The Pros and Cons of Botox

By Michael D. Lemonick Monday, Dec. 30, 2002
    • Kenneth D. Lyons/Newport News Daily Press/AP

    Skin Smoother: A patient takes her beauty shot bravely

    Are you sufficiently bothered by wrinkles to stick needles into your face? That's the question millions of Americans will be asking themselves once the Botox craze starts in earnest.

    Botox injections, as you may have heard, are the biggest thing since nose jobs. They are already the most popular cosmetic procedure in the U.S.; about 1.6 million Americans got the shots last year--a so-called off-label use of a drug originally approved to calm twitchy eye muscles. The fact that the shots reduce wrinkles too was an unanticipated bonus; doctors were allowed to use Botox for that purpose, but the manufacturer, Allergan, couldn't advertise it to the public.


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    Now the company can, thanks to the FDA's decision last week to approve Botox for the removal of certain wrinkles. Once the ads start, clinics will be inundated by women--and men--yearning to be wrinkle free. Before you schedule an appointment, though, you should know what Botox can and can't do, and what the downside might be.

    Botox is short for "botulinum toxin," the substance that causes botulism, a sometimes fatal form of food poisoning. It sounds scarier than it is; in small quantities, Botox merely interrupts nerve impulses to muscles in the face. The lines that furrow the forehead when you raise your eyebrows, the crow's feet that appear when you squint and the creases between the eyebrows when you frown are all caused by tension in underlying muscles, which contract and squeeze the skin like an accordion. Botox keeps this from happening.

    Fortunately, Botox is so diluted that serious side effects like allergic reactions are rare. If the doctor slips, in most cases the worst that can happen is that you will lose the ability to raise your eyelids all the way; or, if you're getting shots around the mouth, a mistake could leave you drooling. But even a perfectly executed procedure has consequences. Depending on which wrinkles you go after, you might not be able to frown or raise your eyebrows or squint.

    Is this a problem? Not enough to discourage Botox enthusiasts. In Hollywood, however, the treatments are so popular that some directors complain that their leading actors can no longer convincingly perform a full range of facial expressions. The good news is that even if there's a little accident, Botox wears off after a while (which also means you have to go back every six months, at up to $500 per treatment). Slipups are pretty rare, however, as long as you go to someone who knows what he or she is doing.

    That includes knowing when Botox won't be useful at all. Muscles cause some wrinkles, but many result simply from the loss of elasticity that goes naturally with aging (or, less naturally, with smoking and sun exposure), causing the skin to sag and crumple. There are treatments for this sort of wrinkle, but Botox isn't one of them, says Dr. David L. Feldman, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y. "I had a patient recently who came in asking for Botox," he says. "It would have done no good at all. In fact, she might have ended up looking worse."

    So Botox isn't a cure-all, and it has some pretty odd side effects. But if you don't mind getting shot up with poison and you don't mind paralyzing parts of your face--well, you've got plenty of company.

    Botox questions? E-mail Michael at michaellemonick@aol.com