BoTox
Stuff@night Magazine - November 7, 2001

Botulinum Toxin – BoTox – sounds familiar, right? ABC’s 20/20 called BoTox a “miracle cure” for crow’s feet and furrowed brows – but isn’t it a poison? How could poison get rid of wrinkles?

BoTox is a poison. In fact, it was discovered in 1895 after an outbreak of food poisoning in Belgium. The bacterium Clostridium botulinum produces a toxin that prevents muscles from receiving the nerve stimulus to contract. This causes the muscle to relax. In 1977 an ophthalmologist started using the purified toxin (BoTox) to weaken hyperactive eye muscles. In 1989 other physicians realized that a very small amount of the toxin could be used to relax muscles of the face. When the facial muscles relaxed, the overlying skin became smoother and many of the wrinkles vanished!

BoTox works best for “dynamic wrinkles” – those that deepen when you squeeze a muscle. Good examples include horizontal forehead wrinkles, vertical wrinkles between your eyebrows, some neck bands, and crow’s feet. Some wrinkles that we’d like to get rid of are caused by muscles that are too important to paralyze, so BoTox can’t erase every facial line. But, in the right situation it is easy and safe. A very small amount of the solution is injected directly into the problem muscles. Over the next 3 - 5 days the muscle weakens, often with a dramatic softening of the overlying wrinkles. A small bruise (from the needle) is typically the worst thing that could happen immediately, and isn’t very common.

If you go to a skilled physician, the most common side effect will be the need for a “touch up” – I’ll tell you why. A novice physician could place the medicine into the wrong muscle, or use the wrong concentration of medicine causing it to spread to a muscle that you don’t want weakened. For example, an eyelid muscle could weaken and a mild droopy eyelid or eyebrow could occur. An experienced doctor places the smallest effective amount of medicine into just the right spots. Of course, some people need a stronger dose than do others so if the minimum amount doesn’t work, you go back for more next week. (It’s better to go back for more than risk getting too much and having a droop.) In order to be certain that the medicine stays in the right spot you may be asked not to rub or massage the injected areas for four hours.

The best and worst thing about BoTox is that it’s temporary. If you don’t like the results, it wears off in around 3 months; if you love it, you need to do it again in around 3 months. Actually, it seems that people who regularly receive BoTox find that the interval between treatments lengthens – even up to 6 months. Because it is expensive to prepare and purify the medication treatments can be expensive. Prices range from $400 - $600 and up depending upon the number of areas treated.

Some of the “side effects” of BoTox wrinkle injections have turned out to be great new uses for the medication. Researchers in California noticed that some of their patients with migraine headaches who received BoTox for forehead wrinkles had a dramatic improvement in their headaches. In one study, nearly 80% of migraine sufferers said that the number or severity of their headaches had been cut in half. In fact, more than 50% of the study participants stopped having any headaches for three months or longer! (Just think, look better AND feel better!) Even excessive sweating can be greatly reduced by BoTox injection directly into the overactive sweat glands. All of this has been very exciting for physicians who are continuing to find new applications for this miracle “poison”.

Many of these uses for the medication, including wrinkle reduction, are considered “off-label” applications; the government hasn’t officially approved of using the medicine in these situations. However, the drug is so effective and safe that many physicians and medical academies are comfortable recommending it for these “off label” uses.

One point to remember is that the medicine works best for “dynamic” wrinkles caused by muscle contraction. Some fine lines in the skin may still be seen even after treatment, although these can be filled in with any of a number of injectable materials (which we’ll talk about another time). BoTox can easily and safely soften wrinkles in the forehead, between the eyebrows, some neck banding, and crow’s feet by the eyes. There’s no age limit and people from their twenties up to their seventies regularly have it done. In many people, it truly is the “miracle wrinkle cure”.