About once in a generation, there’s a profound change in the way plastic surgeons think.
In the '60s, it was breast implants. Despite hundreds of hours exercising those pecs, before implants, there was no way to make small breasts bigger. But once those bags of silicone were introduced, society changed. Playboy noticed. Hollywood noticed. And women no longer had to live with small breasts if they didn't want to.
In the '80s, it was liposuction. Before that time, all the squats and running in the world could not flatten saddlebags. But with the advent of a modified vacuum cleaner, millions of women have beaten their genetic destiny and squeezed their thighs into pants they would not have ever considered wearing.
In the 2000s, it was Botox®. With minute amounts of that wrinkle-killing drug, scornful parents (with un-furrowed brows) could fool their kids into thinking they were not going to punish them. With Botox, the inevitable progression of teeny wrinkles morphing into cavernous crevices could not only be stopped, but actually reversed. And with regular use, we now are in the generation of smooth foreheads.
Botox is not just a wrinkle reducer. It ushered in a seismic change in the way plastic surgeons think about aging. When I was a surgical resident at Harvard, I learned that “as a surgeon, I heal with steel." But now, as a 50-something new-age plastic surgeon, I say, “As a surgeon, I inject a wheal.” Having said that, I’ll now deal you my shpiel.
During this column, I’ll use the term “Botox” because it’s a well-known brand and it’s easy to type. But there are actually three very similar products out there besides Allergan’s Botox. Medicis’ Dysport® and now Merz’s Xeomin® are both on the market, and most plastic surgeons and dermatologists use all three interchangeably.
Some people confuse Botox with botulism. Not to worry—you can’t get botulism from Botox. Botulism is a deadly disease that people get when they eat contaminated food—you know the warnings about throwing out old cans of food that are bulging and filled with killer bacteria. Spores of botulism live in those cans of green beans, survive the wicked acid environment of your stomach and release the botulinum toxin from six hours to 10 days after eating them. Left untreated, botulism is fatal, because those bacteria keep pumping out the toxins, eventually paralyzing your ability to breathe.
The botulinum toxin that we have come to know and love, called Botox, is a purified toxin. There’s no bacteria and no chance of infection. And that means it is safe. Safe with an asterisk… but safe enough for five million people to knowingly inject it into their faces last year.
So what’s the asterisk? Complications from botulinum could be as transient as a headache or bruising, or as serious as death. Whoa. Death? No, not from injection into foreheads or crow’s feet with the standard low doses used, but from injection into the neck for the treatment of severe muscle spasms. These treatments are usually performed by neurologists and can really be life-changing. But they are the ones that can be dangerous, as the Botox can seep into the muscles that protect your airway. Without those, food can find its way down your windpipe and cause pneumonia. And that’s how people have died.
But if you’re like the other five million, put that thought out of your mind and remember that every drug (and even some foods) can be fatal. Eating a couple ounces of salt will wind you up in the intensive care unit, as will drinking one too many martinis.
So what can Botox do for you? By paralyzing the muscles that repeatedly contract and cause wrinkles, Botox flattens your forehead wrinkles. Without constant pull, wrinkles—which are really “repetitive use injuries” resulting in dermal cracking—can heal. They really can. Think about your great aunt who suffered a stroke. The day after the stroke, she could not move half of her face, but she had all her wrinkles. A year later, the side that didn’t move was visibly smoother. That’s because those wrinkles can heal, and that’s just what Botox allows.
Most people don’t realize that the cosmetic version of Botox only has FDA approval for treating the lines between the eyebrows. But for over a decade, the horizontal lines of the forehead, as well as crow’s feet, have been successfully treated. More controversial is the use of Botox in the lower half of the face. Around the mouth, its use can cause asymmetry, drooling and funny smiles. On the other hand, it works well to lower the lip in people who have “gummy smiles." But I would not advise its use in those fine wrinkles around the lips or the bands of the neck.
Botox seems like such an easy treatment, spurring thousands of training courses as short as two hours. Doctors, nurses, dentists and so many others have joined the legitimate docs in injecting Botox. But injecting Botox is not like injecting a flu shot, and the legions of bizarre facial expressions demonstrate that Botox injection is as much an art as a science. And who are the legimate medical doctors? Those who specialize in either plastic surgery, facial plastic surgery, dermatology or oculoplastic surgery. Make sure your doc is one of those and please, treat your Botox like the medical procedure that it is. Don’t go to those Botox® parties or have it injected at the same place you get your hair done. Complications are rare, but they do happen, and the doctor’s office is designed and regulated for safety, sterility and privacy.
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