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The Botox boom: Wrinkle shots are growing popular, but they also zap facial expressions By Judith Blake It's the most potent of all known biological toxins. Swallowing a minute amount of botulin can paralyze or even kill you. So why would anybody want to have it injected into his or her face? For some, the irresistible lure is wrinkle relief. A growing cadre of the facially discontent in Seattle and nationwide are getting injections of Botox, a botulin-based drug that boasts the power to banish or greatly reduce some wrinkles ý minus a face-lift's greater discomfort and longer recovery time. At the same time, in its most common use Botox zaps the ability to scrunch the brows into a frown, raising images of a perpetually sunny-faced populace ý a good or bad thing, depending on your point of view. There are other possible, though apparently temporary, side effects, and the treatments aren't cheap. On a par with Viagra The frown-impaired could soon swell in number. Allergan, sole manufacturer of Botox, expects the Food and Drug Administration to approve cosmetic use of the drug by the end of this month ý though the FDA itself routinely refuses to comment in advance on drug decisions. FDA approval will clear the way for Allergan to advertise Botox's wrinkle-reducing talents directly to the public. Some believe a media blitz could make Botox a household name on a par with Viagra. The upshot, predict enthusiastic advocates, will be the virtual disappearance of frown lines from the face of America. Character too, some critics contend. Chief targets of Botox are the vertical furrows between the brows and horizontal lines on the forehead, though crow's feet and other wrinkles also are sometimes erased. "I think it's going to become as common as whitening your teeth," said Dr. Anna Ragaz, a Seattle plastic surgeon who gives Botox treatments. "It will be as socially unacceptable to have (frown lines) as it is now to have bad teeth." Wrinkling baby boomers Equally enthusiastic is Botox patient Patricia Noel of Enumclaw, who says that, with the treatments, her once-deep between-brow furrows are now nearly invisible (see accompanying photos).
Aging, wrinkling baby boomers seem to make a potentially vast market for Botox. A Seattle plastic surgeon says the typical patient is a woman age 35 to 60. Some patients are younger, some are male, and some say youthful looks are not the main attraction. A 37-year-old Seattle woman says she started the treatments at 32 to rid herself of deep furrows and lines that made her appear "stressed and harsh" ý a detriment to her job working with the public, she felt. With Botox, she says, "You look like you're having a good day." A vigorous look is a goal of Green River Community College dean of student services David Wain Coon, 38, who spoke as he awaited a Botox treatment in Seattle the other day. "As a college administrator, I work in a very energetic environment, and it's important for me to look as energetic as I feel," he said. No toxic effects ý really Botox is made with the same bacteria-produced toxin that causes botulism, a sometimes-deadly food poisoning. In drug form, the toxin is hugely diluted. Also, unlike botulin-tainted food, Botox's impact is not bodywide but is limited to the muscle into which it is injected, experts say. For that reason, you can't become paralyzed or suffer respiratory failure from the drug, as you could with botulin-tainted food, says Dr. William Robertson, who heads the Washington Poison Center. Botox also is metabolized within hours, so does not accumulate in the body, he said. The drug works cosmetically by blocking the signals between nerves and muscle, paralyzing a muscle and halting its pulling and crinkling on the overlying skin. Treatments run from $200 to $500, depending on the facial area; their effects wear off after four to six months so they must be repeated for continued results. (Most insurance plans don't cover purely cosmetic procedures.) Botox has been FDA-approved for more than a decade for a noncosmetic use: correcting crossed eyes. However, doctors can legally use any FDA-approved drug as they deem appropriate and have gradually expanded Botox use to address eyelid twitching, the muscle spasms of cerebral palsy, migraines, certain types of chronic pain and severe underarm sweating, as well as wrinkles. FDA approval for cosmetic application ý performed primarily by plastic surgeons and dermatologists ý would allow advertising of this use. A plastic-surgery industry survey found that U.S. doctors performed more than 1.6 million procedures last year using Botox or Myobloc, a similar, Irish-made product so far not widely used in the U.S. That, said the survey, represented an increase of 46 percent since 2000 and 2,356 percent since 1997. Just how many local patients are getting the treatments isn't known, but one doctor says she has performed the procedure "thousands of times," including patients' repeat treatments. Another estimated that half of local plastic surgeons offer Botox.
'Again, with expression' If you consider taking the Botox trail to wrinkle reduction, you'll need to decide whether frowning is essential to your repertoire of facial expressions or something you can do without. After Botox injections into a brow muscle, you can't knit your brow when puzzled or scowl when furious. Within a few days, your between-brow furrows fade or disappear. Injections into the forehead do the same for those horizontal lines. "My husband loves the fact that I can't scowl at him," says Seattle plastic surgeon Dr. Lisa Lynn Sowder, who's a young-looking 45 with a smooth forehead. "I know this sounds sort of New-Agey," she adds, "but when you can't scowl or furrow your brow, it gives you a more serene feeling." Still, it's hard to imagine some people functioning at peak level without the ability to frown. Could Lou Pinella properly berate an umpire after being Botoxed? One Seattle man quit Botox after a single treatment, complaining it made his face less expressive. Ragaz said some local actors have nixed Botox for the same reason, and The New York Times recently reported that Hollywood directors Martin Scorsese and Baz Luhrmann have complained about Botox's deadening effect on actors' expressions. Ragaz said she often aims for only a 70 percent relaxation of brow and forehead muscles, so that some movement remains. Drooping and drooling Brow treatments can also have unwanted side effects, such as a drooping eyelid, one brow left higher than the other, or bruising around the eye. All are temporary, and the eyelid and brow problems are said to be uncommon. To lower such risks, it's important to choose an experienced practitioner, experts say. Besides forehead furrows and crow's feet, some doctors tackle lines around the mouth with Botox, but many consider that trickier, with a potential for causing temporary drooling, for instance. Botoxing too much of the face could also make one nearly expressionless, some say. The injections themselves can range from "mildly uncomfortable to (more rarely) excruciating," depending on the patient, Sowder said. An anesthetic cream helps. Botox at 3, dinner at 6 An advantage of Botox over a face-lift, she said, is there's nearly no downtime. "You can have it at 3 in the afternoon and go out to dinner at 6. The little needle marks you can cover up with makeup. A face-lift patient has to hide out for 10 days." Still unknown is the long-term safety of Botox treatments over, say, a 30-year period, since the drug hasn't been around that long, said Dr. Daniel Berg, a University of Washington dermatologist who gives Botox treatments. Others note there are rare cases of allergic reactions. Berg also said Botox is not recommended for pregnant women or anyone with a neuromuscular disorder such as myasthenia gravis. But with those restrictions, and within its 10-plus years of use, Berg said, Botox has a good safety track record. Yet unsettled is whether Americans will smile on a drug that clamps down on frowning.
Judith Blake can be reached at jblake@seattletimes.com. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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