BOTOX – A decade later

BOTOX – A decade later

Sunday, June 24, 2012

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SO scribe Sharon Leach sent us all in search eight years ago of our C-spot. What was the use we bawled without an R&B cocktail? Few knew back then that an R&B cocktail was the insider code for Restylane and Botox beauty treatment. Back then in 2004, Sex and the City had come to an end and Plum Sykes's hot new novel Bergdorf Blondes was the must-read chick lit. MoBay, Jamaica, who would have thunk was where those in the absolute loop used the discreet entrance of what was then the MoBay Hope Medical Centre for the Restylane procedure (tiny amounts of crystal-clear, bio-degradable, non-animal, stabilised acid is injected into the dermis with a very fine needle). The husband and wife team of Lorraine Russo and Dr Z Paul Lorenc (pronounced Lawrence) were in residence. The cost back then of the R&B cocktail US$1800, that is US$950 for the Botox (10 injections) and US$850 for the Restylane.

Lots have changed since then, for starters, Botox recently celebrated a decade of existence - and it's still in huge demand. There's no need to go undercover as we did eight years ago...or is there?

The great reveal

Botox is not all about the plastic, 'fake' appearance that makes you look like a waxwork figure straight out of Madame Tussaud's, or like Kenny Rogers in recent years. "In fact," says Dr Norman Morrison, USA board-certified plastic surgeon and Assistant Clinical Professor of Surgery at Columbia University in New York, "the use of Botox is indicated for only certain areas of the face. It has to be used appropriately and in the right areas, and you can't use too much. For example, it should not be used above the mouth and in the cheeks. Botox weakens the muscles, so if you can't animate your face effectively, it'll give you an odd look. Sometimes, when you see this fake look, the patient has actually been using fillers and not Botox. In order to get rid of the smile lines in your cheeks, one would use these fillers."

Born in Jamaica, this Calabar High School alumnus has been working in New York, where Botox has become extremely popular, since 1986, and using it on his patients for over 15 years. He estimates that about 60 per cent of New Yorkers have had Botox at some point, including young girls in the fashion industry and Wall Street sales representatives who don't want to go to a meeting with that 'angry' look. "When it was first introduced for cosmetic purposes, it was for the middle-aged and older people. However, now young persons in their 20s are using it to get rid of their frown lines and lines on their forehead," Dr Morrison informs SO in a telephone interview he's giving while waiting at the airport to fly down to Kingston for a few days of business at the Winchester Medical Centre. He hopes to get some of the dermatologists in Jamaica up to speed on the use of Botox.

"New Yorkers are extremely open about using Botox, which is not only for the wealthy here," states Dr Morrison. "It is easily available and many people are asking for it," he goes on. At about US$500 for one vial of Botox, with so many people opting to use it, it can cost as little as US$240 to have it injected between the eyes in order to eliminate those frown lines, and you only need to have it done twice a year. It is all about economies of scale. The more patients requesting to use Botox at the same time, the less it'll cost each of them. According to Dr Morrison, "Botox lasts for about six months if you make it up correctly, using the right concentration." It works out to cost about 40 bucks a month, which one can see is quite affordable for the average New Yorker! To boot, "the more often you use it," says Dr Morrison, "the longer the effect. The muscles remain relaxed for longer, so they become less active. But you won't really see that in Jamaica yet, as people there have not been using it long enough, like here in the United States."

For example, one 60-something Jamaican, Isabelle, has been flying to Florida for five years in order to get rid of her frown lines between the eyebrows. Her skin doctor in Miami suggested that she try it, and after some trepidation, her worry about the horror stories of eyes drooping, etc, dissipated when she saw the immediate benefits to her skin. "I get it in-between the eyebrows every four months," Isabelle tells SO, "but I find that by default I end up frowning less and less, as it does actually stop me from frowning, so I have less lines to get rid of." Having had no adverse side effects since starting, Isabelle insists, "You have to go to a very good doctor. Don't fool around with that." Are the positive effects due to Isabelle's genetics, or is her doctor in Miami simply excellent at her job? Either way, this picture of beauty vows, "I will keep doing Botox for as long as I can walk!"

Almost 50 per cent of Dr Morrison's patients use Botox. "It gives them a better feeling of health, and in some instances, it helps them in their work," he says. However, Dr Morrison advises that anyone who is allergic to any of the ingredients in the drug should not use it. "I would also never use it in a pregnant or nursing female," he warns. That being said, Dr Morrison has had Botox injected into his own forehead once before, though he laughs and adds, "To me, my looks don't really matter."

