Is it just us, or do others have the same reaction to media stories about the mounting popularity of Botox, the toxo-cosmetic touted as death to wrinkles: People are injecting what into their faces?
Tiny, purified amounts of botulinum toxin type A is what — in other words, tiny, purified amounts of one of the fastest-acting and most toxic pathogens known to medical science. Only anthrax comes close.
Here’s what it does. It interrupts conduction between the nervous system and muscle receptors, effectively paralyzing the muscles. When this occurs on a bodywide scale, as in, say, a case of botulism food poisoning, death from suffocation can quickly follow. Bioterrorism experts recognize the potential threat, though so far only Japan’s Aum Shinrikyo has tried — unsuccessfully, in the early 1990s — to disseminate it.
In minuscule doses, precisely injected, this killer does the same job with happier effects. But it’s still that nasty botulinum. Have you ever seen a corpse? Corpses don’t have wrinkles, either, for exactly the same reason that Botox-treated foreheads don’t: flaccid muscles.
If you want to look the way you’ll look when you’re dead, step right up. Botox is here. Movie directors complain that it’s getting harder and harder to find actresses over 35 still capable of facial expressiveness, because most of them have undergone so many Botox treatments their muscles no longer bounce back. Perhaps you remember that famous line from the 1999 U.S. movie “The Sixth Sense”: “I see dead people.”
In Botox-happy Hollywood, those words are taking on a whole new meaning. And it’s not just Hollywood. Botox is the drug du jour for would-be beautiful people in developed countries all over the world. It is fashionable in Britain, where it is available by prescription for cosmetic treatments. Last month it was approved for limited cosmetic use in the United States, although the only difference this will make is that the manufacturer, Allergan, can now publicize its anti-aging effects.
As in Japan, U.S. physicians were not prohibited from using Botox cosmetically, only from advertising that they were doing it; in 2000, it already accounted for five times as many cosmetic procedures in the U.S. as implants did. In London and New York, the latest social fad is Botox parties.
In Japan, it is approved only for a handful of therapeutic uses. Nevertheless, every big city has its “petit plastic surgery” clinics, where Botox competes with hyaluronic acid as the favorite lunchtime beauty fix for middle-aged women and, increasingly, men. As a so-called lifestyle drug, it is almost as alluring as those other sirens, Prozac and Viagra.
What could be better? Here are happiness, vigor and beauty now all painlessly within reach. The problem, of course, is that they are not. Like Prozac and Viagra, Botox has perfectly legitimate and valuable therapeutic uses. The medical conditions whose symptoms it alleviates include ocular twitching and spasms, facial tics, Parkinson’s-related and cerebral palsies, crossed eyes, muscle-related head and neck pain, and more. Botox is the standard of care for treating such ailments, none of which is trivial. Furthermore, it does have a good clinical safety record. According to a former deputy director of the U.S. Food and Drug Administration, “Considering that it is one of the most toxic materials known, and there was a lot of concern about it, it’s turned out to be very safe.”
He was referring to therapeutic Botox, however. Cosmetic Botox is another matter, with a much shorter track record. As it happens, we are not alone in thinking that something so naturally toxic shouldn’t be taken lightly. (Chemotherapy causes people to lose weight, but you don’t hear of its being touted as a magic slimming device.) Many doctors view the Botox fad with alarm, citing the dangers of casual widespread use: “This is a medical treatment, not a haircut,” one said. “There can be complications. People need to be aware of this.”
But people also need to be aware of the drug’s limits and, by extension, the ultimate futility of the frantic quest for beauty. Just as Botox doesn’t cure spasms, tics and palsies — it merely alleviates them — it doesn’t permanently smooth out wrinkles, either. After a few months, the paralyzed muscles recover and the wrinkles return, necessitating more treatments, more burning and numbness, more headaches, further loss of muscle tone and, ultimately, that death-mask look. In the battle against aging, it’s a temporary and quixotic measure, at best.
The irony is, people think they will be happier if they look younger and more attractive. After a few Botox sessions, though, no one will even know if they’re smiling.
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