Joan had to begin somewhere so, after meeting a visiting California Barbie from next door, all she could focus on was the girl’s perfectly smooth cappuccino-colored skin. How could someone be so smooth and tan, Joan thought to herself?
Joan noticed immediately, when she got home, that her own forehead had more lines on it than Lindsay Lohan’s coffee table. And these weren’t just fine lines, like the lines between whether or not Michael Jackson is a man/woman or black/white. The lines were deep and needed to be removed before they got any deeper. Joan knew something had to be done if she hoped to find a boyfriend, but only, as she insisted, if it did not involve doctors and needles. Joan had read that Botox sometimes left women with frozen looks on their faces, so she immediately booked a trip to the Arctic Circle and checked in to a budget igloo with its own ice machine. She hardly had time to unpack her snowsuit when brand-new lines started appearing on her forehead, thanks to annoying little things about the tundra like frostbite, gangrene, and a scarcity of kosher whale blubber. Joan jumped on the next cargo plane home and, once she fully thawed out, called a dermatologist and booked an appointment for Botox injections.
A dermatologist once told me about the four Rs of facial rejuvenation: Relax, Refill, Resurface, and Redrape.
Refill is about injectable fillers, like Restylane. Resurface refers to various techniques to smooth the texture and tone of the skin. Redrape is the big guns of surgical lifts.
This chapter is about the first R: Relaxing your face with Botox Cosmetic injections. It’s not only number one in the dermatologist’s category system. It’s number one among beauty seekers, and I mean huge. As big as Russell Crowe’s ego. In 2007, 4.6 million Americans had Botox Cosmetic treatments.
The rest, unfortunately, still look like Bea Arthur.
The massive appeal? Botox Cosmetic (or, as it’s commonly called, Botox) is not like magic. Truly, it is magic. A chemical miracle. Wave a syringe, and all your worries (or the appearance of them) disappear. Botox Cosmetic is, literally, an instant fix. And who doesn’t love instant gratification? What is sexier and more beautiful than young, smooth skin? Men want to gaze into a woman’s relaxed, clear, and smooth face, as if she hasn’t a concern in the world, except how better to please him. He doesn’t need to see her worries and anxieties and— worst of all—the proof of her irritation with him etched across her brow. A face that appears placid is alluring, reassuring, and sexy.
Who can forget the corpse of Anna Nicole Smith? The worried woman behind the unworried skin?
Well. Botox Cosmetic won’t make your problems go away, but a smooth forehead is one less thing to worry about.
When I first saw the word “botulism,” it was in screaming headlines about poison cans of soup. Some readers might remember the 1972 vichyssoisse botulism scare. One man died eating the poisoned Bon Vivant brand soup. His wife was hospitalized. A massive recall effectively put Bon Vivant out of business.
Botulinum toxin, the bacteria, was first discovered two hundred years ago, in Germany, when it grew on a rotten sausage. The word botulism is a version of the Latin butulus, which means sausage.
Rest assured, when you use Botox Cosmetic you won’t be injecting sausage into your face. What you do behind closed doors is your own business. You’ll be injecting a bacteria byproduct that grows on decaying sausage.
Chemically speaking, botulinum toxin is a protein. It’s created by the bacteria clostridium botulinum that grows on bad meat. Like daisies, butterflies, and puppy dogs, it is one of God’s creatures. For a long time, it was considered to be the Earth’s Most Toxic Protein! or Worst Poison Found in Nature! Before doctors thought to inject it into people’s faces to make them look pretty, the government tried to turn botulinum toxin into a WMD during the WWII era, calling the bomb project Agent X. *You could almost see the name Agent X used in a marketing campaign for a skin care line today.
Botox was the nickname for botulinum toxin type A. Only a minute percentage of the actual toxin goes into the syringe—hardly any, actually. Or, I should say, just enough. Humans got their first dose in the 1980s to treat eye twitching and crossed eyes. The stuff worked, and the practice of using Botox for optic disorders took hold. A husband and wife pair of doctors, Jean and Alastair Carruthers from Vancouver, realized that not only were the patients’ eye conditions better, but they looked extremely well rested. No more lines between the eyebrows. Their crow’s feet turned into angel whispers.
Faster than you can say “ten years younger,” Allergan, a pharmaceutical company, started turning out Botox Cosmetic as a treatment for forehead wrinkles. In 1992, the FDA approved it. Since then, it has been injected into millions of faces all over the world.
