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Beauty and the Botox Beast

Yashaswini's picture

Beauty and the Botox Beast

Botulinum is a poisonous substance found in nature, secreted by the soil bacterium Clostridium botulinum. It grows in the absence of air and has a lethal reputation as a food contaminant, especially in improperly canned or preserved foods. Botulinum toxin A, given the more popular name "Botox" by its manufacturer, Allergen, is also an increasingly popular cosmetic agent for the treatment of facial lines and wrinkles. When injected to the human body, depending on its application and dosage, it may lead to difficulties in walking and swallowing, and impaired vision and speech. Some studies even assert that injecting botulinum toxin A in the human body may also lead to convulsions, problems of the respiratory systems and severe paralysis.

Due to its paralysing properties, botulinum toxin A was originally used in the 1970’s by clinicians to treat strabismus, for the correction of deviant eye muscles that cause double vision. Since then, it has since proven very beneficial in the treatment of blepharospasm (uncontrollable contractions of the eyelid muscles) and certain types of spasticity in children. Botulinum toxin A has also proved to be effective in treating problems caused by neck and limb spasms, unwanted movements, abnormal postures, excessive sweating and migraine headaches. One of its newest uses, off label, is treating overactive bladder that is unresponsive to other remedies. On the face of it, botulinum toxin A seems to be equipped with potential benefits for humans and its usage seems to be harmless. But can a poisonous substance derived from a bacterium really be full of so much good? If yes, can we trust ourselves to limit its usage to only those avenues that do not have any substantial negative side-effects?

Despite its advantages, botulinum toxin A has not appeared in recent newspaper and magazine headlines because of its clinical applications, but rather its use in so-called ‘Botox clinics’, where an explosively growing number of well-off customers are having unsightly facial wrinkles and furrows removed (along with with all traces of emotion and expression). The medical term for the action of Botox on the human body is selective muscle denervation. Normally, to make a muscle contract, a nerve sends a signal to the muscle. When the signal gets to the neuromuscular junction, the meeting point of a nerve and a muscle, a chemical called acetylcholine is released from the nerve side of the junction. Acetylcholine then binds to the muscle side of the junction causing more chemical reactions that make the muscle contract. Botox works by blocking the acetylcholine receptors on the muscle side of the junction. Thus, when a nerve sends a signal to the muscle to contract, acetylcholine is released as before, but it can't bind anywhere on the muscle. As acetylcholine cannot bind anywhere on the muscle, the muscle does not contract, and is essentially paralyzed. This acetylcholine blockade is irreversible and begins within 48 hours of injecting botulinum toxin A. The clinical effects of such an injection are noticeable between 5-10 days. However, over 3-5 months, the muscle gradually develops new receptor sites and is able to contract again.

As explained earlier, when Botox is injected to a muscle that causes a wrinkle, it prevents the muscle from contracting and thus, prevents the wrinkle from appearing. However, as we age, our skin loses its elasticity and wrinkles appear even without muscles contracting and Botox usage cannot prevent this. Moreover, Botox is rendered useless for treating other aspects of facial rejuvenation such as reducing finelines, age spots, crows feet, skin blemishes and sun damage. As if these shortcomings are not deterrents enough, frequent and regular usage of Botox injections can even weaken the skin, leading to skin and nerve damage!

Recent concerns over botox usage also include what are called systemic reactions, or effects on distant muscles, such as the drooping of the eyelids after using injections to smooth creases around the eyes etc. A study at Italy’s Institute of Neuroscience involved injecting rats with botulinum toxin A doses comparable to those used in people. Neurons at the injection site were seen to absorb the toxin and pass it along to other neurons and within three days, the toxin had migrated to the brainstem, where it disrupted neuronal activity. However, other studies suggest that once injected, the toxin is completely broken down at the injection site into (seemingly?) harmless compounds and does not migrate beyond it – or if it does, only into the bloodstream or lymph system.  These findings, though diametrically opposite, shed light on the potentially dangerous nature of injecting toxins in our system, for whatever reason. It makes us wonder why and to what extent are we, as a society, willing to push ourselves to alter our physical appearance to conform to societal pressures? Despite knowing the serious repercussions of Botox usage, why do we continue with our relentless search for the fountain of youth?

 According to the American Society of Public Surgeons, more than 2.5 million women get Botox treatments done every year, whereas the number of men resorting to Botox treatments is only around 300,000. According to the American Society for Aesthetic Plastic Surgery, over 3 million Botox treatments were administered in USA in 2001 alone. In 2002, the US Food and Drug Administration approved the use of BOTOX® for use in certain cosmetic procedures, specifically to relax the glabellar muscles that cause a “furrowed brow”, and since then the usage of Botox treatments has increased more than 20-fold over the last five years!

As a society, we have gone one step further by making it an unacceptable part of the human condition to look old or anywhere less than picture perfect. A study published in 2001 reveals that nearly a quarter of patients seeking Botox treatments had body dysmorphic disorder. This condition causes a person to be excessively preoccupied with her physical appearance, to the point that it severely affects her self esteem and interferes with her daily activities. This dissatisfaction with one’s appearance further drives the need for altering appearance and increases faith (and maybe dependency?) on Botox treatments, even though psychotherapy would probably be a more appropriate treatment; and thus, a vicious circle is established. This fact is more starkly true for women, as reflected by the earlier statistics. Why is beauty, particularly feminine beauty associated with youth? Why does society refuse to recognize and accept ephemeral youth? Given the prevalence of perennially youthful images paraded before us in the media, through fashion magazines and the television, there is no telling to what limits we will go in our pursuit of eternal youth and beauty. To quote a famous poet, “Where is the life we have lost in living? Where is the wisdom we have lost in knowledge?”

Perhaps it is time we ponder.















Paul Grobstein's picture


"we have gone one step further by making it an unacceptable part of the human condition to look old or anywhere less than picture perfect"

Sounds like this is a bigger problem than the possible unintended effects of Botox.  How do we fix that one?