Injections of Botox, one of the fastest-growing cosmetic procedures on the market today, are used for the reduction or elimination of facial wrinkles caused by dynamic, or hyper-functional, muscles (muscles that get a lot of use). Those are the wrinkles that form when you contract your facial muscles to form a frown, squint, grimace, smile, or other type of expression, resulting in those tell-tale lines around your eyes, mouth, or nose, and across your forehead. Botox can be very effective in temporarily getting rid of some, but not all, of your facial wrinkles. But before we talk about which wrin­kles Botox can banish, let’s find out more about this popular substance.

How Botox Can Help?

Every year in the United States, millions of men and women undergo one or more cosmetic procedures that in some way enhance or change their appearance. From chemical peels to nose reconstruction to eyelid tucks, dermatologists, plastic surgeons, and other cosmetic surgeons across the country are reshaping the way Americans look, and as a result, how they feel about them­selves.

What is Botox?

Quite simply, Botox is a type of toxin produced by the bac­terium Clostridium botulinum. If you’re thinking that some­thing sounds familiar about this substance, that’s because this bacterium is the same one that causes botulism, or food poi­soning. It’s also the same bacterium that some countries stockpile as a bacterial weapon. You might be wondering if this is a substance you would want injected into your face.

Thanks to the wonders of medical technology, injecting Botox into the face isn’t only possible, it’s being done thousands of times a day, and safely. In the late 1970s, scientists discovered that botulinum toxin, when it was diluted to a great degree, had some very positive characteristics, proper­ties that could bring significant relief to thousands of people who had specific neuromuscular problems throughout the body. And after years of science and serendipity, experts discovered that botulinum toxin A (the bacterium has eight different toxins, or serotypes, each named for a letter of the alphabet) has cosmetic uses as well, especially when it comes to getting rid of wrinkles in the upper third of the facethat is, along the forehead and at the outer corners of the eyes. If you’re familiar with the concept of homeopathy, you’ll see a similarity with Botox.

In homeopathy, a substance sometimes one that is poisonous when taken at regular strength, such as arsenicis diluted to such a tremendous de­gree that when it is finally ingested, it is completely safe. Botaulinum toxin is extremely potent, but Botox injections contain a greatly diluted form of the toxin, rendering the in­jection safe yet effective.

The Desire to look young

Own up to it: you may believe the old adage that wrinkles add character to a face . . . but you don’t want it to be your face, at least not just now when you’re thirty or forty or fifty. You want to look as young as you feel. And why shouldn’t you?

The desire to look young and beautiful is far from new. Since ancient times, both men and women have searched for ways and concocted formulas to look more youthful. Eye and face cosmetics were used by the ancient Egyptians, the most famous of whom is Cleopatra, who was known to use lactic acid to peel her skin to look more beautiful. Archaeologists have found formulas, written on papyrus, that explain how to prepare mixtures of plants and honey for women to use as facials. Archaeological digs have also uncovered many con­tainers that once held green malachite, black antimony powder, and lead sulfide, all types of minerals that were ground up and used as cosmetics.

Ancient people even performed crude cosmetic procedures to improvein their opinionpeople’s appearance. In west­ern Russia, for example, a broad, flat nose was considered beautiful, so parents would bind the nose of a child to achieve this result. Because the Chinese believed that dainty feet were a sign of wealth and beauty, the practice of binding the feet of girls to prevent foot growth existed for thousands of years. Among some African tribes, an elongated neck is considered a thing of beauty, so some women keep adding rings around their necks to gradually stretch it to a desirable length.

Modern-Day Cosmetic Procedures

As we’ve seen, there have always been people who are willing to undergo different procedures or use various products to help them look young and beautiful. Apparently many people still feel similarly. According to the American Academy of Cosmetic Surgery, 623,588 Botox procedures were performed in 1999, two years before the Food and Drug Administration (FDA) even approved Botox injections for cosmetic use. These procedures, which were done to reduce or eliminate wrinkles on various sites on the face and neck, are known as “off-label” uses (once a drug has been approved for one use, it can legally and ethically be used for other purposes, at the discre­tion of the practitioner). Botox has been approved for various medical (that is, noncosmetic) uses since 1989. And its off-label uses for cosmetic purposes continue to grow: in 2000, the number of procedures was 730,787; in 2001, it ballooned to 913,484.

