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October 21, 2005

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Publication Date: Friday, October 21, 2005

Searching for the Fountain of Youth Searching for the Fountain of Youth (October 21, 2005)

Botox boom not just in the big cities

by Rebecca Guyon

It's no secret that we are a culture obsessed with youth. Just glance at the grocery store magazine rack and you'll see a batch of dewy-eyed faces peering from the covers. Turn on the TV or watch a movie and you'll find most story lines revolve around characters falling somewhere in the age range of 25-29. Given our love affair with youth, it's no surprise that when doctors started offering Botox injections in the late 1980s, claiming the procedure would get rid of established wrinkles and even prevent new ones from forming, people were clamoring to get it. And they didn't seem concerned that this "miracle drug" is actually a neurotoxin that relaxes wrinkles by paralyzing muscles. These first Botox patients were generally actors and politicians, people who live in the public eye. But since that time, the demographic of the average Botox user has changed. Nowadays, you don't have to be a star or live in a big city to join the Botox fad because many are getting it, including Pleasanton residents.

"You would be surprised at how many people use Botox," said Dr. Robert Gray, a facial plastic surgeon who recently opened a cosmetic spa on Main Street in downtown Pleasanton. "It feels like half of Pleasanton comes through here."

It may seem like an unnecessary procedure for people who in their everyday lives don't live under the scrutiny of the camera, but as Pleasanton dermatologist Dr. Minh Dang said, "Everybody looks at themselves differently." Dang, who administers Botox, added, "Someone may come in with that one wrinkle that really bothers them, but other people wouldn't have even noticed it."

Pleasanton resident Lori Hanson started getting Botox injections two years ago. Hanson, now 50, first noticed the effects of aging when she saw that her makeup was not lying as flat on her face anymore. Wanting to do something about it, she sought out a doctor's opinion and he recommended Botox. Since then, Hanson never looked back. "In general, I like to eat healthy and look nice, and Botox is part of that," she said. "It makes me feel healthy and gives me confidence. When I look good, I feel good."

Hanson, a mother of three who has been married for 23 years, works at Club Sport in Pleasanton. Although she said being surrounded by fit people didn't affect her Botox decision (she is in fit physical condition herself), was was influenced by constantly meeting with people and running into people she knows did.

"We get many people who come in before a high school reunion or a wedding and have one month to get ready. Part of 'getting ready' is getting Botox," Gray said. "We're already planning for the holiday months because they are an especially busy time as people are visiting with family and friends they might not have seen in a long time."

Although some people might think it is vain to be so concerned with appearances, Gray is emphatic that getting Botox is no different than all the other maintenance people do to be presentable.

"You brush your teeth. You get a haircut. Botox is just one more thing you can do to maximize your appearance," Gray said. "If you go to a party, you dress up and try to look your best. It's not just about what other people think. If you look good, you'll feel good."

Admittedly, though, even through all the talk of self-esteem and inner confidence, the reason for using Botox ultimately comes back to wanting to look attractive to others.

"After all, you only get one chance to make a first impression," Gray said.

That's why 46-year-old Pleasanton resident Carol Swenson first started using Botox two years ago. Working in sales, Swenson said she is constantly meeting people and needs to put her best foot forward when trying to get a new client.

"I'm out in the work force, and I need to look good. It's vital," she said. "That's the biggest reason for me, plus everybody likes to look better, and you don't need to be in Hollywood for that."

Both Hanson and Swenson fit the profile of a typical Botox patient. Gray said most of his patients are women in their 40s-50s. For Dang, women are also the main demographic, but she has seen women as young as 30 come in for a treatment either to nip a few minor wrinkles or keep more from forming. While both doctors said men in the same 30-50 age bracket are using it more, women still outnumber them. Ostensibly, Botox patients also have to be somewhat affluent, considering that a single visit costs anywhere from $300-420 with most patients getting an injection every 2-3 months.

