Before we dive into the needle-free Notox trend, I must confess: I am the biggest Botox fan. I’ve been getting injected with Botox (or Xeomin, another type of neurotoxin) two-to-three times a year since 2018. It’s a quick treatment, pain-free, and like clockwork, makes my skin look like glass within five days of getting injected.
Then I got pregnant and had to quit Botox cold turkey. And because I’m a skin-obsessed beauty editor, I immediately started researching skin-smoothing alternatives for my forehead lines and crow’s feet. During my research (which included a lot of scrolling, reading, and reaching out to experts), I kept hearing about “Notox.” Notox is a clever name for all the product and treatment alternatives for Botox out there, and it’s been gaining popularity in the beauty world since I first stumbled upon it last year.
But what is Notox exactly? Does the rise of Notox mean Botox is over? And most importantly, do these needle-free alternatives actually work? To answer all of these questions and more, I reached out to cosmetic dermatologist Shereene Idriss, MD, and facial plastic surgeon Jason Diamond, MD, FACS, for their expert insights. Keep reading for a deep dive into Notox trend—plus all the products and treatments worth trying, IMO.
What is the Notox trend?
Notox is a portmanteau for “no” and “Botox,” but really the term represents a shift in aesthetics. “It’s about the pendulum swinging in the opposite direction—we’re finally embracing natural-looking results from noninvasive treatments instead of frozen and overfilled faces,” says Dr. Idriss. “Back in 2016 when everyone was going crazy with Botox and facial fillers, I consistently preached ‘subtle over dramatic’ because subtle changes can make for dramatic results overtime,” says Dr. Idriss adding that “people are finally understanding this and dialing it back when it comes to injections.”
Society’s current focus on health and wellness likely has something to do with the rise of Notox too. “We have many patients—we call them ‘naturalists’—who prefer to leverage advancements in bio-regenerative medicine, laser technology, and skincare to mitigate signs of aging,” says Dr. Diamond. FWIW, the majority of Notox treatments are far from natural, but they are stimulating “natural” mechanisms in the skin, like collagen production or cell turnover, to improve its tone or texture.
There’s also the fact that the effects from neurotoxins are a short-term solution to skin aging because most neurotoxins only last two to six months. “Many patients asking for a longer-lasting result and are willing to invest in that over the short-natured effects of neurotoxins,” Dr. Diamond says. Which brings us too…
What are the best needle-free alternatives to Botox?
To be clear, there are no true needle-free alternatives to Botox because neurotoxins are the only thing that can inhibit muscle contractions and soften the resulting fine lines and wrinkles. But Notox isn’t about trying to replicate the exact effects of Botox, it’s about taking a well-rounded approach to skin aging by improving skin elasticity, firmness, hydration, and texture. Now, I’ve tested a ton of Notox products and treatments that promise to do just that. Some didn’t work for, some were just meh, but a few really delivered. I’m breaking down my top five needle-free Botox alternatives below.
Peptide serums and creams:
You know all those “Botox in a bottle” serums trending on TikTok? They’re largely powered by peptides, specifically a peptide called Argireline, or acetyl hexapeptide-8. When applied topically, “Argireline mimics the effects of Botox without actually having to be injected by weakening facial muscles,” says Dr. Idriss. The keyword here is “mimics” since Argireline very subtly smooths lines and for a short amount of time, but the results are impressive, nonetheless. I personally like to use these serums and creams as a part of my daytime routine, so that my skin looks nice and smooth and my makeup doesn’t settle into any creases while I’m out and about.
3 peptide-filled products I love:
The Ordinary Argireline 10% Serum for Facial Wrinkles
Peter Thomas Roth Peptide Skinjection Moisture Infusion Cream
Exosome serums:
Topical exosomes are relatively new on the skincare scene, and if I’m being honest, I was genuinely confused by what they were/how they worked until I started researching this story. An aesthetician told me to think of them as “little ziplock baggies” full of growth factors, proteins, lipids, and other molecules. When the “ziplock baggies” come in contact with skin cells, they unload their contents and signal those cells to function better and faster, resulting in skin repair and regeneration. Dr. Idriss says “incorporating exosomes and other collagen-boosting ingredients in your routine can be helpful for preventing the formation of wrinkles in the long run.”
Exosomes are great to use every day, but they’re especially beneficial for using after a cosmetic treatment since they can significantly reduce downtime and bolster the results of a treatment too. I first tried exosomes as a part of a facial at SkinSpirit, a fancy skin clinic with locations all over the U.S. The aesthetician who did my treatment (and also gave me the clever ziplock baggie analogy, so ty for that) did a thorough cleanse and exfoliation of my skin using the DiamondGlow device first and then she massaged a few pumps of Plated Skin Science’s Intense Serum all over my face. The exosomes in the serum are designed to complement the treatment by triggering the skin’s natural healing process and helping reverse signs of aging, like dark spots and fine lines.
