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Death, Lies, and Addiction: Is BOTOX® Cosmetic Really That Dangerous?

Death, Lies, and Addiction: Is BOTOX® Cosmetic Really That Dangerous?


BOTOX® Cosmetic is like a celebrity that we love to hate. We eat up all the nasty rumors about it, gossip about its most recent fling with popular Hollywood starlets and high-powered politicians, and try to deny that, deep down, we love it. Fact is, as much as we may try to fight it, we respect BOTOX® Cosmetic, if not for its proven efficacy as much as for its palpable staying power in the media and medical worlds (not to mention the faces of millions of people worldwide).

According to the American Society of Plastic Surgeons, the 4.1 million BOTOX® treatments performed in 2006 represented a 420 percent increase over the number performed in 2000. It would seem, then, that nationwide news stories about people contracting botulism from receiving bunk BOTOX® injections is not affecting its popularity. Now, a recent study released by a plastic surgeon and psychologist team in Britain claims that BOTOX® therapy is addictive. So what’s the real story? Is BOTOX® Cosmetic safe? Is it possible to become a “BOTOX®-aholic”?

Building Street Cred: The Rise of BOTOX® Cosmetic

Botulinum toxin has been used safely to treat muscle disorders in the eye area for more than two decades. After receiving FDA approval in 1989 for the treatment of uncontrollable blinking and asymmetrical eyes, the toxin was approved to ease and treat severe muscle contractions of the neck and shoulders in 2000. In 2002, BOTOX® Cosmetic received FDA approval for the reduction of frown lines between the eyebrows and has since been proven effective for numerous other medical uses, from treatment of excessive underarm sweating to migraine headache and TMJ relief.

“BOTOX® is a medicine,” says Dr. Scott Miller, a renowned plastic surgeon in La Jolla, California. “There’s nothing fancy, nothing perilous about it. What it does is it weakens the muscles when you put it in, so depending what muscles you put it in, how much you put in, and where you put it, it has different effects.”

Sounds simple enough, right? But what about its deadly past? Its addictive nature? How safe can a potentially paralyzing or deadly substance truly be?

Beware of Doc: Safety Precautions

The growing popularity of BOTOX® Cosmetic has inspired many unassuming locales to offer the wrinkle-reducing shot in casual environments. Indeed, from dental offices to gyms, salons, and “BOTOX® parties,” receiving BOTOX® injections is quickly becoming as convenient as buying a sack of peanuts at a baseball game. But the “would you like BOTOX® Cosmetic with that?” mentality is a dangerous trend that the FDA, the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgeons, and physicians everywhere are denouncing.

“People who don’t know how to [administer] BOTOX® properly in the first place also don’t know the treatments for the little issues that can arise,” explains Dr. Miller. “Having BOTOX® done by a well-qualified, well-trained, proper provider is really critical in avoiding complications and getting the results you desire.”

Potential complications associated with BOTOX® Cosmetic include “eyelid droop,” which occurs when the substance is injected into muscles too close to the eyebrow, and the appearance of a “frozen face.” While some patients want a natural look with less-apparent wrinkles, others request their forehead not move to prevent the appearance of wrinkles altogether. Discussing your ideal results with a qualified doctor who knows the anatomy of the facial muscles can reduce the risk of complications and help ensure you receive the effects you desire.

Black-Market BOTOX®

Last year, a Florida doctor landed himself and three patients in the hospital with paralysis that resulted from counterfeit BOTOX® treatments. He was among some 200 doctors who purchased an unapproved form of botulinum toxin with hopes of turning high profits. Instead of enjoying “the good life,” many of these prominent doctors are finding out about prison life. From California and New Mexico to Oregon and Idaho, numerous doctors have lost their licenses and been indicted on charges of fraud, landing them in federal prison after injecting hundreds of patients with bad BOTOX®.

