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Botox buzz


JILL WING, The Saratogian
May 14, 2002

botox shot Dr. Jean Buhac, a Saratoga Springs dermatologist, injects Botox into Jill Wing's forehead. On average, it takes five injections to erase frown lines.
CLARK BELL/The Saratogian

Sitting still while somebody loads a syringe with botulism and injects it into your face is a little disturbing. But thousands of people are going under the needle every day.

The search for the elusive fountain of youth has taken a toxic turn. Botox, the phenom pharmaceutical that claims to flatten frown lines and stamp out crow's feet, is a byproduct of one of the most poisonous substances on Earth -- the bacteria that causes botulism. But when administered in small, therapeutic doses, it is nothing short of remarkable -- erasing five to 10 years of age off a person's face with a 10-minute treatment.

Only the drug Viagra has created as much buzz as Botox, which was approved by the FDA for cosmetic use in April.

The appeal is that Botox offers the not-so-rich-and-famous the equivalent of a drive-thru face lift at fast-food prices.

Although it has generated a lot of press recently, the drug, manufactured by Allergan Inc., is not new to the medical community. Botox was originally approved by the FDA for medical use in the late 1980s. It was, and still is, used by eye doctors to correct crossed eyes and by physicians to treat migraines.

During its medical use to control involuntary muscle contractions, doctors and patients noticed an unexpected side effect. The skin around the affected area appeared smoother after Botox injections. The drug paralyzes the muscle at the site of injection by temporarily blocking a neurotransmitting chemical called acetylcholine. The overlying skin maintains a smooth appearance -- if the muscle doesn't move, neither does the skin.

Because it had been approved for medical use previously, dermatologists and plastic surgeons have administered Botox for cosmetic purposes as an "off label" drug for more than a decade. But it wasn't until its FDA approval April 15 that the refined, purified protein, Botulinum Toxin Type A, became a hot pharmaceutical.

Television news anchors and celebrities have used Botox for years to rejuvenate and freshen their stressed out faces. Results after treatment are almost instant, plateauing about a week later and lasting four to six months.

Dr. Jean Buhac, a Saratoga Springs dermatologist, has administered Botox cosmetically for about five years, and has even used it herself.

"It provides a more relaxed, refreshed look," she said. "It is very effective and safe in rejuvenating the upper part of the face."

Side effects are minimal, the most common being slight bruising or swelling around the injection site, particularly if someone is taking aspirin, Vitamin E or ibuprofen, she said.

"But that goes away pretty quickly. I haven't had anybody with bruising or any complications." "The worst that can happen, though rare, is a weakness of the eyelid that would resolve itself within two weeks, and there are special eyedrops to help counter the weakness," she said.

Botox is only effective for wrinkles or lines around active muscle sites, Buhac explained. "Many times, the more active you are with your facial expressions over time (smiling, frowning, squinting), you'll create lines." She differentiates between those lines "at rest," which Botox would not have any effect on, and the "more active lines" that the drug softens.

"When you evaluate a patient and they have wrinkles at rest -- grooves from the nose to the mouth or acne scars, for example -- chemical peels are recommended," Buhac said.

The average age of her Botox patients is 35, younger than one might imagine. "A lot of younger people are interested in maintaining the health of their skin now," Buhac said, adding that more young people are using alpha hydroxys, such as Retin A or Vitamin C creams. About 10 percent of Buhac's Botox clientele are men, and that's growing, she said.

Buhac is not crazy about the idea of Botox parties, where people are invited to someone's house and are administered the treatment outside the doctor's office. "The majority of people, I imagine, would prefer coming into the office," she said. "I would really prefer doing it in the office. It's less distracting." Buhac also cautioned against serving wine or other alcoholic beverages at a Botox party. "It can reduce the effectiveness of the Botox if you drink (alcohol) before the treatment. You can probably get away with it, but results may not be optimal."

The most popular area of treatment, she said, is right between the eyebrows, to soften frown lines, and around the eyes, for crow's feet. She said it takes about five injections for the frown lines and three around each eye for crow's feet. The average cost is $250, up to $400, depending on the extent of treatment. Frown lines and crow's feet, all in one sitting, being at the top end.

Dr. Steven Yarinsky, a Saratoga Springs-based plastic surgeon, also administers Botox as a temporary treatment for wrinkles. He cautions however, about creating the "Botox stare." "It can happen," he said. "The action of Botox is to paralyze the muscles. A lot of us communicate with facial expression. If the eyebrows sit in one position and are not used, you lose that expression."

But the only real drawback Yarinsky sees surrounding Botox is its temporary effect. "It's fine for special occasions, like weddings, or having pictures taken. But for a lot of patients, I would recommend a forehead lift, which is permanent," he said. "It gives a more natural result and only takes about an hour in the office."

A (surgical) forehead lift costs about $2,000, he said. But, he added, Botox is a good adjunct. "There are some people who can't afford a bigger procedure or maybe they want to have something done for a particular life event, and don't really care for the long haul," Yarinsky said.

For patients interested in Botox, Yarinsky has special hours of treatment, 5 to 8 p.m., on the second Tuesday of each month. For visits at this time, he charges $250 and up for a Botox procedure, depending on the extent of treatment. He said this is more cost-effective to him and to his patients.

"It costs the manufacturer $40 to make a vial of Botox. Doctors pay $400 for the vial. We don't usually use a whole vial on one person," Yarinsky said. He explained that once a vial is open, it's best to use it all and not store what's left. In effect, his Tuesday evening hours are like a Botox party at the doctor's office, without the wine and hors d'oeuvres.

Yarinsky doesn't advise having a Botox treatment outside a doctor's office. "It's a medical procedure and best done in the safety and sterility of a medical office. It's not like putting on makeup. I like to take a health history, make sure a patient is in good shape and understands the risks involved in the procedure."

He agrees that side effects from Botox are minimal. "With anything, there can be an allergic reaction. But most side effects are short lived and wear off with time. The worst, droopiness around the eye, can last two to four months, but that's not too common," he said.

Botox, or any cosmetic procedure should be well thought out, Yarinsky said. "From a psychological standpoint, if you're doing it to solve all your life's problems, it's not going to work," he said.

The Saratogian 2003