FYI: “Botox” is the preparation of the drug used on eye twitches and other spasms of the face and neck. “Botox Cosmetic” is the preparation used to treat wrinkles. The most commonly injected areas for Botox Cosmetic are the horizontal forehead lines, the two vertical lines between the eyebrows (the elevens, as they say in England), and crow’s feet.
Habitual facial movements cause wrinkles. Over time, the wrinkles become etched in your skin. What controls the muscles? Nerves. Facial nerves release neurotransmitter chemicals that signal muscles to move. Botox Cosmetic blocks the nerve from putting out the neuro-transmitter acetylcholine. Without the chemical go-ahead, the facial muscles might as well be an inert steak on a slab. Without the chemical signal, the muscle is essentially paralyzed. It does not move. So if you have no muscle movement, you’ll have—voilà!—no wrinkles. It takes about four months for your skin to break down the toxin and for acetylcholine to stage a comeback. The muscles will start moving again, and the wrinkles will slowly reappear.
However, one great thing about Botox Cosmetic is that the more you use it, the less you need to. If you keep the nerve chemical blocked for eighteen months by getting regular treatments, the muscles begin to atrophy. Any muscle that isn’t used will weaken, and eventually, the muscles become so feeble, they won’t contract much, even after the Botox Cosmetic wears off. When the wrinkles start to show up again, they’re not as deep, and people can go longer between treatments.
It’s fast! And instant! The actual procedure takes minutes. After you’ve been shown into the examining room, the doctor (a dermatologist or plastic surgeon—don’t even think of letting anyone less qualified stick needles in your face!) will do a quick check of your skin tone and facial wrinkles. You’ll be asked to make some faces so he can see how and where you wrinkle. Your wrinkles will become the guidelines for where the doctor will target the Botox Cosmetic.
I asked Shilesh Iyer, M.D., a Yale-and Harvard-trained doctor at the New York Dermatology Group on Fifth Avenue, a diplomat of the American Board of Dermatology, and a fellow of the American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society for Laser Medicine and Surgery, where he likes to inject the needle. “Muscles produce the wrinkle,” he said, “so I ask patients to make faces to see how their muscles contract, not to find the wrinkles. Injections are made into the muscles, not into the wrinkles themselves. Any trained doctor knows the anatomy of facial muscles. That’s why you have to see a doctor for Botox Cosmetic treatments.”
The number of shots depends on the treatment area. Dr. Iyer said, “Usually, I do four or five shots across the forehead. For frown lines, three to five. Crow’s feet, three shots on each side,” he said. To treat larger areas, like the rings around the neck, he does more. “To relax the platysma muscles in the neck, I do two or three rows of five injections.”
The depth of the shots also depends on the area. The eye and neck muscles are superficial, and the needle goes in shallowly. The muscles between your eyebrows are deeper, so the needle has to go in farther. No matter how deep it goes in, the needle itself is tiny. “Most people are shocked by how easy it is to get a Botox Cosmetic treatment,” said Dr. Iyer. “And, unfortunately, that’s why so many untrained people are giving them.”
Me? I go in for shots every six months or so. Most doctors will tell a patient the pain is minimal, but I think the injections hurt. They don’t want to have to give you topical numbing cream because it takes fifteen minutes to take effect. They’d rather have you in, sit you down, load the syringe, bingo, bango, bongo, you’re out of there. So either get a prescription for numbing cream and put it on yourself beforehand, or make good friends with the nurses and get them to give you some to apply while in the waiting room.
Results are almost immediate. You’ll have to wait a few days to see the change, but by week’s end, the Botox Cosmetic is in full effect. The creases are ironed out and will stay that way for four months. When the wrinkles start to reappear, you know when it’s time for another treatment.
Like nearly every drug on the market, doctors have figured out beneficial applications that have nothing to do with what the drug was originally used for or given FDA approval for. Like women taking Viagra. Or spraying Windex on pimples.
Botox Cosmetic, you should know, has only one officially sanctioned application—to get rid of frown lines caused by the glabellar muscles between the eyebrows.
Any other use of Botox Cosmetic is “off-label.” That includes using it on crow’s feet, horizontal forehead lines, and the hateful rings around your neck. If you get such treatments, you’re not breaking the law, and you won’t be carted off to jail, nor will your doctor. Every doctor I spoke to said Botox Cosmetic is just as safe and effective in the crow’s feet as it is between the eyebrows, so don’t ask me why the FDA is so damn picky about where you can and cannot shoot botulinum toxin in your face.
I’ve also heard of many dermatologists injecting Botox Cosmetic into women’s armpits in June to prevent unsightly sweating all summer long. No, I’m serious!
