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Freeze Face by Elvira Maricic

It's got the elements of a good spy plot--a US military fort, one of the world's most potent poisons, and biological warfare. Is it the screenplay for the next Mission: Impossible installment? A new Tom Clancy novel? No, it's Botox, a muscle-relaxing agent used by plastic surgeons and dermatologists to soften frown lines, crows feet, and other wrinkles caused by the day-to-day use of small muscles in the face.

Botox, or botulinum toxin, is a purified form of one of the most potent poisons in the world. Its structure and function were originally determined at Fort Derrick, Maryland as World War II researchers attempted to understand and develop antitoxins to potential agents of biological warfare. They probably never envisioned that in addition to keeping the US safe, decades later their research would be keeping America beautiful--or at least wrinkle-free.

A Measured Dose of Toxin

While extremely high doses of botulinum toxin can cause the clinical disease botulism, in carefully administered low doses, it can reverse the effects of aging skin. "Botox is botulinum toxin, but it's a very dilute amount," says Sunila Walia, MD. "Basically, we'd have to inject you with a gazillion units to cause you to become infestated, so it's absolutely, perfectly safe."

Botox is not a new treatment. It has been used successfully for more than 15 years by physicians for a variety of conditions. "Neurologists were the first to actually use it to deal with involuntary eye movement. It can also be used to treat dystonia, which is an esophageal dismotility dysfunction," says Dr. Walia, who practices with Dermatology Associates of Atlanta. "We use it in dermatology to treat movement or dynamic associated wrinkles in the glabella area [the smooth area between the eyebrows just above the nose], in the forehead, and around the eyes--the so-called "crows feet. We've also started using it in the neck area."

Wrinkles are caused by the contraction of the underlying muscle under the skin, which pulls the skin together to form the wrinkle. Botox works by blocking the release of acetylcholine, the neurotransmitter that tells the muscles to contract. "It actually prevents the neurotransmitter from being picked up from its receptor site. If you deplete [acetylcholine], the muscles aren't going to be able to contract," says Dr. Walia. As a result, the underlying muscles are paralyzed and the skin's appearance improves.

Injection Time

Botox is injected with a fine-gauge needle into the skin and muscle of the area to be treated. The procedure is relatively painless, although some people may experience a slight sting.

Side effects can include a drooping of the eyelid or eyebrow, which disappears after approximately four weeks. In addition, a small percentage of patients may develop a small bruise or hematoma at the treated site, which also disappears after a few weeks. A positive side effect noted by some patients is the disappearance of tension headaches.

Occasionally, an injection does not take, and a repeat injection is required. You should check with your physician ahead of time to see if an additional cost is involved. The results last between three and six months, and then the procedure can be repeated. And because Botox decreases the patient's ability to frown or squint, it prevents the progressive worsening of wrinkles over time, making the method both corrective and preventive. Patients can have one or more areas treated at a time, although that's not always advisable. "We can do all areas at one time--the glabella, the forehead and the crows feet--but I find that if someone's never had it done before and all of a sudden goes from having movement to not having movement, they might get a little freaked out, " says Dr. Walia.

"For a first-timer, I think it's a good idea to do one area at a time, just to see if they like the fact that they don't have any movement in the area. However, on a veteran we can do all three areas at one time," she adds.

The price of the Botox treatment varies by region, physician, and the amount of material needed. Treating crow's feet can range from $200 to $900, while the forehead can cost anywhere from $300 to $1,300.

It's Not for Everyone

While in some cases Botox is a great alternative to traditional plastic surgery, it's not for everyone.

"Anyone who has any sort of neurological disorder, such as multiple sclerosis or any type of neurological dysfunction, is not a good candidate. Neither is anyone who is pregnant or contemplating getting pregnant," says Dr. Walia.

Additionally, Botox is not recommended for women who are breastfeeding and for those who have an allergy to human albumin or botulinum toxin. Also, if you are planning to have Botox injections, you'll have to avoid beer, wine or alcohol for one week and aspirin or anti-inflammatory medications for two weeks prior to the procedure.

What's in Store

In addition to treating facial wrinkles, two recent studies have shown that Botox may be effective in treating wrinkles in the neck area, which have traditionally been eliminated through surgery. In one study, 1,500 patients were treated by three independent practices during a 36-month period to test the use of Botox in treating the aging neck. Of the patients in the study, 98.5 percent had good-to-excellent results and 1.5 percent had fair results.

"Botulinum treatment for the aging neck has several advantages," according to Alan Matarasso, MD, a New York-based American Society of Plastic Surgeons member and co-author of the study. "No preparation is required, the results are rapid, it is highly successful and predictable, does not require systematic anesthesia and patients experience little discomfort."

A second study on the use of botulinum toxin A in facial aesthetic procedures was conducted by Michael Kane, MD, who administered 50 separate treatments of platysmal bands between May of 1992 and August of 1998. Twenty-six separate patients were treated.

According to the study, the procedure is most appropriate for older patients who are not good candidates for surgery, older patients who have previously had neck rejuvenation surgery and younger patients with strong, dynamic platysmal bands who are not yet surgical candidates.

"Although most of the patients were very happy with their results, botulinum toxin A is not a replacement for surgery and definitely not a "face-lift in a bottle," says Dr. Kane.