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The Misconceptions of Botox Part 1
Despite the increasing uses of Botox, many people are still frustrated by the misconceptions surrounding it. Some of the misconceptions have come about through tawdry science, others through anecdotal evidence and others through ignorance.
Misconception No 1: Botox injections are highly toxic
Nearly every worthwhile drug in medicine is a diluted solution of a toxin. If you had a major cardiac event today and ended up in hospital most of the drugs that would be used to save your life, digoxin, atropine, lignocaine or adrenalin are all chemicals extracted from plants, microbes or animals that are used in a controlled fashion. Some drugs such as digoxin are extracted from the foxglove plant can actually stop your heart beating if they are used in a strong enough strength. If we dilute them they have less effect but could stop your heart from beating uncontrollably and allow it to beat normally. Other drugs such as atropine are extracted from deadly nightshade can block the nerves that slow down your heart and allow it to beat normally again. Roman girls put a diluted form of this compound into their eyes to dilate them and make their suitors feel they were chemically attracted to them. In a similar way, Botox is a mild dilution of botulinum toxin, which can cause a serious form of food poisoning. The safety of Botox is also ensured by its selective administration into a certain muscle or a group of muscles, which leaves it largely incapable of action outside the given area. Remember we give new born babies who suffer cerebral palsy or muscle spasms much higher doses every day without evidence of problems. Many physicians would agree that aspirin and antibiotics are potentially more harmful than Botox. However like any drug, anaphylaxis can occur and Botox procedures should be performed by trained physicians in proper clinics with adrenaline on standby.
Misconception No 2 Patients can develop an "addiction" to Botox injections
This misconception was based on a recent UK psychological study, which was apparently based on a survey of clients at eighty-one clinics. The study reached the conclusion that more than forty per cent of patients regularly using Botox expressed a "compulsive motive" for doing so. The research was conducted by Dr Carter Singh, a psychologist, and Martin Kelly, a plastic surgeon with London Plastic Surgery Associates. The results of the study showed that about forty percent of people who have resorted to Botox injections to reduce wrinkles were very prone to request another such treatment in the near future. Those who had received five or more injections displayed more "addictive traits" than those who had not. However, I personally feel the study was totally unscientific and as I stated in a press release at the time.
“Primarily, the medical definition of addiction means it has to involve repeated use of a substance or behaviour despite the patient being aware that it is detrimental to their health. There is no evidence that Botox has any detrimental side effects, in fact to the contrary it has a built in mechanism to protect the patient by the use of new nerve regeneration"
“In essence, this type of tawdry science appears from time to time and should not get a public airing. It only serves to confuse the public and give these people some short lived glory that the rest of responsible medical doctors have to take many years to diffuse”.
Misconception No 3 Botox injections can cure depression
The idea that Botox can cure depression came from a study in the May 2006 issue of the Journal of Dermatologic Surgery, where Dr. Eric Finzi from the Chevy Chase Cosmetic Center in Maryland claimed to have treated clinically depressed patients with Botox. This led to further exposure on Good Morning America, where he claimed that by taking away the ability to frown, he was breaking a neurological feedback mechanism to the brain and thereby taking away the ability of his patients to feel depressed. I must say that I was initially heartened to see the study of the treatment of depression with Botox as many doctors will reveal a similar picture from their patient's own experience. I examined Finzi's paper in the Journal of Dermatologic Surgery and was concerned that this doctor used a very small number of patients, lacked a control group, had no psychiatrist assessing the patients and even allowed the patients to assess themselves. I noted in an accompanying commentary, the editor Alastair Carruthers, cited a series of flaws with the study and concluded that its finding must be considered anecdotal. It is of more than passing interest that this doctor has now filed a patent concerning this treatment. If Botox does relieve depression then this is not the paper to prove it.
Misconception No 4: Botox injections distort a facial expression
This is one of the most common misconceptions about Botox procedures. Many people seem to forget that the resultant expression on a patient's face is really dependent on the skill of the proceduralist and has little to do with the Botox. This means that the ability of the brow to raise or lower, the ability of the frown to move or not, the ability of the crows feet to disappear or slightly remain is usually dependent on two factors, the amount of Botox added and to the location to where it is added. Accordingly, facial expressions can be distorted only in case of an overdose or misdirected injection of the drug. By analogy, if your house flooded after installing a new washing machine, surely you would blame the plumber and not the water company. The bottom line is those who want to look five years younger are strongly recommended to use services provided by certified experienced doctors rather than attending home-based charlatans who frequent beauty parlours and salons.
Misconception No 5: Botox injections cause headaches
On the contrary, although Botox can cause headaches in about 2-3% of people, it actually relieves them in the vast majority of patients treated. It has been known for some time that Botox can help prevent and treat migraine sufferers. To do this, doctors usually inject it into various trigger points that can differ from patient to patient. The duration of action of Botox in migraine prevention varies from about 10 to 13 weeks and the onset of effect may take a few weeks. Ideally, the medication should not be administered more frequently than every 3-4 months. I was interested to see a recent paper by Brazilian dermatologists Dr Bertha Miyuki Tamura and Dr Bobby Chang (Dermatol Surg 2003) who used known acupuncture points to achieve temporary relief of pain in acute migraine. They gave the treatment to 10 women who regularly suffered from severe and prolonged migraines and after 2 weeks, 90% were pain free and one had minimal pain. The results lasted between 4-6 months. This is about the same level of effect that we see in clinical practice.