The combination of Botox needing to be retouched, and the lack of makeup could definitely explain how she looks-though I also wouldn't be surprised if it was 'touched up' or taken in a light so as to make her look older and/or more tired.
A lot of women are unrecognizable without their makeup. It's a bit frightening TBH.
As for the effects of long term use of Botox, or any other cosmetic procedure to take care of wrinkles? Let's just say I think that growing old gracefully should make a comeback-based on how they look to me, since I don't know of any studies.