To Botox or Not to Botox, that is the question!

We have often wondered the price a person would pay to be young forever. Would someone poison themselves to make them look younger? Would health officials allow such a procedure to exist?

The answers to all of the above are:

i. It seems youth has no price and people will pay whatever it takes.

ii. Yes, a person would poison themselves to make them look younger.

iii. Yes, health officials have approved the poisoning of one’s body in the name of beauty.

Surprised? Probably not and most of you will know what we are referring to. Botox or more specifically the botulism toxin has become the world’s most popular cosmetic procedure. Tens of thousands of men and women have Botox injections every three to four months. It is a multi-billion pound industry and you do not need to have any medical qualifications to administer it! What! I hear you cry, inject me with a syringe containing poison and you do not need a medical qualification, this cannot be. Well, in fact, it can and is actually the case; you can attend a course for a few hours and become a trained administrator of a medical grade poison, all in the name of ‘beauty’.

In a world caring more about how one looks as we get older, it seems Botox is becoming part of what seems to be a normal routine. The procedure itself if done correctly and by a qualified medical practitioner can be relatively safe. But you cannot help wondering what the long term effects can be. Botox is produced by the bacteria Clostridium Botulinum, this is a deadly neurotoxin that can cause botulism, a rare and life threatening paralytic illness. In cosmetic procedures it is injected in tiny amounts, but in large doses, this is one of the most powerful poisons known to man.

The official NHS web site states that although botulinum toxin injections are generally safe the risks of treatment include:

  • flu-like symptoms for the first 24 hours after treatment and there may be bruising at the injection site
  • facial features in the treatment area may be weak and droopy after the injections, although this usually improves as the effects of the treatment wear off – for example, your eyelids may droop temporarily if the injections are used to treat the vertical “frown lines” between your eyebrows
  • developing a resistance to the treatment if it’s repeated too frequently
  • in rare cases, serious problems in the hours, days or weeks after treatment – including blurred or double vision (if the area around the eyes is injected) and breathing difficulties (if the neck area is injected)

That is quite a frightening list of potential side effects. The NHS also points out the safe use of the botulism toxin depends on the product being correctly stored and administered by a qualified doctor. One should also seek immediate medical attention if your breathing or vision is affected after having a treatment.

It is quite surprising that these procedures are not regulated in the same way as cosmetic surgery. You can actually buy a DIY Botox kit from the internet. There have been some shocking stories of people being left with disfigured faces and infections from inexperienced applicators injecting the wrong amount or in the wrong muscle, ouch!

Manufacturers state that the side effects associated with their products are uncommon and fleeting. This may not really be the case judging by the reports online. Many women report muscle weakness, nerve damage, headaches, muscle pain, muscle stiffness and many other adverse effects. Sobering reading we must say.

Repeated use over several years can result in weakening and shrinking of muscle that are injected and even adjacent sites. This will have the opposite of the desired effect, i.e. in the pursuit of eternal youth, one may end up looking disfigured and not be able to express themselves using their facial expressions or even move their eyelids. Something we doubt many regular users think about.

Something that has always concerned us about Botox is what does happen to the toxin once it is injected. Does the body remove it? Does it become inactive but remain in the muscle? The truth is we do not really know as yet.

Regular use of Botox can result in a tolerance effect, where a larger dose is required to achieve the same result. If a nerve or muscle is being routinely injected, it may not be able to absorb the entire toxin. So where does the rest of it go? It may enter the blood stream and migrate from the injection site.

There are also studies that show that the toxin may in fact move within the nervous system itself. An Italian animal study found the toxin can attach itself to nerve cells in rodents and migrate to the brain. This opens up the possibility that this could also happen in humans. The scientists who published this study have stated in no uncertain terms, not enough is known about this toxin and how it migrates in the body, more research is needed.

Closer to home, Dr Peter Misra, a leading London neurologist confirms that the long term effects of the botulism toxin on the brain, nervous system and muscles are unknown. It is being used routinely ahead of clear scientific evidence of its long term effects. The use is based on small scale studies that ran for a maximum of two years. The dramatic increase in users means that more and more people are putting themselves at potential risk of adverse effects. There have been no studies to show the long term effects of routinely injecting this poison, even at the low doses used for cosmetic procedures.

Dr Stewart Jessamine, head of Medsafe, has also acknowledged the fact, and we quote, “we don’t actually know if there are long term side effects. This is a relatively new medicine and a potent poison. It’s not been used for prolonged periods”.

So, in the name of beauty and youthfulness, we must ask, what might the long term consequences be for people who repeat these injections every three months for years on end and will carry on for the rest of their lives?

Are there alternatives? Well, yes if one wants to use cosmetic procedures then perhaps dermal fillers are a viable alternative. Although, they will not paralyse muscle movements, the combinations of hyaluronic acid and collagen will plump the skin and fill out lines and wrinkles.

Of course, if one is looking for non-surgical methods to age gracefully and make the most of what you have. A healthy lifestyle with plenty of fresh fruit and vegetables, as well as plenty of water will always help.

We now also have many more topical and some effective oral supplements that have sound science behind them without the risks involved as there are in invasive cosmetic procedures. Perhaps the last word should go to the lovely Drew Barrymore, who looks quite stunning for her age:

“To all those women putting botulism in their faces – we don’t know what the long term effects are, so stop! I’d rather look like a basset hound than do that to my face!”

Pupinder Ghatora MPharm MRPharmS SCS and David Hyland MSc MBA CEng

Co-founders of Ingenious Beauty

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