Lifestyle: The base line on Botox

Ahem... George Clooney, of course.

BOTOX today is one of the most closely-guarded secrets among the beautiful people who throng Page Three. But what is it all about? Is it medically beneficial? Does it lift both the sagging of the spirit and the face?

Dr. Stefania Roberts, an Australian doctor of Italian descent, married to an Indian IT professional, provided some vital answers in an interview in Bangalore. A sclerotherapy specialist, she currently works as a cosmetologist with Dr. Greg Goodman in Toorak, Melbourne.

She was in India recently for six days for training sessions on Botox in Mumbai, Bangalore and New Delhi, followed by a symposium in Jaipur. The trainees included plastic surgeons, dermatologists, cosmetologists and ophthalmologists.

“We’re looking at artistry with Botox, its application to the muscles to create a different look,” Stefania explains. “We’re trying to bring in uniformity in Botox applications across the globe. I’m here to share the American and Australian perspectives, so that the Indians can adopt Botox to suit their needs here.”

What is Botox? The drug, which first came to India in 2006, is a trade name for botulinum toxin type A, a neurotoxin produced by a bacterium, Clostridium Botulinum. It has been used to treat neurological disorders over the past four to five decades, according to a press note. As a therapeutic or cosmetic injection, it works on the neuro-muscular junction to stop the release of acetylcholine, known to cause excessive contractions. Originally, it was used to treat, say, cerebral palsy. Now, gastroenterologists even use it to ease a tightening at the base of the eosophagus. It is even said to work in 75 per cent of migraine cases. Botox is currently being tested for use in prostrate problems.  

But what of its cosmetic usage? In 1981, Canadian pediatric ophthalmologist and ophthalmic geneticist Jean Carruthers joined her dermatologist husband, Alastair Carruthers, on a fellowship in California. They proved that Botox could be used to ease frown and smile lines, brown spots and skin creases. Besides, it seemed safe in the long run, with temporary effects from three to eight months. The couple now practice in Vancouver.

An Indian angle? “The Indian population ages very well,” explains Stefania. “In the 1970s, we had quite a bit of migration to Australia. With Botox, what we’re addressing is a very non-invasive technique where we’re injecting a purified protein to relax the muscle. It takes only five minutes to do. We treat mainly the glabella or frown lines, or crow’s feet. Or the muscle imbalances in the lower half of the face, like the sagging corners of the mouth, or the neck muscles to give the jawline more definition. It’s all about looking good, feeling good, and going out into the world.”

What of culture-specific applications? She points out that in Korea, there is a huge demand for Botox shots to decrease the squareness of the jaw. In Australia, it is often injected for people who clench or grind their teeth. The Europeans, she stresses, come across as well-dressed, confident, sometimes with subtle cosmetic enhancement, including Botox.

But, of course, its side-effects on the individual are still cloaked in incertitude. Rare, spontaneous reports of death have occurred, sometimes associated with cardiac arrest, allergies, or even pneumonia.

Stefania’s practice mainly covers Botox fillers, operating on vascular lasers, and treatment of varicose veins in a private hospital. She is a Botox trainer in both Australia and New Zealand .

“I’ve been using Botox for the last ten years. The worst complication I’ve had with it would be a bruise. Or an eyelid could potentially drop, which usually lasts one to three weeks, then reverses itself because a little Botox has gone into one of the little muscles that elevates the eyelid,” she says. “In one or two cases, it has led to a crooked smile for two to three weeks, but it reverses itself. This is the safest procedure that I do. With my vein patients, I’m actually scared I could create a deep-end thrombosis while treating them intravenously.”

Stefania earlier worked in general practice. So, she makes out a case for children as young as three who have been treated with Botox for cerebral palsy. She reiterates the importance of updates in the use of the medication.

That brings us to the glamour value of enhancement by Botox, collagen or other methods. Say, in the revamped features of Michael Jackson. “Personally, I think that’s cosmetic surgery gone wrong,” Stefania says. “I think we need to learn from these people who have taken surgery too far. Jackson’s probably had some Botox along the way, but it’s surgery that’s altered his appearance. That’s facial restructuring. He looks nothing like he used to.”

“In my practice, the procedure is non-invasive. The patient looks refreshed. We don’t change their appearance,” she reiterates.

As larger numbers look to natural therapies for alleviation, where does Botox fit into the overview? “I think there’s a place for both,” stresses Stefania. “If people want to choose a more natural path, it’s certainly there. There will be many who will prefer to age naturally.”

Perhaps with Demi Moore, Sharon Stone or George Clooney in mind, she adds, “We have to learn from the Hollywood stars. The effect of gravity and time leads to sagging. At the end of the day, they will continue to age. Is that a good look? Patients often say: I don’t want to look like that.”

As the global urban individual searches intently for the forever young look, what would her focus be? “I’d be concerned that the cosmetic industry is growing by the minute. There are new procedures happening to reverse the signs of ageing ~ laser to Botox, different forms of lifting. It’s like technology. We can’t reverse this trend,” she says.

As more men join women in seeking out botulinum toxin, there is a yearning to lift the face, and thus the spirit. That would be the base line on Botox.

(I wrote this piece for The Hindu Business Line in 2003)