One identical twin, aged 38, had Botox for 20 years – the other had not. Who looks better?

Record numbers of Americans are gifting significant others cosmetic surgery for Christmas this year.

For those wondering what they’d look like with some Botox, a unique study provides one of the clearest examples of how the shots change the appearance of one’s face.

The women were followed for almost 20 years, with one getting 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 multiple images of each twin at different time intervals.

They were photographed for the first time in 2006 at the age of 38 and were taken with their faces ‘resting’.

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

The twin who received the treatments regularly had noticeably smoother skin with shallower wrinkles on her face.

Her sister, meanwhile, had deeper forehead lines and more prominent crow’s feet when she smiled compared to the twin who had undergone the shots.

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

They were then followed up at the age of 44 in 2012 – at which point the Botox twin had been getting the injections for almost 20 years.

At this point the non-Botox duo had a noticeably more puffy face and wider jaw – although it’s not clear if Botox was a factor.

For the 2012 follow-up, both twins said they used sunscreen consistently, ruling out the possibility that the wrinkles were caused by long-term exposure to the sun’s UV rays.

Neither used retinol for wrinkles and lived mostly healthy lives.

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

The twin with sporadic treatments and more lines resided in Munich, where the average UV index is lower compared to Los Angeles, the location of the other twin.

The crow’s feet when they smile are more visible on the duo who let nature take its course – images A and B. The regularly treated twin – images C and D – had much less pronounced crow’s feet

The photo shows where a duo had botox injections on the forehead, pavement (between the eyebrows) and crow’s feet areas

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

“With long-term treatment, the patient may become accustomed 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 stress of chronic muscle contraction in this way, skin remodeling may be facilitated.”

Wrinkles form when 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 able to maintain its shape, leading to the formation of wrinkles.

A 2012 follow-up showed that the Botox recipient twin had almost no forehead wrinkles at rest

Woman treated with Botox had more shallow wrinkles compared to her sister around her eyes and mouth

Botox injections are extremely popular. Over 8.7 million cosmetic procedures were performed with them in the US in 2022. But the injections are not without risk.

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

More serious reactions, such as anaphylaxis, shortness of breath, headache, and even flu-like symptoms.