Even though Botox has only been used cosmetically for the past few years, the product has actually been in use for more than 20. It was first approved by the Food and Drug Administration in 1984 to treat medical conditions such as strabismus, better know as crossed eyes, and blepharospasm, a condition that causes involuntary muscle spasms in eyelids resulting in uncontrollable blinking. In 2000, the FDA approved its use to treat cervical dystonia, a condition characterized by spasms in the neck and head. All these conditions are caused by spastic muscles, so Botox, with its paralyzing properties, was seen as an ideal remedy. Soon, patients using Botox to treat their medical conditions found that it not only lessened their spasms, but also made them look younger. The effect was most dramatic in people being treated for muscle spasms around their eyes who noticed their crow's feet disappearing.

This is when doctors got the idea to start using Botox for cosmetic purposes. Dang and Gray both said they have seen Botox used in their field for at least 10 years, even though it was not approved for cosmetic use by the FDA until 2002. "I had been giving Botox for 10 years, but the FDA approval really opened the door and helped make it so popular now," Gray said.

Now the cosmetic procedures outnumber the medical. Part of the popularity is that it is so easy compared to a full-blown facelift, Dang said. Patients get three to four injections by a small needle on the area they want treated. The whole procedure takes no more than 10 minutes. The injection causes a little bit of swelling, but that dies down after about 30 minutes. Compare that to a major surgical procedure that may require weeks of bandages and bed rest.

And while, like Swenson said, you don't have to live in Hollywood to want to look good - Dang believes the prevalence of Botox use by celebrities has made it less taboo for others.

"Minor cosmetic procedures are widely accepted," she said. "People come in to do it without thinking there is something to hide. While you can get Botox and no one will know that you got it done, at the same time people don't feel like it's something to be embarrassed about."

Although some celebrities have been quoted as saying they don't want Botox because they fear it will limit facial expression, many people consider Botox a "miracle drug" because it is administered with relative ease and there appear to be few side effects. Some patients may experience bruising, drooping of the eyelid or headaches after receiving an injection, but even those side effects are temporary. However, people considering Botox should make sure their doctor is using Botox from Allergan, the only FDA-approved company that makes and distributes the product for human use. Recently, there have been reports of complications resulting from the use of knock-off Botox products, specifically in Florida where four people became paralyzed after injection. Toxin Research International, a Tucson-based company, sold the illegal botulinum toxin to at least 180 doctors and initially purchased the toxin from several biological laboratories, one of which is based in Campbell. TRI, which claims the paralysis incident is not related to their product, goes on trial next month in a federal court in Florida.

As for the FDA-approved Allergan Botox, there are currently no reported long term side effects. Of course, it is hard to know if new side effects from long term use will be discovered 20 or 30 years down the road. But for now, it seems that those looking to stave off the effects of time have found the closest thing possible to a fountain of youth.
How does Botox work?

The active ingredient in Botox is botulinum toxin, an enzyme that breaks down proteins and interferes with nerve impulses by inhibiting the release of neurotransmitters to muscles. The effect is paralysis. Used in a small dose, like in Botox injections, the poison only causes minor, contained paralysis, according to the National Institutes of Health. If ingested, the toxin can cause botulism, a rare, but serious, paralytic illness.
From food poisoning to face priming

How a little poison became the center of a cosmetic revolution.

1822 - Justinus Kerner, a German physician and poet, first develops the idea of a possible therapeutic use of botulinum toxin, the active ingredient in Botox, which he called "sausage poison."

1895 - Emile Van Ermengem is the first to identify Clostridium botulinum as the causative agent of botulism.

1946 - Edward Schantz and colleagues purify botulinum toxin in crystalline form.

1949 - Arnold Burgen and colleagues discover that botulinum toxin blocks neuromuscular transmission.

1980 - Alan Scott uses botulinum toxin for the first time on humans to treat crossed eyes.

1984 - FDA approves the use of botulinum toxin for the treatment of crossed eyes and spasmodic blinking.

1987 - A patient in Canada being treated for spasmodic blinking notices the product eases her brow furrow. This is the first noted cosmetic benefit for the drug.

1991 - Allergan, the company that currently makes and distributes Botox, buys the rights to botulinum toxin and gives it its name, taking it from BO-tulinum TOX-in.

2000 - FDA approves Botox for treatment of cervical dystonia.

2002 - FDA approves use of cosmetic Botox to temporarily ease the appearance of moderate to severe lines and wrinkles.

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