"Botox is easy and safe to use," stresses Dr Morrison. The fact that "a lot of my plastic surgeon friends have had it is testament to its safety. I injected them". He adds, "These doctors would not have it done on themselves were it not safe."

Another Jamaican, Felicity, who is in her forties, also feels completely safe getting Botox injected between her eyebrows. For five years she has been going to American board-certified, Consultant Plastic Surgeon Dr Geoffrey Williams, at The Doctor's Surgi-Clinic in Montego Bay, and Felicity's life has changed. "I had these deep frown lines, and I was looking very unfriendly and becoming unapproachable," she tells SO. "My job is customer service-related in a big way, and one day I heard someone say, 'I am not approaching her, she looks mean.' It was upsetting, so I decided to go and investigate my options, and I'd heard about Dr Geoff in relation to other procedures. I did my research - speaking to others within the medical field, and reading about Botox on the Internet, before actually doing it. But after that, I wasn't nervous at all and started getting Botox straight away, every six months. Now I only do it once a year."

Going to Dr Williams, who trained in New York at Mount Sinai Medical Center and has been using Botox for as long as it's been available, has made Felicity "more confident, as I know that people are now not hesitant to approach me, and I feel happier approaching them". Did those who knew her before realise she'd had Botox done? "No," Felicity stipulates, "they just thought I looked fresher after a vacation I'd taken."

Felicity's close friends know that she gets the treatment done, but only a couple think she is narcissistic. The thing is, many of us do care about our appearance, and we wear make-up, spend money on nice clothes, have our body hair removed, and go to the gym regularly. Isn't Botox just another form of human vanity? And what about the 'raised eyebrows look' that some patients get, SO asked Dr Williams? "Initially, when we gave the injections for the frown lines alone, a common complaint would be the arching of eyebrows because we were relaxing the muscles in the middle and not affecting those on the side. If we only do frown lines, we must also give a little Botox outside each eyebrow to prevent the arching," he answers.

In contrast to what some may think is a self-absorbed exercise, there are real medical uses of Botox. "Botox is probably the most revolutionary thing that has happened in medicine," insists Dr Michele Lee-Lambert, Consultant Neurologist & Headache Pain Specialist at the Caribbean Neurology Pain & Headache Center on Altamont Terrace. Dr Bruce Rubin, Assistant Professor of Neurology at the University of Miami, who specialises in neuro-rehabilitation and has been using Botox since 1996, shares Lee-Lambert's sentiments about Botox, which he believes has "revolutionalised neurology in some sense, as there was no treatment for so many things before Botox, but now there is".

Dr Lee-Lambert has been doing Botox treatment on her patients for over a decade-and-a-half now, and pointed out a plethora of its benefits to SO, when we interviewed her at her private practice in New Kingston two weeks ago. These include helping and eliminating chronic headaches and migraines, muscle spasm/pain (Botox is a muscle relaxant), blepharospasm (movement disorder involving the involuntary closure of the eye(s)), facial spasm/hemifacial spasm/Meige syndrome, and hyperhydrosis (excessive sweating under the armpits). "A condition like blepharospasm can mean that the patient is unable to read, drive, or carry out any daily functions, because they are constantly blinking. For those with Meige syndrome, their entire face twitches all the time. And for the people with Torticollis, they have sustained movement of the neck, such as turning to the side or backwards," Dr Lee-Lambert informs SO. "In these cases the muscles in the face are hyperactive, and as Botox is a muscle relaxer that weakens, it ends up helping these patients. Basically, nerves talk to the muscles by way of neurotransmitters, and Botox blocks the release of these neurotransmitters," she explains.

SO sat with her and one of her patients, Harriet, an artist who has suffered from excessive blinking since 2004. Upon visiting with an ophthalmologist Harriet was told that the cause was dry eyes, but "when I had a car accident in Fern Gully, my eyes just closed", she says. "I thought I was exhausted as I hadn't been sleeping well. They didn't close permanently, but they'd close for a long time, then open, and so on," she continues. After seeing three more ophthalmologists, Dr Donovan Calder finally diagnosed her with blepharospasm, and Harriet went to Washington for an initial treatment of Botox, which relaxes the tense muscles around the eyes that are causing this uncontrollable blinking. "I then found out about Dr Michele Lee-Lambert in 2006, and have been going to see her every three months for Botox injections since. Sometimes I do stretch for a bit longer," she goes on, as her eyes close and SO witnesses the effect blepharospasm can have. "It then becomes painful behind my eyes," she says matter-of-factly. "And I become blind with perfect vision."

