Botox

Botox is a brand name for botulinum toxin type A (botulinum), a neurotoxic protein. The substance is commonly used for the reduction of facial wrinkles. In the United States, in 2008, botulinum was administered more than 5 million times-a quadrupling since 2000. Botulinum injections made up about half of the 10.4 million “minimally invasive” cosmetic surgery procedures reported by the American Society of Plastic Surgeons in 2008. Worldwide, across various demographics and ethnicities, it is the most common cosmetic surgery treatment; women make up approximately 91 percent of its users. This entry traces the history of botulinum, its administration, side effects, and cultural implications.

Botulinum toxin is a naturally occurring poison found in decomposing meat. While the contraction of botulism from contaminated food can be fatal, when highly diluted and purified the toxin has therapeutic uses. British scientist Arnold Burgen discovered in 1949 that botulinum blocks neuromuscular transmission and can be injected directly into muscles to cause temporary paralysis. He undertook experiments to test the substance's efficacy in treating tics, spasms and other neuromuscular disorders. Botulinum was approved for therapeutic use in the United States or conditions of the eye, such as uncontrollable blinking, in 1984.

It was later noted that the wrinkles of patients were lessened; in 2002 the drug was approved for use in treatment of facial lines. It has since been aggressively [Page 178]marketed as a wrinkle treatment by its U.S. manufacturer, Allergan Pharmaceuticals, under the trade name Botox. Botox has become a household name and is one of the most widely recognized prescription medicines in the world. Hence, botulinum is often conflated with Botox, although the product is also produced by other companies under the labels BTX-A, Botutox, Estetox-A, Refinex, Novotox, Canitox, QuickStar, Linurase, Dysport, and Neuronox.

Botulinum is part of a suite of nonsurgical cosmetic surgery procedures and is administered, usually without anesthetic, via a very fine needle into multiple points on the face. It takes about four days for the effects to be seen. Side effects can include temporary flu-like symptoms, headaches, hematoma, bruising, drooping eyelids, and double vision. Some scientists maintain that botulinum has not been used long enough to accurately determine its carcinogenic or long-term effects.

Botulinum injections diminish the appearance of wrinkles on the face, especially those around the eyes, on the forehead and between the eyebrows. As with other cosmetic surgery, it is most often used by women aged 40 to 54. However, it is also marketed to the public as a means of avoiding the development of wrinkles in a preemptive manner. The product can cause a “frozen” or “plastic-” looking face, and is often criticized for the way it diminishes the range of facial expressions available, especially to actors.

Botulinum's effects last about 120 days. It is dispensed in glass vials that each hold enough liquid for several injections. In 2008, the average cost of a botulinum treatment in the United States was $500. The substance has a four-hour life once a vial is opened but not all recipients need an entire vial.

To address this discrepancy some patients and surgeons host “Botox parties,” where the cost is shared between multiple recipients. These gatherings, held in clinics or in private homes, have become part of the popular mythology around Botox. A Botox party, for instance, was featured in the pilot of the Nip/Tuck television series. Botox parties are indication of how cosmetic surgery, once kept secret and hidden, is, in the early 21st century, far more acceptable: even a status symbol. The parties are controversial in part because of the likelihood of alcohol being imbibed while undergoing a medical procedure. In 2008, they were banned by the United Kingdom's General Medical Council.

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