One identical twin, 38, had Botox for 20 years – the other didn’t. Who looks better?

Record numbers of Americans are giving cosmetic surgeries to their spouses for Christmas this year.

For those wondering what they would look like with a little Botox, a unique study provides one of the clearest examples of how the shots change a person’s facial appearance.

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

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

They were first photographed in 2006, at the age of 38, and taken while ‘resting’ their faces.

At the time, one of the twins had had at least 26 Botox injections since she was 21, and the other had only a few injections.

The twin who had undergone 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 twins who had the injections.

The images show that the twins who received very few injections – images B and C – and the one who received regular Botox – E and F – had significantly more forehead wrinkles

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

At that point, without Botox, the twins had a noticeably thicker face and wider jaw, although it’s not clear whether the Botox was a factor.

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

Neither of them used retinol for wrinkles and lived a mostly healthy life.

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

The twin with sporadic treatments and more lines lived 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 twins – images C and D – had much less pronounced crow’s feet

Pictured are the areas where twins received Botox injections in the forehead, glabellar (between the eyebrows) and crow’s feet

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

‘With long-term treatment, the patient may become accustomed to having little or no need or ability to contract the target muscle, and may eventually ‘learn’ to stop even trying to contract it.

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

Wrinkles form when the 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 in shape, leading to the formation of wrinkles.

A 2015 follow-up found that the Botox recipient twins had virtually no forehead wrinkles at rest

The Botox-treated woman had more superficial wrinkles around her eyes and mouth than her sister

Botox injections are extremely popular. In 2022, more than 8.7 million cosmetic procedures were performed in the US. But the injections are not without risk.

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

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