By Nelson Lee Novick
Undoubtedly, the fastest growing non-surgical cosmetic procedure is Botox injections, with over 1.3 million administered last year alone. Type-A exotoxin, or Botox Cosmetic®, marketed by Allergan, Inc., Irvine, CA, is produced, perhaps surprisingly, by the bacterium Clostridium botulinum, the cause of botulism.
While skin researchers have demonstrated that wrinkles in the aging face are clearly related to the accumulated effects of excessive sunexposure, smoking, volume loss, and gravity, facial expressions and animation, known as dynamic wrinkling, also play a major role in the development of many types of neck and facial lines and furrows. By binding to the junction between nerves and muscle tissue, Botox effectively blocks the release of acetylcholine, the chemical responsible for normal muscular contractions, weakening the ability of certain facial muscles to induce fine lines, wrinkles, frowns and furrows through their repetitive use.
Botox has an excellent safety record in humans. Since the late-1970s, it has been used to treat muscle abnormalities associated with certain tic disorders, vocal cord problems and ocular abnormalities. And in the more than twenty-five years since its introduction and FDA-approval for these indications, it has consistently proven not only safe but reliable in millions of injections.
Cosmetic Uses of Botox
While other procedures, like laser resurfacing, dermabrasion and chemical peeling deal primarily with wrinkled skin at rest, Botox is considered the treatment of choice for movement-related wrinkles. Although initially used only to treat the so-called “scowl” (frown) lines between the eyes, Botox injections have been found remarkably effective for treating a wide range of facial and neck lines and furrows. Great improvement may be seen in the horizontal “worry” lines of the forehead and the “crow’s feet” lines on the sides of the eyes, which in many cases may be eliminated entirely with treatment. Even more recently it has been used as a chemical (nonsurgical) browlift to restore the more youthful-appearing subtle upturning of the lateral eyebrows, to reduce the crepe paper-like crinkles under the eyes and creases around the chin, to counter the “marionette” line downturning at the corners of the mouth, to soften “smoker’s” (lipstick bleeding) lines around the lips, and to reduce laugh lines. Even the so-called “bunny” lines on the sides of the nose may be eliminated by Botox. In the neck, Botox has been employed successfully for improving the appearance both of the vertical “chicken-neck” (“turkey gobbler”) ropelike bands on the upper neck and the horizontal “necklace” lines encircling the lower neck. Even more recently, it has been successfully employed to lift the tips of drooping noses, a common problem with aging. Results of these treatments are usually seen between one and ten days after treatment and typically last for four to six months, although after several treatment periods more prolonged benefits may be seen.
Best Candidates for Treatment
While the “typical” Botox patient is usually a woman in her mid-forties to mid-sixties, many men and women older and younger have also been treated successfully. Individuals with neuromuscular disorders and pregnant women and nursing mothers, however, are not candidates for treatment.
What To Expect
Botox is a watery-looking substance, which is administered, for greater comfort, through a needle finer than most sewing needles. The actual number of injections and the amounts given vary with the areas being treated. Prices for treatment sessions also vary considerably, depending upon locale and the number of sites treated, and may range from $500 to $2000.
Certain medications and food supplements may increase the possibility of bruising, so you should discuss with your doctor stopping them prior to treatment. These include aspirin, non-steroidal antiinflammatory drugs (eg. Advil, Aleve), alcohol, vitamin E, ginseng and ginko biloba. Although injections tend to be somewhat uncomfortable, a simple ice pack applied beforehand generally suffices to reduce discomfort. It take about fifteen minutes to treat an entire face and neck.
Happily, complications of Botox treatments are few and short-lived, and Botox can truly be counted among the “lunchtime beauty fixes,” meaning that in almost all cases, patients can immediately return to work or social activities. Minor complications include swelling, bruising and tenderness at the injection sites, which usually disappear in a few days; slight headache, which may last a few hours; and rarely, a slight lid drooping, which most often resolves in two weeks. There have been no reports of generalized illness from treatments with Botox. One treatment session is often sufficient, but If a touch up is needed, it is best done at least a month later to reduce the chance of inducing any resistence to the material.
To prevent Botox from spreading beyond the treatment sites, a few physicians advise their patients to remain upright for at least four hours immediately afterward and not to massage the treated areas. Most simply advise patients to repeatedly contract the treated muscles for up to hours hours afterward in order to work the material into the body of the muscles.
Some patients fear, unreasonably, that following Botox therapy they will have a “Kabuki-like” mask appearance and that they will also lose skin sensation. In reality, only the treated muscles will be relaxed leaving all else functioning perfectly intact, including sensation. In the overwhelming majority of cases, Botox patients are delighted with their “calmer,” more relaxed, less wrinkled, less frowning look. And the future of these treatments looks bright as other forms are being studied and newer uses being tested.
Dr. Nelson Lee Novick is a Clinical Professor of Dermatology at The Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He also maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan's Upper East Side. His biography has been included in the most recent 46th through 61th editions of Who's Who in America, and he has been listed in Consumer Research Council of America’s Guide to America’s Top Physicians--2003-2006 eds.
He is the author of nine mainstream trade books, the senior editor and lead author of several medical textbooks and numerous professional articles and has written by-lined articles for many popular magazines and newspapers. Dr. Novick has been featured on network television and has appeared with, among others, Oprah Winfrey, and Matt Lauer. He has been interviewed by all the major print venues, including the The New York Times, The Washington Post, and USA Today.