If Harriet didn't go on to receive treatment later that day, which only takes eight minutes and involves injecting Botox into the lash lines, she would be unable to drive, paint, or carry out any daily chores. Of course, by the time Dr Lee-Lambert finishes with her that afternoon, Harriet is fine, and she will be for the next three months.

Dr Lee-Lambert explained the lengths those who don't get Botox to help with their condition go to. "People will have the muscle surgically cut, tape up their eyelids, or use a sling to keep their eyes open." The problem is, many who have this condition do not realise that Botox is even an option, and those who do may be concerned about getting dry eyes, "but then one can simply use eye drops to help with that", Dr Lee-Lambert confirms. "Lots of people don't realise they can get help, because doctors tell them it is caused by stress, or other psychological reasons," she continues. She explains that this is not the case and that Botox is a viable solution. "There is no other permanent solution. Botox is really the only thing that controls these movement disorders," she continues.

Dr Lee-Lambert has another patient, Barney, a 70-year-old businessman in Kingston who has also been afflicted with blepharospasm for a very long time. "For ages I thought I had viruses in my eyes. I would blink excessively and would react badly to sunlight (photophobia). The blinking got progressively worse, and by sheer coincidence, someone mentioned blepharospasm to me. I went to UHWI and was told that there had been many attempts to find a cure, but the medical profession actually know very little about it. That being said, they told me that there was treatment, in the form of Botox," Barney enlightens SO. "The professor I saw advised me to go abroad, but I found Dr Lee-Lambert two-and-a-half years ago, and after one treatment I saw the benefits. Unfortunately Meige's syndrome also developed, so I get Botox for both conditions, and it controls them well for about three months.

"These conditions are the most aggravating and uncomfortable things to deal with. Prior to getting Botox, I was in a pretty bad state, couldn't deal with bright sunlight or overcast skies, had stopped everything and withdrawn from society, as I didn't want to look like an idiot." Interestingly, Barney tells SO that being on an oxygen machine helps him, but that it was simply impractical to be on one 24 hours a day. With Botox he only has to think about doing something about it four times a year! "Of course," he says, laughing. "The funny side about getting Botox is that people have warped ideas about it, and can't understand why I get it done when I barely have any wrinkles."

Dr Geoffrey Williams also treats blepharospasm. "You know it was one of the first uses of Botox in the Sixties," he says. According to Dr Williams and Dr Rajeev Venugopal, Consultant Plastic Surgeon at The University Hospital of the West Indies and Associate Lecturer in the faculty of medicine at The University of the West Indies, Botox started off as a treatment for blepharospasm and crossed eyes. "As a side effect," Dr Venugopal tells SO, "it got rid of the patients' wrinkles. In fact, a lot of things in medicine are stumbled upon like that. Then people started using Botox cosmetically, and elsewhere."

Dr Venugopal, who also has a practice at Seymour Park, has been doing Botox on patients for about nine years and during that time he thinks its uses "have changed dramatically, in terms of what has been offered. However, the public doesn't really know about the conditions it helps with, like excessive sweating, migraines, anal fissures, achalasia, and neuro-muscular disorders". Although he has had a fair amount of experience using Botox, and has about 18 regular patients in the cycle, he urged SO to talk to doctors of other specialties, who also use Botox, so that we could get a full scope of its amazing uses. That being said, he praises its ability to "stop the aging process, albeit temporarily, without having to undergo surgery. And compared to surgery, it is not as technically demanding". What about the side effects? SO inquires. "The dosing of Botox is not an exact science, and it does depend on the sensitivity of the patient, but the good thing about Botox is that it is reversible, and its effects wear away," he assures. "The fact that it has been on the market for such a long time, and is still on the shelves, and that patients are happy with the results and keep coming back, should say something."