As I’ve explained, Botox Cosmetic is the only preparation used to treat wrinkles. Another formula, Botox, has a higher percentage of the toxin, and is FDA-approved to treat eye disorders like twitching, crossed, and wandering eye, and spasms in the neck and back. It’s also used to stop excessive sweating in the palms. Migraine sufferers await results of a study currently underway to ease their symptoms with Botox. There are other studies testing Botox on neurological disorders like epilepsy and cerebral palsy. We’ll see how huge a drug it becomes over the next several years.
For all we know, it could be the miracle drug of the twenty-first century.
Then again, if the toxin were good for nothing more than making the world a prettier place, as far as I’m concerned, it would still win a spot in the Bacteria Hall of Fame.
According to the American Society of Aesthetic Plastic Surgery, the national average for a Botox Cosmetic treatment is $382 a syringe. Depending on where you live, you will pay more than $382 per syringe. I came across a Botox Cosmetic price map that divided America into zones. Guess which region was the most expensive? The Northeast, thanks to New York City, where the average price was $510/syringe. The next priciest region was the Southeast, with its aging population in Florida, which had an average of $502. Next came the Southwest, and its millions of aging Texas debutantes. The average fee there was $382. Next, the Midwest, with an average fee of $377. And, the least expensive region? The West, from Colorado to California. You can get Botox Cosmetic for a very reasonable $369 in the region. I can assure you, however, if you want to pay New York or Palm Beach prices in Los Angeles, you will NOT have a hard time finding someone to take your money.
Dr. Iyer told me that one syringe is all you’ll need for a face, even if you treated a couple of areas. Be wary of a doctor who tries to sell you half a syringe worth. He might be trying to finish off what was left over from his last patient.
The biggest reasons we all love Botox Cosmetic?
It Works. As one doctor friend, the wonderful, amazing Pat Wexler, told me recently, “You know why there are so many different fillers, peels, and laser treatments on the market? Because none of them are perfect, or work on every person all the time. If there was one foolproof laser or one amazing filler, it would become the gold standard, and the others would fade away. Botox Cosmetic is the gold standard. It works every time, on every body. The only potential danger is the person holding the needle. If you have a skilled and experienced doctor doing the injections, you will love the results.”
It gives you an air de mystère. Since you were a little girl, you admired the mysterious beauty of Greta Garbo. Well, with an un-lined face and limited expressiveness, you, too, can be Garboesque, opaque and inscrutable, letting only the gleam of your eyes give a hint of your true feelings. Those who ordinarily wear their hearts on their sleeves can now take comfort in keeping some emotional privacy for a change. No one needs to see every tiny feeling flit across your face. Botox Cosmetic is a guaranteed way to keep ‘em guessing.
Promise in a needle. Max Factor famously said that makeup was hope in a jar. He certainly ran with that notion and created an empire. Botox Cosmetic is more than hope in a needle. It’s a promise that you can stay fresh and beautiful, safely and quickly (if not so cheaply). Wrinkles add years to your face, and Botox Cosmetic takes them right off. You are as young as you look. Botox Cosmetic might not be spouting from the fountain of youth …actually, it IS spouting from the fountain of youth! And it’s yours for the taking.
Okay, about the risks:
Maybe, after a treatment, you might get a wee headache. Or nausea. Flu-ish symptoms. A splotch of redness where the needle went in, or a twinge of pain. Worst case, you could get some temporary eyelid droopage or general weakness in the eye area. Here are the potential problems:
Kabuki mask syndrome. Not a medical condition. Just your average, everyday creep show example of too much of a good thing. Some people do not understand the meaning of the word “moderation.” Too much Botox Cosmetic in too many areas on one face = a frozen mask. It all depends on how much the doctor puts in. If you’re worried about looking like a mummy, tell your doctor about your fears. He’ll err on the side of caution and use small amounts. Wait a week and, if you want more, go back.
Just go to Beverly Hills. I have not seen that many frozen faces since the Donner Party.
Communication breakdown. You might have trouble communicating basic human emotions non-verbally.
Your husband comes home and announces he just got a huge raise at work. Then he says, “Why aren’t you smiling?” You say, “I am smiling.”
Granted, most people don’t get Botox Cosmetic around the mouth and chin, not if they need to eat to live (unlike Victoria Beckham).
Even if you can move your face (and you should be able to), the expressiveness of your eyes and forehead will be slightly downplayed.
Personally, I’d rather look younger and feel happy than look older and be depressed. Just get used to declaring your emotions.
“I’m thrilled!”
