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Animal and human studies show that serial type-A injections produce measurable, partly persistent changes in the treated muscle—atrophy, increased stiffness, and a two- to threefold rise in intramuscular collagen in long-term rodent models—and that the effect can creep into neighboring, uninjected muscles.23 In people, serial facial injection can durably atrophy the targeted muscles, and a body of clinical commentary warns that very high-frequency, decades-long use may thin the muscle layer and, secondarily, alter the skin above it.24 There is a more flattering finding too: by removing chronic folding, Botox can let the skin over a quiet muscle increase its collagen density.25 Both can be true at once
