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Botox Cosmetic At-A-Glance

Strengths: An injection procedure that genuinely works to eliminate expression lines and minor wrinkles due to the effect it has on muscles that control facial movement; far superior to any topical product claming to work like Botox.

Weaknesses: Cost; the procedure needs to be repeated every 3-6 months to maintain results; some people have a fear of the needle; Botox parties, where women gather to drink alcohol and get injections of Botox, are never a good idea.

Botox is short for the botulinum toxin, type A. When injected into specific muscles it prevents movement through partial and almost complete paralysis of those muscles. The inability to use certain facial muscles causes certain wrinkles to disappear completely. This helps eliminate almost all of the wrinkles of the forehead, the crow's feet area (by the eyes), and the lines that run from the nose to the mouth (the naso-labial folds), though this area is injected far less often then the forehead. We know this sounds outlandish and frightening, but in reality it is no more bizarre than any other cosmetic surgery or treatment, or simply getting a shot for other medical considerations.

What is most significant, and what consumers need to understand when told by the cosmetics industry how scary these injections are, is that the results for Botox are truly astounding, which explains the consistent and ever-growing popularity of this medical procedure for the treatment of wrinkles. If you're wondering how Botox makes the face look, given that if you choose that treatment there are muscles you won't be moving for a while, (assuming you don't know anyone who has had it done), check out any Hollywood actress over the age of 35. They haven't moved their foreheads once. Of course we can't say for certain that any of these actresses have had Botox, but given the way they can't use their foreheads (they never frown or furrow their brows) and they have no lines on their foreheads (especially not in comparison to their male counterparts), we assume they all have.

Botox is also not anything new. It has been used by ophthalmologists since 1973 to treat patients with disabling eye tics, as well as to treat the problem of crossed eyes. It is also used by other medical specialists for the treatment of spasmodic neck muscles, spasmodic laryngeal muscles, multiple sclerosis, cerebral palsy, some post-stroke states, spinal cord injuries, nerve palsies, Parkinson's disease, facial spasms, and, most recently, migraine headaches. What this extensive use (and the corresponding research) has shown is that Botox has a great success rate and no detrimental side effects.

As glowing as this all sounds, there are downsides and risks, but they are minimal and transient. From my perspective the worst side effect is that the results aren't permanent (it does make the forehead look fabulous). It will only paralyze the muscle for three to six months, which means repeated injections are necessary to maintain results. The serious risk is that a misplaced injection can cause facial or eyelid drooping, bruising, jaw weakness, and neck or back weakness, although this rarely happens. The good news is that if you are one of the few who experience these side effects, they only last as long as the effect on the rest of the face lasts, so they are rarely, if ever, permanent.

Sources for the above information about Botox: Dermatologic Surgery, May 2007, pages 567-571; Facial and Plastic Surgery, February 2007, pages 7-18; Opthamology, June 2005, pages 1159-1167; Cosmetic and Laser Therapy, November 2004, pages 145-148; Journal of the American Academy of Dermatology, August 2004, pages 223-233; Journal of Pediatric Orthopedics, July 2007, page 303; and Developmental Medicine and Child Neurology, May 2007, pages 331-337.

One of the hottest trends at cosmetics counters and drugstores is products claiming to mimic the effects of Botox. "Antiwrinkle" products are certainly not new, but connecting a moisturizer's efficacy to Botox or other medical corrective procedures such as dermal fillers (i.e., collagen or Restylane injections) is definitely an attention-getting marketing angle, and sales are booming! Cosmetic companies from Avon to Estee Lauder are linking their products with Botox, which isn't surprising since the results are so instantaneously impressive and the procedure is incredibly popular. According to The American Society for Aesthetic Plastic Surgery, it is now the No. 1 non-surgical cosmetic corrective procedure in the U.S. Alas, it is also costly, and the thought of being injected with the botulism toxin leaves some people fearfully furrowing their brows.

Botox injections introduce a minute amount of the synthetic botulinum type A toxin into areas where it is injected, thus preventing the use of those muscles (you can't frown or lift eyebrows after being injected until the effect wears off around four months later). Within 24 to 48 hours of receiving Botox, forehead wrinkles are gone. Prior to the treatment of wrinkles, Botox has been used for decades to treat eye spasms, dystonia, and cerebral palsy.

So can any cosmetic lotion or cream work better than Botox, or in any way similar to Botox? The short answer is a resounding no! According to Dr. Alistaire Carruthers, Clinical Professor of Dermatology at the University of British Columbia who has published many studies about Botox, you can't affect muscle movement topically. And if you could, it would be problematic for the body since it would affect muscles you do not want "relaxed," such as those in your hands or near your mouth. In reality, there are no topical ingredients that can come remotely close to improving wrinkles like Botox does.

StriVectin-SD ($135 for 6 ounces) is the product that started the whole "better than Botox" craze. It went from ads in Parade magazine to prominent shelf space in Nordstrom and Sephora. However, the only studies proving StriVectin's benefits (via peptide technology) were paid for by the manufacturer, and they have never been published. There have been papers presented on this topic at dermatology conferences, but such presentations are not held to the same standard as peer-reviewed, publishable studies.

Trying to capitalize on StriVectin's marketing success are a growing list of creatively-named Botox wannabes, including Avon Anew Clinical Deep Crease Concentrate with Bo-Hylurox, DDF Wrinkle Relax, Dr. Brandt Crease Release Estee Lauder Perfectionist [CP+] with Poly-Collagen Peptides, Freeze 24-7 Anti-Wrinkle Cream, L'Oreal Dermo-Expertise Wrinkle De-Crease Wrinkle Corrector, and Revlon Age Defying Makeup and Concealer with BotaFirm SPF 20. The only thing these products share in common is their inflated marketing claims.

We know many of you hope that the next works-like-Botox product really will fulfill that promise, but the lack of substantiated studies, the fact that the FDA does not require cosmetic companies to prove their claims, and the sheer complexity of skin aging make it impossible for any cosmetic to eliminate wrinkles. Claims of "better than Botox" are simply bogus. As nice as it would be to get Botox-like results "without painful injections," it just isn't possible. (By the way, about those injections, they are more of a minor, temporary discomfort than an agonizing experience.) Despite the ads, there isn't a plastic surgeon or dermatologist going out of business because of any antiwrinkle cream being sold.

For more information about Botox, call Allergan at (800) 433-8871 or visit

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