“I’m sad!”
“I’m sexually frustrated and have been for ten years!”
Botox brow. Again, this is a problem of too much of a good thing. If you over-juiced your forehead muscles, your eyebrows might get an arched appearance. A witchy, “The Joker” style forehead is called Botox brow.
Just scale back on your next treatment.
The danger of easy access. Do not be tempted to go to Botox Cosmetic parties where women sit around someone’s living room as a “nurse” or “technician” makes the rounds with a loaded syringe. How can you be sure the needler has any training? Or that he or she knows how to handle the toxin? (For instance, it should be stored cold.) There’s no guarantee that it’s Botox Cosmetic in the syringe. It could be Kool-Aid, saline, or antifreeze, for all you know.
If I were invited to a mud mask party, fine. Go. Have your fun. But do not, do not, do NOT attend a Botox Cosmetic party, unless it’s given by a dermatologist or plastic surgeon, at his office, during regular business hours.
Myth risks. Two reports came out recently that raised doubts about the safety of botulinum toxin type A: Both reports turned out to be nothing as far as Botox Cosmetic is concerned. But to cover all the bases, here’s what was said:
Report #1: An Italian study found that Botox injected on one side of a rat’s brain traveled across to the other. Also, that Botox injected into rat whiskers wound up in their brains. When this study was published in April 2008, worldwide panic ensued. Botox causes brain damage! Alzheimer’s! Dementia!
Everyone relax! The purified stuff the Italian scientists injected was NOT the preparation used for wrinkles. Scientists concluded that there wasn’t a legitimate comparison between the two different concentrations of botulinum toxin type A. Botox Cosmetic has been used for almost two decades as a wrinkle treatment, without any neurological or brain disorders occurring.
Report #2: In early 2008, a watchdog group called Public Citizen alerted the FDA of sixteen Botox-related deaths, claiming the toxin traveled from the treatment site to other body parts, causing muscle weakness, and problems swallowing and breathing.
The dead were, tragically, children getting off-label high doses of the drug to treat cerebral palsy. None of them were Botox Cosmetic patients.
Public Citizen wants to have warning labels put on Botox Cosmetic packaging. At this writing, the FDA is investigating whether a warning label is justified. Meanwhile, the percentage of people who have had any adverse reaction to Botox Cosmetic is too tiny to calculate. Millions do it. In the report by Public Citizen, one woman was hospitalized after getting a treatment, but Botox Cosmetic wasn’t necessarily the cause.
If you have any doubts, talk to your doctor. Afterward, should you have lingering worries, forget about the treatment. All cosmetic intervention is voluntary.* If you’re not excited to do it, then don’t!
One more tiny downside. Except the possibility of loving it too much. You can go back to work five minutes after a treatment. You could go dancing that night. The only warning you’ll get from your injector is to drink in moderation for the week before and after treatment and to stay out of the sun, which is good advice regardless, and not to lie down for four hours after a treatment.
Just assume that every star over thirty on TV and in movies is using Botox Cosmetic, and your assumption is probably right. Plastic surgeon Anthony Youn, M.D., wrote on his funny Celebrity Cosmetic Surgery blog that the injections are so common in Hollywood, he notices when stars don’t use Botox Cosmetic far more than when they do.
Nicole Kidman has been kicked around the block about her overuse, which showed on her frozen forehead and arched eyebrow. Then, in photos taken while she was pregnant, her forehead lines were suddenly visible and her eyebrows were straighter. The contrast—on the juice, off the juice—was obvious.*
Vanessa Williams has been a vocal supporter and user. She’s told Barbara Walters that Botox Cosmetic is a “miracle” and that every woman she knows uses it. If you look at photos of her, you see that her forehead is unlined, but she does allow herself to have some crow’s feet. The overall effect is of a woman who looks her years, but is fresh, awake, and happy. She should be! She’s gorgeous!
Teri Hatcher isn’t exactly “Desperate,” either. She’s admitted to using Botox Cosmetic, then she said she was against it. It seems she can’t make up her mind—the one behind her suspiciously smooth forehead.
Virginia Madsen told interviewers that she used the injections to get rid of the vertical lines between her eyebrows, and, the next thing you know, she landed a hot gig as the spokesperson for the company that makes the stuff! Just one more example of how being honest pays off.
Simon Cowell has been quoted saying, “Yes, I’ve had Botox [Cosmetic], but not in an obsessive way. Then again, every guy I know who works in the City [London] has had it now.” I love it when men ’fess up to cosmetic intervention.
What’s next for Simon? How about a breast reduction?