect on fine lines and wrinkles. “You need a lot of treatments and you need to do them every day or every other day and those benefits will fade, however we’ve looked at it over the years for skin rejuvenation in something we call photobiomodulation.” The key is to be sure you are getting a device that is using a beneficial wavelength and not just a red lightbulb — Dr. Katz says it should be in the infrared light zone (which is 700 to 1,000 nanometer wavelength). Try the LightStim for Wrinkles, a handheld device that emits four different wavelengths simultaneously, including one that’s 855 nm.
Also known as acetyl hexapeptide-3, argireline is a type of peptide that — unlike its short-chain amino acid brethren — has been shown to have an impact on muscle movement by impacting the nerve-to-muscle communication, meaning that it is often billed as helping to target expression lines and wrinkles.
“It’s touted to have ‘Botox-like’ effects in a cream form” says Dr. Sunder. “While that is hyperbole, it has been reported to have some wrinkle-fighting benefits.” So, again, any sort of effects you would see with a topical argireline cream is going to be minuscule compared to actual Botox, but if you aren’t looking to spend thousands of dollars on in-office treatments and want to do something at home, this is the ingredient that is said to give you the most Botox-like bang for your buck. Try Goldfaden MD’s Needle-Less Line Smoothing Concentrate, Noble Panacea Absolute Collection Restoring Eye Cream, The Ordinary Argireline Solution 10%, or Estée Lauder Perfectionist Pro Instant Wrinkle Filler With Tri-Polymer Blend.
As our dermatologists all pointed out, at this time there isn’t really a true comparable alternative to Botox because no other treatment targets muscle movement in the same way. “Dynamic lines, lines which are caused by repetitive muscle movement, will only be treated adequately by treatments that limit muscle movement,” says Dr. Sunder. “Short of doing that, there will not be a true competitor to Botox. While creams, lasers, devices, and microneedling can superficially erase any lines that have formed, they are only serving as a bandage. They are not addressing the root cause like Botox is, therefore, the results will never be as impressive or as long-lasting as targeting the muscle movement.”
That said, innovation has come a long way since Botox was first introduced almost two decades ago, with new technologies and ingredients being introduced each year. Many of these alternatives are either new to the scene or advanced evolutions of older technologies, meaning for those that are Botox hesitant, there may be even more advanced alternatives on the horizon.