Bride of Botox

Botox has overtaken Hollywood in a big way. The shine reflecting off those smooth, wrinkle-free foreheads is blinding. We need a new term for these shadowless faces. Suggestions anyone?

Approved for cosmetic use by the FDA in 2002, Botox (Botulinum Toxin Type A) has numerous established therapeutic applications. It is a neurotoxin protein produced by a bactierium, one of the most poisonous naturally occuring substances in the world. It acts by blocking neuromuscular transmission, the body's signal for movement. Used in minute doses, it treats conditions caused by muscle spasms, from blepharospasms and dystonias to hyperhidrosis. (That's tics, spazzes, and flop sweat for the lay person.)

It also happens to work quite well on those wrinkles that come with facial muscle movement. In fact, physicians refer to them specifically as "lines of expression," which is also the secret to verifying it's Hollywood use: can the actor in question emote using a full range of natural facial expressions?

Who admits to it? Teri Hatcher confession is perhaps the most common: "In the past I've had Botox and collagen." The picture at right gives the lie to that. It's the same claim made by the author of Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery. Alex Kuczynski (39) says botox was her "gateway drug" before she swore off everything. One look at her television promotion for the book tells you she isn't clean just yet.

But a few are open fans. Vanessa Williams (43) endorses it: "I think it's fine...It's a reality that so many people are incorporating into their lives...bring it on!" Virginia Madsen (45) is actually the spokesperson for Allergan, manufacturer of Botox and Juvederm. There's probably not a virgin face in Hollywood over the age of 12 right now. Even the youngest of actors is indulging in 'preventative injecting.' Early intervention immobilizes the movement that causes eventual wrinkling.

Botox is the gold standard for treating crow's feet, brow furrow, and forehead lines. It works by partially paralyzing the muscles creating those wrinkles. Done well, it provides a 'chemical browlift' and rejuvenates the upper third of the face. But a heavy-hand with the needle yields an immobile forehead like Nicole Kidman (40), Marcia Cross (45)...Nicollette Sheridan (43) won't comment. All exhibit shiny foreheads so frozen, it's almost frostbite.

What are the giveaways? Sometimes a still picture is more than enough. A grinning 40-year-old Caucasian woman has wrinkles. Inept technique can yield 'Spock' eyebrows, arched too far laterally or sprung apart medially. In motion, the face no longer emotes within anthropological norms because the eyes and brows don't move. Women in particular express a great deal with the upper third of their face (ask any man). Bad Botox really flattens an actress's range of emotion.

This mixed message has implications elsewhere, as well. Outside of Hollywood, Katie Couric fell victim to incautious use of Botox. John Kerry's presidential bid was almost derailed by a venture into Botox (or the appearance of it). Too much Botox garbles the visual cues for the observer, the face doesn't 'read.' When that happens, the viewer is liable to think all sorts of things.

What's exciting are the new, emerging uses of Botox for pain disorders in dentistry like TMJ (temporal mandibular joint disorder), bruxism, and temporal masseteric fasciitis pain syndrome. How you might ask? Botox works on smooth muscle fibers and, as it turns out, some pain fiber nerve termini– a source of many pain syndromes. Blocking the nerve transmission in pain fibers yields relief for all sorts of neuralgias such as migraines. Major medical research centers are actively exploring new treatment avenues using Botox for many intractable medical problems involving hyperfunctioning of muscle fibers. Emerging uses at Mayo Clinic (search on the word 'botox') include treatment of BPH (benign prostate hypertrophy) and irritable bladder syndrome. There really is a lot to be said for Botox, but don't expect to hear it out of the mouths of Hollywood stars.

Jane Fonda (69) famously blurted out: "No, I have not had Botox. I will see a woman in Hollywood walking towards me and I'll think that I know her but I don't know who she is. It's terrifying. Everyone looks the same....What I like about England is that people look like they're supposed to look."

Now Jane Fonda has had plenty of work done, but she still looks natural and age-appropriate. In moderation, Botox can look natural. Her objection has legitimacy, however. Many of these younger women who seek to emulate a creaseless existence have ended up erasing their individuality, who they are. In some cases they take it to an extreme and change species (think Joan Rivers).

As Cate Blanchett (37) shouted "...just live your life, death is not going to be any easier just because your face can't move!"



