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Serious questions raised about casual use of Botox

Less than two months after the government approved the prescription drug as a temporary wrinkle-reliever for the brow - turning a closet cosmetic of the rich into a tsunami-sized fad - serious questions are being raised about its casual use.

By Marie McCullough
Knight Ridder Newspapers
(KRT)

The Botox backlash has begun.

Less than two months after the government approved the prescription drug as a temporary wrinkle-reliever for the brow - turning a closet cosmetic of the rich into a tsunami-sized fad - serious questions are being raised about its casual use.

Doctors, medical societies and patients are stepping forward to frown on blithe use of the toxin, especially at Botox parties.

"How voluntary and intelligent is an `informed consent' that follows a glass or two of wine?" fretted New York City cosmetic plastic surgeon Paula Moynahan.

The American Academy of Dermatology and the American Society for Aesthetic Plastic Surgery have announced their disapproval of injecting Botox in "casual social settings" - something that, in Pennsylvania, Florida and several other states, is supposed to be done by a doctor or by a nurse under a doctor's supervision.

Some of the tsk-tsking smacks of turfism - dermatologists and plastic surgeons are now facing competition in the lucrative Botox beauty business. But there is no doubt that even in the best hands, the paralyzing poison can have unexpected results.

Consider Ruth Wittington, 46, of Southampton, Pa.

About 18 months ago, a dermatologist she consulted about a laser treatment suggested Botox for her forehead furrow. A week later, she said, both of her eyelids were so droopy that she had to lift the skin with her fingers to apply eyeshadow.

"For a couple months, I looked like I was sleepy all the time," said Wittington, a mother of three who manages her husband's plumbing business office. "I had people say to me, `What's wrong? It looks like you've been up all night crying.'''

The dermatologist, who refused a refund, suggested another try in three or four months, after the Botox wore off. But Wittington's eyes had been opened, at least metaphorically: "Would I do it again? I'd have to be out of my mind!"

Botox (and competing brand Myobloc), a highly purified toxin from the" clostridium botulinum bacteria, has been a godsend for people with neuromuscular disorders that cramp and disable some part of the body - the hand, leg, foot, neck, eyes, even voice box.

But vanity, not disability, is what makes Botox such a pretty poison.

A $450, 100-unit vial of powder, mixed with saline, might treat two typical movement-disorder patients, but it can dose three to five cosmetic patients. At $300 to $1,000 per face, three or four times a year - cash, please, insurance won't cover cosmetic use - cosmetic treatment is a nice sideline for any physician. (Drug-maker Allergan expects its $310 million Botox sales to climb by as much as a third this year.)

A party makes things even nicer by reducing the chance of wasting the reconstituted drug, which should be used within four hours, said Allan Wulc, an ocular plastic surgeon in Abington, Pa., who does Botox information sessions - but not parties.

"I think if people are at a party, there is a subtle peer pressure to have the procedure that wouldn't exist if people took the time to go to a doctor's office," Wulc said.

Many doctors who do parties forbid alcohol. Besides impairing judgment, alcohol dilates the blood vessels, increasing the chance of injection-site bruising.

But even when alcohol is banned, Botox does not belong in hotel rooms, hair salons or other nonmedical settings, critics say. Among potential problems: The patient's medical history may be glossed over; biomedical waste may be disposed of improperly; the drug's effectiveness may be reduced due to lack of refrigeration; the injection may go astray because the patient's head is not in a headrest; and patients may faint.

"You can get people who will faint with any injections," said Kirk Brandow, a Bala Cynwyd, Pa., plastic surgeon. "In the office, we have smelling salts and oxygen and an EKG machine to check the heart. I think any doctor's office would have that, but not any party."

In forehead areas, a bad Botox shot can cause droopy eyes or even double vision. Chronic use can also lead to what Wulc calls the "Joan Rivers look": a devilish V-shape droop in the brow.

But the lips and neck are where incorrect or unskilled cosmetic Botox injections can really be dangerous. (Doctors have discretion to use Botox in areas that are not specifically approved.) Case reports of patients unable to speak or swallow have appeared in medical journals.

At least one nonmedical person, a Tallahassee, Fla., beauty salon owner, has faced criminal charges - practicing medicine without a license and illegal possession of prescription drugs - for giving Botox injections.

"I think the next story will be a Botox party gone wrong," Brandow said.

© 2002, The Philadelphia Inquirer.
Distributed by Knight Ridder/Tribune Information Services.

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