Immediately post-treatment, my skin looked really calm, plump, and hydrated. Fast-forward to now, after four weeks of using Plated’s exosome serum in my daily routine, I’m noticing a difference in the smoothness and suppleness of my skin—especially around my eyes, which is an area I’d typically get injected with Botox.
Lymphatic drainage facials:
Like a deep tissue massage for your face, a good lymphatic drainage facial will melt away facial tension, boost circulation, and create temporary lift and smoothness. I recently had one with NYC-based celeb aesthetician Miranda Sturce, and the sculpting and firming impact it had on my skin was nothing short of miraculous. My jawline and cheekbones were chiseled, my forehead looked relaxed, my brows appeared a bit lifted—a subtle brow lift if you will.
Now the results from a lymphatic drainage facial are very temporary (like a couple days a most) and they’re also very dependent on your provider and their skill level. In my lymphatic drainage facial with Sturce, she used her hands and a gua sha stone to manipulate my facial muscles and get my blood flowing. And while I’ll never be able to replicate her magic hands, I have been using a gua sha-type tool in my skincare routine to give myself a little facial massage at home. I primarily use gua sha tools in a gentle scraping motion on my forehead to try and lift my brows and smooth fine lines, but you can use one anywhere on the face to address a myriad skin concerns, including puffiness and sagging.
A few top-rated gua sha stones:
Mount Lai Gua Sha Facial Lifting Tool Jade
RF microneedling treatments:
RF microneedling combines two therapies—radiofrequency and microneedling—to help firm skin and soften lines. During a treatment, ultra-thin needles that emit radiofrequency energy are stamped into your skin to create a controlled injury, which, in turn, prompts collagen and elastin production—the two key proteins responsible for skin firmness, tightness, and smoothness. Technically RF microneedling isn’t needle-free, but the needles aren’t doing any injecting, so I consider it a Notox-friendly treatment.
There are a few different RF microneedling devices on the market, including Potenza, Vivace, and EndyMed, but I’ve personally seen great results from the ultra-popular Morpheus8 (you can read my full review with before and after pics here). I’m NGL—the treatment is a bit painful and definitely pricey (a single session will set you back $1,000), but the tightening and smoothing effect it has on skin was pretty damn dramatic but not at all unnatural looking.
Ultrasound treatments:
The two big names here are Ultherapy and Sofwave. I recently tried the latter and was OBSESSED with the results. Sofwave works by heating the tissue below the surface of the skin to prompt collagen and elastin production and, according to Dr. Idriss, “it’s ideal for those looking to improve overall skin texture and firmness, as well as for treating sagging in areas like the neck and jowls.” I couldn’t agree more.
I did two Sofwave treatments, spaced three months apart, along my jawline and on my forehead. The results didn’t appear overnight (collagen takes time to ramp up), but when they finally kicked in about six weeks after my first treatment, my jawline looked more “snatched,” my forehead looked smoother, and my brows a bit more lifted. A single Sofwave session takes about 45 minutes and there’s zero downtime afterward, which is really nice and kinda rare for a noninvasive cosmetic treatment, but it definitely hurts, so just be prepared for discomfort. The biggest downside is the cost, IMO—prices vary widely based on location, but expect to spend $1,500 or more—but the results are said to last up to two years.
The takeaway:
Notox is having a moment, but that doesn’t mean Botox is over by any means. There’s no way to freeze a muscle without getting injected with Botox (or Xeomin, Daxxify, or Jeuveau), but there are other ways to soften fine lines and wrinkles and firm skin, including the skincare products and treatments above. So if you’re not a candidate for Botox or you just don’t love the idea of injectables, you’ve got plenty of excellent alternatives.
Meet the experts:
- Shereene Idriss, MD, is a board-certified dermatologist and an expert in facial rejuvenation, as well as minimally invasive body contouring. She’s the founder of Dr. Idriss Skincare and Idriss Dermatology in New York, NY, and a clinical instructor in dermatology at the Icahn School of Medicine at Mount Sinai.
- Jason Diamond, MD, FACS, is a double-board-certified facial plastic surgeon in Beverly Hills, CA. He is founder of the Diamond Skin Institute and skincare brand Metacine, which is loved by Hollywood A-listers.
Why trust Cosmopolitan?
Lauren Balsamo is deputy beauty director at Cosmopolitan with more than a decade of experience researching, writing, and editing skincare stories that range from the best exfoliators for sensitive skin to a comprehensive Hydrafacial review. She regularly tests and analyzes new cosmetics treatments, while working with the industry’s top dermatologists and aestheticians to assess new technologies.
Lauren Balsamo is the beauty director at Cosmopolitan where she writes, edits, and produces all types of beauty content—from product reviews to personal essays and trend reports. She has covered beauty for more than a decade at Cosmopolitan. Follow her on Instagram.
