Botox has certainly become part of our lexicon since the new millennium. When I was in medical school at Penn in the early 1990s, botulinum toxin was only something to be memorized in pathophysiology class as the virulence factor for the Clostridium bacterium that caused botulism. Later on, in residency at the Hospital of the University of Pennsylvania, it was used in the treatment of involuntary muscle contractions and eyelid spasms. At the beginning of my plastic surgery fellowship in 1998, Botox was just beginning to be explored as a novel approach to facial wrinkles. The literature and the applications were still in the infancy when I started practice in 2001.
Fast-forwarding to the present, what would women and yes, men, do without this little protein for facial rejuvenation and the prevention of early aging? What started out as a means to control our “elevens” or “mommy frowns” has now blossomed into a method to actually sculpt the face by applying the knowledge of muscle anatomy to deploy Botox in the right areas to balance opposing muscles of the forehead, mouth, jaw and neck, creating pleasing facial postures.
Having been part of the rise and current use of Botox, I can testify that using this neuromuscular-blocking agent can improve your current appearance with regular use and also prevent or postpone the aging process of your face. Today many clients, particularly women, look at it as yet another maintenance activity like getting your hair and nails done.
Botox can be used to selectively weaken the central brow area to reduce horizontal lines in the forehead. It can also be used on the circular superficial muscle surrounding the eyelids to minimize lateral fine lines around the eyes. Applied properly, Botox can preferentially reduce the lateral eyebrow depressor muscles to allow unopposed lift of the lateral brow by the forehead muscle, weakening the fine lines around the mouth, correcting asymmetries of the mouth, and reducing the banding appearance of a thin neck.
While the results are limited to around three months without reapplication, nothing else can achieve these desired effects as well as prevent the future etching of these lines deeper into your skin.
However, when something becomes commonplace, people begin to feel comfortable with the product to the point that they may oversimplify the treatment process. This comfort level can lead to the misconception that anyone can deliver Botox safely and reliably. For optimal safety and efficacy, Botox should only be purchased from Allergan, the owner and developer of the product. The company will only ship to licensed physician offices.
Some people try to purchase Botox online from out of the country in order to save money, which may or may not be safe or effective. The FDA recently reported that fraudulent Botox packaging was being sold on the Internet. There have been deaths or seriously neurologically impaired events when patients got a different kind of botulinum toxin which was a much stronger concentration and resulted in overdoses.
It’s my professional opinion that no one should receive Botox from an establishment that does not have a medical director who is intricately involved in the day-to-day practice of the office and has a firm command of the anatomy of the face and neck. I am baffled by the concept that dentists are now offering this service to patients as well. Having graduated magna cum laude from dental school prior to going on to medical school, I can emphatically state that dentists are not qualified to participate in these services. Botox is not inexpensive — why purchase it somewhere that might result in substandard results, not to mention nerve damage or death? The quality of the result is directly related to the skill level and knowledge of anatomy of the injector. Be good consumers and check the credentials of your provider. Caveat emptor.