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injection and you can wipe the lines off your face
"Bo-tux",
"Bu-tox", "Ba-tox", "Buttocks",
"Bo-tax". Actually it is Bo for botulinum
plus tox for toxin A, Botox, the trade name for botulinum
toxin A, the wrinkle remedy lovingly referred to as
a "coffee break facelift". The mispronunciations
were heard recently in a ballroom full of Mumbai's glamorous
and glamour-conscious who had congregated for a coffee
break minus the facelift. Actors, actresses, patients,
clients and friends-mostly women (though the experience
is unisex) came to get greater knowledge on this latest
wonder-drug when leading cosmetic plastic surgeon Dr
Narendra Pandya and his daughter Dr Sonal Pandya-Sheth
launched their book Botox-A Ready Reckoner.
Though more than 15-years-old internationally, Botox
was introduced in India towards the late 1990s. Botox-A
Ready Reckoner predicts the possible phenomenon Botox
might become in India (it's already the most popular
cosmetic procedure carried out in America for the last
eight years) and demystifies it and aims to make the
injected protein more user-friendly. The presence of
actors like Jaya Prada, Hema Malini and Sanjay Khan
at the book launch certainly led to great speculation
and close scrutiny of their faces for lines and signs
of expression-though all denied having tried Botox.
In fact one wonders how actors and actresses can expect
to stay employed if they freeze the ability to show
expression with certain parts of their (previously wrinkled)
faces?
But it turned out that most present expressed curiosity
about the procedure and its effects. How much does it
hurt?
"It pains only at injection site and feels a little
like a bug bite," replied Dr Sonal Pandya-Sheth.
How long before you feel its full effect?
"Two days."
Have you tried it?
"I have tried it," said Dr Narendra Pandya,
"and no complaints so far."
Men and women across the world are opting for this non-surgical
cosmetic procedure that wipes lines (and supposedly
years) off your face. In India alone that figure has
risen from 3,500 procedures in 2003 to 7,000 in 2004,
and counting.
Hema Malini says she is not ready for Botox. "I
may think of using it if it's ever needed. After all
we have to look good and be photographed." But
Zarine Khan, interior designer and wife of Sanjay Khan,
has a different point of view. Though she says she has
not tried it, her fear of the 10-minute procedure is
the pain. "I might be tempted but for the pain,"
she says. Administered through tiny injections, the
procedure is said to feel like an insect sting and might
be followed by soreness, mild bruising, headaches and
drooping eyelids. Fortunately the injected substance
dissolves after 48 hours however its effects can last
from between three to six months at which time you can
go back to your doctor for another dose. If you opt
not to, your original lines or wrinkles will return.
So what is this new-age vanity drug that has people
lining up for line removal? And how does it help you
cheat ageing? Botox is injected in muscles that cause
wrinkles and lines, like horizontal and vertical lines
on the forehead or crow's feet near the eyes. The botulinum
toxin A temporarily paralyses the muscles so that the
lines cannot be formed.
In the 1950's, Dr Vernon Brooks, a doctor working in
Montreal, first discovered the effect of the type A
toxin on muscles: it paralyses them. Research was taken
over by Dr Alan B Scott, California, in the 1960's and
1970's. He was able to determine that the toxin could
be an effective treatment for crossed eyes (strabismus).
Scott and Dr Edward Schantz of the Food Research Institute
at the University of Wisconsin, created the first botulinum
toxin type A product, which they called Oculinum.
In the late 1980's, pharmaceutical company Allergan
bought the rights to distribute Oculinum, and changed
its name to Botox. And that is the name by which we
know the procedure and substance that is supposed to
render all expressions-and signs of ageing-non-existent.
Approved by the US Food and Drug Administration in 1989,
1.6 million Botox procedures were reportedly recorded
in the US as far back as 2001. Whether you are 18, 65
or somewhere in between, Botox can be yours. But, like
those other products that carry statutory warnings-smoking
and alcohol-Botox is not recommended for pregnant women,
nursing mothers, patients with skin conditions and neurological
disorders. Other than cheating Nature, and time, Botox
has also been used as a treatment for children's squints,
to control excessive sweating on the underarms, palms
and soles of feet, blepharospasm, strabismus, and cervical
dystonia-conditions that in some way involve spasms,
involuntary muscle contractions. It can also be used
cosmetically on the horizontal lines of the forehead,
the vertical lines between the eyebrows, for crow's
feet, under eye lines, bunny lines near the nose, the
tip of the nose, to lift up a sad mouth, to relax an
upward-pointed chin and on necklines.
