Beuaty Investigator

A Better Wrinkle Smoother?

A new Botox with bonus medical side benefits is leaving women begging for Bo. Below, crucial news if you're thinking about giving it a shot.

By Judith Snowden
    IN 1996, IF A WOMAN had walked into a dermatologist's office and asked the doctor to inject a toxin into her skin to paralyze her facial muscles and thus relax her wrinkles, any M.D. worth her student loans would have responded, "You want me to do what to your what?" Today, just five years later, Botox is the number-one noninvasive cosmetic proce-dure in the United States, with more than one million shots given in 2000, according to the American Society for Aesthetic Plastic Surgery. That's a 120 percent increase since 1999. Sally, 36, a pro-Bo New Yorker, explains, "I don't like lines that make you look angry." So Sally has had two $400 treatments on the vertical lines between her eyes. "Before, I could really see them, espe-cially after I'd been in the sun. Now I can't."

    This helps explain why Botox is the new national beauty pastime. So far, it appears to be the only proce-dure to work so dramatically without requiring recuperation time. The toxin, an extremely diluted version of the compound botulinum toxin, temporarily para-lyzes facial muscles so that they can't contract and exacerbate lines. A single treatment which isn't covered by insurance and can set you back $300 to 8800 lasts three to six months. "The treatments are extremely effective and relatively pain-less, and you're in and out of the office in 15 minutes," says Brooke Jackson, M.D., a Dyer, Indiana, dermatologic surgeon who reports that Botox is no longer the domain of only the New York—Los Angeles ladies who lunch. "Wrinkles are everywhere, even in Indiana!" she says cheerfully.
    Of course, just because a procedure is popular doesn't mean it's appropriate for everyone. We've got the scoop on a new for-mulation, plus clues about who should and shouldn't try Bo.

The new Botox
    The biggest news right now: There's a new formula—Botox B, or Myobloc that doctors hope will target small muscles more precisely than Botox A does. Botox B also has a longer shelf life, which means that patients are less likely to be injected with Botox that has lost its potency. "When people complain that their Botox didn't work, it's usually not because they have a resistance to it but because the Botox has been sitting around too long," explains San Francisco der-matologist Seth L. Matarasso, M.D. The spike in cosmetic Botox use has brought to light unforeseen medical benefits
of the treatment. For decades, Botox has been used to treat a variety of muscle spasms. But in the past five years, patients who sought only to have forehead wrinkles removed reported that they weren't getting as many headaches, leading doctors to believe that Botox can also treat certain kinds of migraines. Beth, 37, of Miami, had suf-fered incapacitating tension headaches since she was a teenager. After repeated Botox sessions for lines around her brow and eyes, Beth says the pain isn't as bad. "Before, I'd have to go into a dark room and try to fall asleep," she says. "Now I can take two Tylenol like everyone else." Botox has also been found to help hyperhidrosis (excessive sweating) when injected into the hands, armpits and feet.

Should you give it a shot?
    As far as safety goes, few allergic reactions have been reported to the FDA since the agency approved the medical use of Botox A in 1989. Canada, in fact, has approved Botox for cosmetic use, and Allergan, the company that manufactures Botox, has applied for the OK in the United States. "It's been used safely in other clinical situations for more than 20 years," says John W. Canady, M.D., associ-ate professor of plastic surgery at the University of Iowa. Doctors do caution against using Botox during pregnancy or while breast-feeding, since its use during these periods has never been studied.
    So you think you want to give it a try? Bear in mind that there may be temporary consequences. Injections of Botox near the lip area can make it difficult to sip through a straw. Also, if it isn't injected into exactly the right spot, it can paralyze the tiny muscles on either side of the mouth that pull the lip down, resulting in Flipper Face —a teeny, porpoiselike smile. When such mishaps occur, "It could be that too much Botox was used or that it was put in the wrong place," explains Dr. Canady. Doc-tors hope using the potentially more precise Botox B will help.
    Sometimes, Botox treatments can result in an unnatural look. One woman hoped it would zap her crow's-feet before her wedding, which it did, but it also made her look like a clown with a painted-on smile. "The shocker came when a friend gave me some snapshots of the wedding," says Betsy, 35, of New Haven, Connecticut. "My eyes were raised in this 'I've just been surprised' look. My husband asked, 'Honey, were you worried? You look like you were."
    Such complications are rare, but doctors still urge women not to use Botox overzealously. "I mean, come on, people who Botox every-thing—it's just not a good look," says Dr. Matarasso. Jennifer, 33, a Los Angeles Botox fan, agrees. "It's especially true of the assistants I see at the dermatologist's office to whom it's obviously too readily available. They literally have rounded foreheads." And the treatment takes a few days to kick in, soil you hope to be wrinkle-free for a specific event, plan ahead.
    The final verdict on Botox? The price tag is steep, but medically, it's a safe way to spend your tax-rebate check with one important caveat: Shop around for an experienced doctor. "Look at before and after pictures, ask to talk to other patients and check that the doctor has no complaints against him from the state medical board," advises Dr. Can-ady. "Don't just pick the doctor from the biggest ad with the lowest price in the Sunday paper." It's your face and your wallet we're talking about. Who wants to take chances with those?

Know before you Bo!

Two must-heed warnings from one of the country's top Botox experts
Watch your mouth More women are turning to Botox—previously used primarily on the flat area of the forehead to calm down mouth lines. But Bahman Guyuron, M.D., clinical professor of plastic surgery at Case Western Reserve University in Cleveland, cautions that doing so can be risky. "We have to be extremely careful. You don't need the muscles that squint your eyes or cause you to frown, but you do need the lip muscles to show expression or to commu-nicate," notes Dr. Guyuron. "If too much is injected, your smile may not move up and down, or the corners of your mouth may am become droopy." In fact, Dr. Guyuron says that he doesn't offer Botox around the mouth because, in his opinion, the results are too unpredictable. If you're set on trying it, remind your doctor to use a small amount until the effects are known, as the correct dosage varies from person to person. "Inject too much Botox there, and the lips become incompetent," says Dr. Guyuron.
Make it last Don't be shy about asking how much Botox you're getting, advises Dr. Guyuron. "Some physicians can charge $200 and still make a profit by injecting only a small amount six to 10 units which will last only a couple of weeks. For an average forehead or crow's-feet treatment, I'd use about 50 units. It may cost $500 or so, but the results will last three to six months."