Social media, selfies and reality TV celebrities are among the influences driving millennials to the cosmetic surgeon’s office for neurotoxin injections and more, according to 2015 stats released earlier this year by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
But the experts we interviewed say treating younger patients with Botox (onabotulinumtoxinA, Allergan), Dysport (abobotulinumtoxinA, Ipsen) or Xeomin (incobotulinumtoxinA, Merz Aesthetics) isn’t necessarily the same as treating middle-aged and older patients.
Manolis G. Manolakakis, M.D., an oral/maxillofacial surgeon and fellowship trained facial cosmetic surgeon in Shrewsbury N.J., says he has noticed the upswing in demand for botulinum toxin treatments among patients 30 and younger. The surgeon says he has been treating younger patients with “subclinical” Botox, to give them a smooth — not frozen — look.
“By relaxing the resting state of the muscle, the skin will have smoother appearance,” he says. “Preventative Botox is something that has been sort of a controversy. My belief is that if done properly (conservatively) on younger patients, Botox can be utilized as an antiaging modality to prevent dynamic rhytids to turn into static rhytids, without creating a disuse atrophy.”
Washington, D.C.-based facial plastic surgeon Houtan Chaboki, M.D., says he commonly starts Botox for women and some men in their 20s.
“Generally, I will recommend starting with the basics: sun block/protection, hydration, gentle cleansing, no smoking, avoid excess salt. Next, some patients will start tretinoin topical ointment. Lastly, Botox for those who still want to maximize their appearance. Even young skin can benefit from Botox (or similar wrinkle relaxers such as Dysport),” he says.
Reevs O'Neal is a transgender man who's about to have a life-changing operation that he says he would not have felt comfortable doing in his home state of North Carolina.
"In North Carolina, it definitely wasn't safe for me to transition," O'Neal told ABC News' "Nightline." "It was just terrifying."
O'Neal had a double mastectomy to remove the female breasts that he was born with. He said the hospital bed at George Washington University Hospital in Washington, D.C., where he had his "top surgery," felt worlds away from where he grew up in North Carolina.
O'Neal's home state has become the latest battleground for LGBT rights. Last month, North Carolina's House Bill 2, the state's so-called "bathroom bill," was signed into law. It requires people to use the bathrooms in school and government buildings that correspond with the sex listed on their birth certificates.
North Carolina Governor Pat McCrory said the law is meant to protect men, women and children in bathrooms.
"It is basic common sense. It's etiquette, privacy that we have had for decades," McCory said on "Fox & Friends."
The law, which critics say is discriminatory to the transgender community, has sparked outrage and prompted some corporations to boycott the state. Rock legend Bruce Springsteen even cancelled a sold-out concert in North Carolina because of the law.
"You have to hurt people economically to have them do the right thing morally," Steven Van Zandt, the guitarist in Springsteen's E Street Band, said at the Rock and Roll Hall of FameCeremony on April 8.
But there is still plenty of support for the law in North Carolina and across the country. According to the American Civil Liberties Union, states like Indiana, Kentucky, West Virginia, and Mississippi have proposed similar measures.
O'Neal said that House Bill 2 will not only make life harder, but more dangerous.
"People are going to get harmed," O'Neal said. "[The] biggest risk is murder, being killed."
O'Neal, who was born "Reva" to a southern Baptist family in North Carolina, said that from an early age, he knew something didn't feel right.
"I was probably 7 or 8 and refusing to wear the church dresses because of, you know, the representation that comes with wearing a dress," O'Neal said.
It wasn't until much later that he learned on social media what it meant to be transgender.
"You never heard that word," O'Neal said. "It was like this 'a-ha' moment."
He remembered the moment as being scary and worried about what his parents would say. For years, he lived two different lives. Every time he left his house, he wrapped his chest with elastic bandages in his car as a way to flatten his breasts. It was a painful process.
"That's like really terrible. Oh my God, it's awful," he said. "Having that wrapped around your chest all day. And I had like two or three on."
Believing he could never come out to his own mother, the two stopped talking. Feeling misunderstood and scared, O'Neal fled North Carolina for Washington, D.C., where he became homeless.
"It was terrifying," he said. "No job and I only had like $100 to my name when I got here. And it was frightening."
When "Nightline" first met O'Neal, he had just found a lifeline in the form of Casa Ruby, an emergency shelter that welcomes young transgender men and women.
It's run by a larger agency with the same name that's devoted to D.C.'s LGBT community and was founded by Ruby Corado.
"I was blown that this stranger, someone who didn't even know me, was going to take me in and trust me on their property and, like, give me a place to stay," O'Neal said. "I was like, 'Wow!' I had never experienced that kind of kindness before."
Corado, a well-known local activist, calls those who end up in her shelter her children. Like O'Neal, everyone in the shelter has run away from something.
"For at least six months I've been sleeping on trains. I've been sleeping outside," Nicki Williams said through tears at one of the house's Sunday dinners. "Without here, I wouldn't have nothing."
"Everybody walks in the door with some trauma," Corado told "Nightline" from her agency's resource center, where clients have meetings. "I often have to repair their dignity."
Family rejection, discrimination and violence are facts of life for many in this community. One in five transgender people end up homeless at one point in their lives, according to The National Center for Transgender Equality.
And according to the National Transgender Discrimination Survey, nearly half of this population has attempted suicide.
"We live in a system that's not made for us," said O'Neal. "Our society isn't for transgender people and we're still having to fight to make space for us so, like, yeah there's still a lot lacking."
After several months of support and a job with Casa Ruby, O'Neal was able to rent an apartment of his own.
"I'm a nervous wreck," he said while packing up to move out of Casa Ruby in November. He continues to work at Casa Ruby as a housing monitor. "I've had, like, a lot of potential safe spaces, but was always let down."
O'Neal soon found love with a college student named Emem Obot who has been by his side throughout the process of getting surgery.
"When we go from female breast to a mastectomy for gender affirmation surgery we're actually trying to realign the characteristics with the chosen gender," Dr. Benjamin Wood, assistant professor of Plastic and Reconstructive Surgery at the George Washington University School of Medicine and Health Sciences, told "Nightline."
Wood performed O'Neal's double mastectomy as well as the reconstructive surgery.
When "Nightline" caught up with O'Neal a few months later, all of the positive change in his life seems to have given him a new-found swagger.
Despite his hardships, O'Neal knows he's been more fortunate than others. He's now mending his relationship with his mother back in North Carolina, and she's learning to accept him for who he is.
His mother told "Nightline" that she and the family will even stand up against the new bathroom law.
"They're just like, 'Come here and I'll go the bathroom with you,'" O'Neal said. "'No, Mom. You really can't actually go into the bathroom with me. You'll probably be arrested too.'"
O'Neal said it's one important step in a long journey towards healing.