Cosmetic physician Dr Jamuna Pai says that it was she
who introduced Botox to India almost eight years ago
and over the last years she has noted a perceptible
increase in clients. "There was initial apprehension
but people have started opening up. Each year we find
30 to 35 per cent more people opting for Botox,"
says Dr Pai who has used Botox regularly for almost
four years. "I inject it in myself," she shares,
adding, "but one must know the anatomy of muscles
before administering Botox. I believe non-doctors are
also offering this service but one must be careful.
If the wrong muscles are injected (and therefore paralysed)
it can result in adverse side effects."
Recently there have been a few cases of cosmetic users
of Botox filing complaints against their doctors and
the manufacturers. For instance Irena Medavoy, wife
of producer Mike Medavoy, sued Botox and her dermatologist
for severe complications after she was injected with
Botox for facial cosmetic treatment and migraines. It
is said that Medavoy was bedridden for several months,
in the hospital for respiratory problems, had mind-altering
headaches, severe muscle pain, etc. "We have 20
years of data to show Botox is safe. But with anything
not given correctly there are dangers. You need to know
your practice and the precautions. In the West they
tend to give very large doses-as are given for neurological
conditions or optic remedies. These large doses (over
100 units) can have very adverse effects." Citing
her own experience, Dr Pai says that a doctor in Singapore
once gave her such a high dose of Botox (all over her
face) that her upper lip drooped so much that she could
not see her upper teeth for six months.
On the dangers of Botox, Dr Pandya's book says: "Although
theoretically this is of concern, in practical reality
the amount of toxin in Botox is so small that it is
well within the safety limit… Allergan, the manufacturers
of the toxin, state that it is broken down and leaves
the body within 24 to 48 hours, so that there is no
possibility of longer term build-up with repeated treatments."
However, Dr Pandya's book also adds that "medical
science is an ongoing field and it is impossible to
guarantee that some negative untoward effect may not
appear in the future." The authors add that some
of the side effects are headaches, bruising and swelling
at the injection site, flu-like or respiratory symptoms,
nausea and temporary eyelid droop.
 In
the US, each sitting costs between $500 and $600. Each
vial contains the vaccine in the form of dry powder
and when reconstituted it has 100 international units.
Most patients, says Dr Pandya, require 25-75 units.
Doctors may share vials to amortise the cost. Dr Pai
charges Rs 6000 per session. "We get through about
a vial a day, but we also administer much smaller doses
to give a fresh look. I don't believe in giving our
clients expression-less faces." So Dr Pai uses
about 12 units for women and about 18 units for men.
In the West, women and men get together for cocktails
and wrinkle-banishing injections. Yes, Botox parties
arranged by physicians, patients or manufacturers are
causing some concern amongst practitioners. Inject while
sipping champagne. But here's the small print: alcohol
and Botox do not mix well. Says Dr Pandya, "It
is unwise to participate in such parties. Although they
are not yet being held in India, someone may start organising
them."
Sylvester Stallone, Madonna, Celine Dion, Cher and Kylie
Minogue are rumoured to be users, but Joan Rivers, actress
Annie Potts and Cliff Richards have come out of the
Botox closet. Closer to home, television personality
Pooja Bedi wrote in her column in a Mumbai newspaper
last year that as she was preparing for her role as
a TV presenter, she: settled for a few quick shots of
Botox, which miraculously wiped clean the deep lines
from my forehead." And she's never looked back.
"One should be the best one can be. I am proud
of mankind and science for discovering Botox,"
says Bedi who has so far used Botox twice. "The
first time I went to a doctor, it was painful, but the
second time when I went to a skin clinic it was quite
painless. You need to select the practitioner carefully,"
advises Bedi who confesses to being needle-phobic but
went ahead with this anyway. "I just wanted those
three lines to go and it's all for the better! I can
say or do anything and those three wrinkles just don't
appear."
Architect and art columnist Nisha Jamwal feels that
there is no excuse for "looking frumpy and succumbing
to the ravages of age." Both Jamwal and Bedi are
women who believe you must look the best you can-at
all times. "I've had a very stressful life and
felt all that stress was sitting on my forehead. So
I had 10 botox injections all over my forehead. It was
like a metaphorical release," confides Jamwal who
believes that as a professional she needs to be "well
packaged" at all times. "I will have it again
and again. We are in charge of our possessions, so why
not our noses, brows and lines?"
But what of the argument of letting Nature run its course?
Bedi is clear. "Why do we medicate ourselves when
we fall ill? Things decay and degenerate but I don't
think there's anything wrong with fixing things to make
them work better. You need to set your own personal
standards. The problem is when it gets obsessive. I
would never opt for invasive surgery but I'll use creams,
massages, Botox, exercise. Each one has to draw their
(sic) own lines."
Botox disagrees and offers to erase all those lines.
Finally, it's up to you to draw your own lines-wherever
they may be.
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