FDA-Approved for Cosmetic Use

With the new FDA approval of Botox on April 15, 2002, for removal of frown lines also known as glabellar lines on the forehead, experts believe the number of procedures will greatly surpass the million mark. Right now, only one other cosmetic procedure chemical peel performed more often: more than two million people undergo them each year. And some combine a chemical peel with Botox injec­tions to get rid of wrinkles and improve skin texture. It’s important to note that the only cosmetic use the FDA has approved Botox for is the removal of glabellar lines. However, doctors have been using Botox for cosmetic reasons in this and other areas of the face for about ten years. Some of the wrinkle sites, like smile lines that run from the nose to the corners of the mouth and down the sides of the mouth, do not respond as well to Botox because the facial lines that form there are not as strongly muscle-driven as those in the other regions. However, Botox can be used along with other cosmetic procedures to get the look you desire.

But overall, the risks of Botox, when administered by a knowledgeable professional, have been very low. And this safety factor has fueled a growing interest in Botox among people of all ages.

Botox injections have become all the rage, and not just among aging baby boomers. Approximately 17 percent of the people who underwent Botox injections in 2000 were be­tween the ages of nineteen and thirty-four, hardly an agegroup one usually associates with bothersome wrinkles and aging skin problems. By far the largest percentage of Botox users was the 35 to 50 age group, at 41 percent. Those in the 51 to 64 age group counted for 29 percent, with men and women 65-plus rounding out the total at 13 percent.

As of spring 2001, about 12 percent of those getting Botox injections were men. And the number of men seeking Botox injections is expected to grow. Botox is an easy, convenient way to accomplish the look they want. And it’s not just actors, jet-setters, and chief executive of­ficers who are lining up for their injections. Even construction workers, police officers, social workers, and others from all walks of life are looking to get rid of their wrinkles.

Why is everyone doing it? You may want to look younger to help advance your career. For some industry, pleasant looking is a must, and you’d better look young and vital to stay in the game.

Plastic surgeons have raised concerns following a catalogue’s decision to offer botox treatments to its customers. Grattan, a UK clothing catalogue, has offered customers a range of non-surgical procedures, such as Botox, from Transform Cosmetic Surgery.

The move has prompted the British Association of Aesthetic Plastic Surgeons (BAAP) to raise concerns that “off-the-shelf” undermined the seriousness of the procedures. However, Transform responded by saying that consumers received a consultation and were fully informed before undergoing any procedure.

Botox is a highly purified and much diluted form of the botulism bacterium which paralyses the muscles. It has been widely used in the cosmetic surgery world to smooth out wrinkles. The Grattan catalogue is offering botox alongside lip enhancement and skin peels, and allows its customers to pay in instalments for any treatments.

BAAP had advised members of the public not to buy non-surgical cosmetic procedures in this way with BAAPS president Douglas McGeorge saying: “I’m surprised that any cosmetic surgery company claiming to provide quality of care would choose to market through a clothing catalogue. It is essential the public understand that aesthetic procedures, even if they are non-surgical, are not commodities to buy off-the-shelf and cannot later be exchanged for a different style or size. Side effects from injectables may be rare but they do happen, and the latest warnings from manufacturers serve to highlight the need for proper consultation and thorough informed consent by the patient.”

Speaking to the BBC, Pat Dunion, operations director from Transform Cosmetic Surgery, defending the company’s decision to offer botox via a catalogue buy saying that they had over 30 years of experience in providing cosmetic surgery.

“Transform is regulated and audited by the Healthcare Commission and all our skilled and experienced non-surgical practitioners across our 22 clinics are either a qualified doctor, surgeon or a registered general nurse. The partnership with Grattan is an effective means of widening the non-surgical market. The clinical decision process for Grattan customers is the same as for all our non-surgical patients. Regardless of how they heard of Transform, all are fully informed about the procedures before they consent to proceed. Transform is committed to high quality patient care and is currently leading the way, alongside industry partners, to push the current government to introduce formal regulation of the non-surgical market in the UK.”

The makers of Botox, Allergen, had recently put out a statement reiterating that the toxin should only be administered by physicians and warning of adverse events in people with certain disorders.