One user calls it "liquid gold." Another says it's "miraculous." They're raving about a substance called Botox, even though the "bo" part of the name comes from bacterial botulinum spores, and the "tox" from "toxin." This is the same stuff, in other words, that causes botulism, one of the deadliest types of food poisoning on the planet. Last year alone, an estimated 500,000 Americans happily endured Botox injections to fight everything from wrinkles to migraine headaches to excessive sweating.
So popular is this product, people are throwing Botox parties! A publicity release on behalf of two New York physicians reads, "Just because you're turning 40 doesn't mean that you have to look 'over-the-hill.'"
When the Food and Drug Administration approved Botox in 2002, the latest craze became throwing intimate cocktail parties for a handful of your closest friends, which brought an entirely new meaning to having a few 'shots' after work.
Plastic surgeon Elliot Duboys, who practices on New York's Long Island, is one of the doctors who administers Botox at these parties. They're patterned after theme parties in which friends get together to buy the latest kitchenwear, lingerie, or cosmetics. Dr. Duboys says quickly administering Botox shots to several people at a time at these gatherings brings down the cost. "But please hold the cocktails," he says, "Botox is a medical procedure, and let's not lose track of that. It's not like some drunken sailor going in and getting a tattoo. Botox parties where they're serving alcohol are something that I don't get involved with."
Dr. Duboys says the parties begin with a presentation in which he explains what Botox can and cannot do for wrinkles, which are no more than deep creases in facial muscles caused by years of squinting or frowning or raising one's eyebrows.
"Botox is not a permanent fix," Dr. Duboys said, "It really has to be touched up every three or four months to give you a continued and long-term improvement. Some people think Botox is a quick facelift. It certainly is not a quick facelift."
After his short course, party guests are invited into a room for a private consultation and, if they choose, the Botox shots.
Botox's appeal as a skin enhancer was discovered by chance. Doctors knew that botulinum bacteria kill by paralyzing the diaphragm and preventing victims from breathing. The toxin the bacteria produce, botulin, blocks brain messages to muscles.
In the 1970s, eye doctors wondered whether diluted doses of the toxin might be effective in calming eye twitches and correcting "lazy eye," in which a weaker eye fails to align with a stronger one. Not only did minute injections of the botulism toxin, mixed with saline solution, improve these conditions, doctors also noticed that wrinkles around the eyes disappeared in some patients.
Other researchers discovered that Botox was effective in treating excessive sweating in the palms and armpits by stopping the contraction of muscles that release perspiration from sweat glands.
And still more applications for Botox evolved. Chuck Lampe, 44, an independent publisher in Florida, has been taking shots of Botox deep into the muscles of his legs for 10 years to lessen the discomfort of a genetic disorder called torsion dystonia, an extreme and long-lasting version of the condition commonly called "writer's cramp." These painful cramps appear elsewhere in the body besides the wrist.
"My brain, as everyone else's brain works, sends signals for walking and bending your feet," Lampe said, "And what happens with a dystonia patient is that the signal is amplified anywhere from 10 times to 100 times. The Botox, they were deep injections, and what it does is, it inhibits the signal, paralyzing the muscle so that it takes the signal and knocks it down."
Dr. Lawrence Newman, a neurologist at the Headache Institute of Saint Luke's Roosevelt Hospital in New York City, says people suffering from the disabling form of headaches, called migraines, who happened to be getting Botox wrinkle treatments, were astonished to find that the frequency and severity of their migraines decreased for months at a time.
"We had patients who were not responding to anything," Dr. Newman said, "And just as a last resort, we decided, 'Well, let's try the Botox.' These are people I'd been following in our practice for five years, six years, and nothing was really working terribly well to prevent their headaches. And within a couple of weeks of getting the injections, their headaches disappeared. So it really made me a believer."
Doctors are not yet certain exactly how or why Botox relieves headaches, Dr. Newman says. Indications are that it deadens, not muscles as in the case of wrinkles, but pain-producing nerve impulses.
Dr. Newman says it took considerable trial and error before neurologists figured out just where to inject Botox to relieve migraine symptoms.
"There are approximately 25 different sites above the eyes, on the sides of the head, and in the back of the head, sometimes extending down into the neck. And using those 25 sites, we seem to have our much greater success level," Dr. Newman said.
Plastic surgeon Dr. Duboys says curiosity about Botox became a stampede when the product was found to soften forehead wrinkles, co-called "crow's feet" around the eyes, and frown lines that make some people look like they are forever angry, tired, or worried. Usually, he says, just two or three injections with a fine needle do the trick, at a cost of $600 to one $1,000 every three or four months.
Duboys said, "Wrinkles come from overactivity of a muscle. Let's take the forehead, for example. If you raise your eyebrows, your forehead's going to furrow. Those furrows, as we get older, become more and more deep. If you paralyze that muscle over there, you can't contract that muscle. And therefore you can't furrow your forehead."
Because it can eliminate lines of animation, there's a danger that overuse of Botox will rob expressiveness from one's face. Most Botox providers restrict its use to the forehead and the area around the eyes. Injections near one's lips, they discovered, can cause the mouth to droop or drool.
To address wrinkling below eye level, plastic surgeons turn to fillers, including tiny plastic beads, liquid silicone, and collagen from cows and even humans to plump up the grooves in one's skin. Facelifts are a far more serious matter. They involve radical surgery that corrects sagging by tightening and trimming the skin.
Some potential Botox clients are skeptical about the toxin, diluted or not. They want to see the long-term impact of injecting such a substance into the body.
But Kansas City, Mo, dermatologist Audrey Kunin not only trusts it for her patients, she has also taken Botox injections herself for five years for what she calls "a few tiny lines here and there."
"It would take three hundred vials of Botox to sicken a mouse," Dr. Kunin said, "not kill a mouse but sicken a mouse. And the typical wrinkle patient coming in for skin rejuvenation receives approximately one-quarter of one vial. So you can see that the levels are minuscule. And to date there have been no reports of anyone becoming severely ill or dying from the use of Botox injections for any reason."
But Dr. Kunin, who runs an educational Internet website called "dermadoctor.com," worries when medical treatments get so trendy that people throw parties to get them. Botox works, she says, but it's not a wonder drug. Excessive swelling and delayed allergic reactions can develop, and the fanatical war on wrinkles can be carried too far.
"Early on in Hollywood, a lot of producers and directors were complaining that their actresses had a very plastic, nonexpressive look. In fact, there was a term called 'the Sleeping Beauty look' for people who had absolutely no upper facial expression. With time and practice, dermatologists and plastic surgeons have become very skilled at how to use Botox to get rid of wrinkle lines. But you're not using so much in such a generalized area where you are getting that total loss of expression," Dr. Kunin said.
Dermatologist Audrey Kunin says women in American society, in particular, are forever searching for an elixir from the Fountain of Youth. And she notes the irony that the Botox elixir comes from a source that in other situations would be a Fountain of Death.