Dr Rubin, to whom SO spoke on the phone last week, gave examples of patients who come to see him in Miami for spinal cord injury, cerebral palsy, Parkinson's disease, stroke and Multiple Sclerosis (MS). "We use Botox in these instances of spasticity, where the muscles become tight and don't move the way they should. Think of MS, where the patients often have spasms in such a way their legs are pulled together, and they are unable to pull them apart. This makes it difficult for them to use the bathroom or clean themselves. When we inject Botox into these muscles, it relaxes the muscles and makes a big difference to their mobility, and now they, or their caregivers, are able to do what needs to be done," he enlightens us. "And when it comes to strokes, patients may well have spastic arms drawn up by their side, or are only able to run on one side of their foot. Botox can improve the arm movements, and pull the foot down so it lies flat on ground, which makes a huge difference in their balance."

Dr Rubin, who has been using Botox since 1996, and now has a few hundred of his patients on it, tells SO that although it's actually been around for about 50 years, Botox hasn't always been FDA-approved, and its different uses became FDA-approved at different times. For example, it was finally approved for migraines in October 2010. "For some things like Temporomandibular Joint (TMJ) Syndrome, Botox is very effective, but has not been FDA-approved," he informs. TMJ is pain in the jaw joint that can be caused by several medical problems, and can lead to severe aches and pains around the face and head. "Actually, there are about 80 different uses for Botox. Most are not FDA approved, but Botox does help them."

Why haven't they been approved, then? "It is a fairly safe toxin," Dr Rubin assures SO. "Sure it has side effects, like muscle weakness, and it can spread to muscles near the injected site, but any side effects you don't like will wear off within a few months. Of course, the bad news is that its effects do wear away, so if you like what it does, you will need more Botox."

Dr Rubin confirms that "there has been more research into the toxin and the understanding of how it works, and its use in pain outside of muscle relaxation. We use Botox for migraine, but we are not sure why it works. Botox ends up working in the same way as a neurotoxin, which stops the release of the chemical acetylcholine in the nerve that controls the muscle. We inject Botox into the muscle and it finds its way to the nerve, so it probably does similar things in the sensory nerves".

How did doctors even get to the point where they knew Botox would help people with migraines? "Botox was found to be helpful for migraines, when it was observed that when patients had plastic surgery to remove the lines between the eyebrows, in the glabellar region, their migraines were improved," Dr Lee-Lambert tells SO. The absolute tragedy of those who aren't aware of this is that many people go through their entire lives never getting relief from their migraines.

This almost happened to Hayley, a 43-year-old mother who remembers getting her first migraine when she was 10. The migraines got progressively worse, and she would have to lock herself in a dark room and try to sleep them off. "Finally I went on preventative medication after I had my second child, and it helped somewhat. But I had to come off it when I wanted a third," she recounts. "I even did a food log, upon advice from my doctor, to see if there were any triggers. I found that staying off citrus and chocolate really did work for a while, but then a few years ago the migraines started coming on again. I couldn't do a thing, not even get out of bed, or take my kids to school. I went to see Dr Lee-Lambert, and she put me on some new preventative medications, but the migraines were so unbearable, two years ago, that she suggested Botox. Of course I said no at first, as I thought Botox was only for cosmetic reasons. In fact, I thought she was crazy telling me to use Botox. However, at this point I was unable to face the light, and I'd have to be hooked up to an IV of pain medication in her office in order to function at all. I was living a nightmare, being very quiet and feeling like I was dying.

"One day I decided to try it, and I instantly felt my neck and shoulders relaxing. It really did work. The pain started to come back after a year, but not as severe, and I nipped it in the bud with another treatment of Botox. Now it has been over a year, and I am only on preventative medications. The moment the migraines return, I will go and do it again. I would never wait for it to get bad. Right now I don't feel tightness in my neck and shoulders anymore, and if I have a slight pain in my head, I pop some Tylenol. Botox may still be a bit taboo, but it has changed my life for the better," Hayley concludes.

Hayley's neurologist, Dr Lee-Lambert, regularly gives about 80 of her patients Botox, a third of whom she treats for medical reasons, two-thirds for cosmetic. While she recommends it for all of the above, she stresses, "Botox is not recommended for pregnant patients. And there are adverse effects if you get a bad job done. For example, if it is done in the neck, it can cause difficulty to swallow as it can make the muscles weak," she warns. "This will wear off, but the key is to make sure your doctor starts you on a low dose, and increases from there if needs be."

"It is effective, extremely safe, and easy to use," Dr Norman Morrison insists. "Speak to a doctor who knows about it, and someone who has been using it for several years, and read as much as you can about Botox. It is all about patient's education."

"Bottom line," asserts Dr Lee-Lambert, "Botox is one of the greatest medical inventions, especially for neurological disorders."


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