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I'm flattered if you thought I was a doctor. Not so. I may have picked up bits and bobs of general knowledge here and there, but it's very far from comprehensive. Does botox or other stuff have no long term effect at all? I've seen pictures of people who have had repeated procedures to try...

It's different because piercings and hairstyles are both temporary and will grow out without medical intervention. Botox or lip fillers, like tattoos, have a permanent effect. Most people have fashion disasters in their youth, but it's a relatively new idea to make those fashion statements...