However, Dr. Miller maintains that genuine BOTOX® injections are, indeed, safe. He says BOTOX® Cosmetic uses botulinum toxin in a form diluted to a millionth of its strength. “If you put BOTOX® at a million times its strength into the heart muscle, of course it’s going to cause somebody a problem,” he says. “But when you put BOTOX® Cosmetic, as delivered and as appropriately formulated, into the muscles of the face that cause wrinkles, it’s very safe.”

The true danger lies in receiving treatment from an unlicensed or unethical provider who offers so-called BOTOX® injections at a bargain price. “BOTOX® comes as a powder and then you reconstitute it with saline,” explains Dr. Miller. “Of course, there are people who are going to reconstitute it with more saline than it’s supposed to be reconstituted with.” Dr. Miller warns people to beware of too-good-to-be-true prices on BOTOX® treatments. If they receive diluted doses of BOTOX® Cosmetic, patients won’t see the youthful results they desire.

More worrisome, perhaps, are the providers who, attempting to cut costs, illegally order raw botulinum toxin with the intention of creating “garage BOTOX®,” as was the case with the Florida surgeon who was lucky to survive his ordeal with the bunk, overly potent substance he concocted. However, Allergan, Inc., has gone to great lengths to prevent look-alikes and stop counterfeiters. BOTOX® Cosmetic now comes in a specific bottle with a hologram on it to ensure its legitimacy, and patients are advised to ask their doctor to see the bottle if they have doubts about the injections they’re receiving.

“Unfortunately, the ethical majority has been brought down by the unethical minority, and everyone has to pay the price of having to do the extra due-diligence and homework,” says Dr. Miller.

Might As Well Face It, You’re Addicted to BOTOX®…

Although there’s no harm in receiving BOTOX® injections from a qualified provider, Dr. Martin Kelley, a plastic surgeon at London Plastic Surgery Associates, and Dr. Carter Singh, a psychologist at Britain’s Derbyshire Royal Infirmary, recently presented a study to the British Association of Aesthetic Plastic Surgeons claiming that BOTOX® has addictive qualities for some people. According to the study, four in ten people who receive BOTOX® injections are compelled to continue BOTOX® therapy regularly. More than half of the participants in the study felt that they needed BOTOX® injections to maintain their youthful appearance. Many patients return for follow-up visits before the effects of their BOTOX® treatments have worn off.

Some critics argue that this so-called addiction is a psychological issue, wherein some people will never be completely satisfied with the way they look, despite plastic surgery, artificial tanning, treatments with injectables, or new hairstyles. Because underlying psychological issues are not addressed before undergoing treatment with BOTOX® Cosmetic, when the results fade, these patients either have to face the problems that led them to the procedure in the first place or continue running from their personal issues. By the same token, addictions to sex, drugs, food, and alcohol temporarily mask underlying issues and leave a person seeking the psychological “high” they receive from such behavior.

Physically, I don’t believe there is any addiction to BOTOX® Cosmetic. A physical addiction would be one where the problem came back worse and you actually needed the product more and more,” says Dr. Miller.. “I would say it’s exactly the opposite. The longer you go without using a muscle, the more the muscle atrophies, and you get out of the habit of using the muscle. When the BOTOX® wears off after three or four months, you still are out of the habit of using that muscle and you see the effects for several more months after the BOTOX® is out of your body. That wouldn’t happen with a physical addiction.”

He continues, “Psychologically, what’s addiction and what’s desire?” The desire to enhance one’s appearance is undoubtedly common in our culture. Ultimately, it is up to ethical providers to identify unhealthy behavior and unrealistic aesthetic goals in their patients to curb these “addictive” practices.

Dr. Miller believes providers are obligated to tell patients when they don’t stand to gain anymore from a particular product or procedure. “This isn’t Jack in the Box®. It’s not delivery on order. This is medicine, and medical care involves taking a history, making a diagnosis, and prescribing a treatment,” says Dr. Miller, who turns away about two in ten patients because they have unrealistic cosmetic goals. “In the cases where there’s not really a lot to gain from further treatment, I think an ethical provider is required to tell the person, even when that’s not what the person wants to hear.”

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