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Early Intervention (Authentically Aging)

Today's topic deals with those first steps– no, not the toddler ones, the surgical ones. Is it ever too soon, too early? Or, the earlier, the better? Read on...

The statistics vary, but the percentage of 20-something patients seeking out anti-aging therapies is on the up-tick. And it's not just lotions & potions that they are after. It's also the non-surgical procedures like laser treatments and dermal fillers and botox.

Premature aging is really the venue of pack-a-day smokers and girls who own tanning goggles, yet full-blown age-orexics are popping up everywhere. Hollywood has it's share– just read the tabloids to see what Lindsay Lohan, Jessica Simpson, Nicole Richie, Britney Spears, etc. are having done– but the antiaging obsession is affecting younger and younger women all across the country.

A young woman may pursue a series of light glycolic peels and microdermabrasion over several months to encourage skin cell turnover; Intense Pulsed Light therapy (IPL) laser treatments to eliminate broken blood vessels and sun spots; lipodissolve for cellulite; a little bit of Botox to forestall furrow lines between the brows or crowsfeet; and finally, Restylane or Juvederm to soften any smile creases should she be so reckless as to grin a lot (see above). And of course religious application of a topical retinol (vitamin A) preparation at night and sunblock, moisturizer and topical vitamin C everyday.

(You could also institutionalize yourself transfixed, motionless, and out of the sun ala Oliver Sacks's patients in Awakenings. All of the above will keep the face looking younger, longer.)

These would-be patients are completely preoccupied with the quest for sexy, ageless skin. Physiologically they don't want to leave their 20s. Middle-age has become no-woman's-land. Where does this antiaging fanaticism originate?

In the last decade cosmetic procedures have moved out of the exclusive domain of the surgeon's office into day spas, salons, you name it. It's now ubiquitous amongst the beauty industry. More and more surgeons have responded to the competition with...well, injections, laser, etc. for those who request it– whether or not it's medically indicated.

It's been described by one provider as akin to giving a kid who's underaged a sip of beer: "Okay, take a little taste of this. Better you try it here than at some party." No one involved in this is going to put the kibosh on it.

And today's young woman is raised in a media-driven culture. There was a time when Vogue's top fashion models were actual society beauties well into their 30s and beyond, who could afford the dresses they were wearing. Now haute couture is sold on the backs of emaciated 16-year-old giants. Hollywood has only character parts for the 'aging actress' while the surgically rejuvenated ones try desperately to fit into roles written for cellulite-free 25-year-olds. Television shows most of all exemplify the media's ever increasing tendency to marginalize the middle-aged female.

When people think of facelifts, images of aging Hollywood stars with their faces pulled as tight as their red carpet gowns might come to mind. But some of these 'ageless beauties' hung on with the help of subtle early intervention; threadlifts were said to have long ago helped the facial contours of Catherine Deneuve (63) (she's since had a lot more). And Nicollette Sheridan (43) clearly had work done when she turned 40. Sharon Stone (49) had her first facelift in her mid-30s immediately after wrapping Basic Instinct.

What constitutes subtle? Endoscopic browlifts have replaced the old-fashioned hairline deforming coronal forehead lift (Elizabeth Taylor) and nearly scarless lifts allow plausible deniability. Top-flight aesthetic surgeons have refined the techniques used for early surgery to a fine art. The best are now able to combine several minimally invasive procedures to give a final result which surpasses that of traditional facelift surgery IF the patient starts early– in her late-30s to mid-40s and her skin is in great shape.

Key here is the integrity of younger, intact skin. Pampered epidermis is elastic and resilent before hormone shifts kick during a woman's 40s. So these 20-somethings do have some validity to their concerns: rejuvenation really is all about the skin.

Can you age-proof the body? Not really. You can turn back the clock, like daylight savings time, but the clock is always running. It is a youthful conceit to believe that medicine has conjured up a surgical Dorian Gray.

So what's a girl to do? The most effective anti-aging interventions are well within the pocket book of every 20-something. Wear sunscreen liberally, year round. Indulge your inner movie star with polarized sunglasses when you venture out. Exfoliate daily and avoid smoke like the deadly wrinkle-producer it is. Save some of your money for another decade or two when gravity really kicks in.


Hear Anne live on the Kevyn Burger show Thursdays featuring Knifestyles of the Rich & Famous.