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In Love With the Needle
 

In Love With the Needle
I first wrote about Botox 14 years ago. It was one of those "only in America, shock, horror" stories about the ageing, vain and clearly mad who were injecting lethal toxin into their faces in a deluded effort to look young.

Fast forward to June 2006, and I am sitting in a surgery in Wimpole Street, London, having my top-up of the same toxin. I am ageing and vain -- but not mad or deluded -- and, having now had Botox for six years, I think it is one of the best nonsurgical anti-ageing treatments around.

As do millions of others, because Botox, or the botulinum toxin, is the western world's most popular medical anti-ageing treatment. But it is also the one with the worst press.

When it comes to Botox and its detractors, a little knowledge is a dangerous thing. The medical facts are pretty straightforward. The overhyped and apocryphal stories against it are, at best, ill informed and, at worst, another urban myth.

Botox is safe, but don't take my word for it. It has been used medically since 1980 (treating facial tics, muscle spasms, excessive sweating, lazy eyes and cerebral palsy) and was approved by the FDA in 1989. It has been used cosmetically since 1987.

Last year, the Journal of the American Academy of Dermatology reported the findings of the first independent study on those who had had Botox regularly for more than 10 years. It wasn't stored in the liver, or elsewhere in the body, and it didn't leave long-term treated muscles withered and dying.

As for those women I keep hearing about whose faces have been irreparably damaged -- apparently, one woman has been wearing a veil for years since her Botox disaster -- the simple fact is, Botox can't do that. It stops the muscles from contracting, but only for a limited time before the body naturally breaks it down and gets rid of it. That's why I have to keep going back for top-ups.

It can, however, migrate, and, as most of it is injected on the forehead and crow's-feet, you could get a droopy eyelid, which would undoubtedly be traumatic. However, while this will wear off with time, experienced Botox doctors can potentially lessen the effect by injecting more into the relevant depressor muscles to help lift the droop.

Botox is the one treatment that most administering doctors also use on themselves. Many dermatologists use it to stop themselves sweating before giving a speech at international conventions: something, perhaps, for Tony Blair to think about.

The main, and admittedly fair, criticism levelled at Botox is the appearance of all those hideously frozen, Stepford-wife faces we've seen in recent years. But, as the dermatologist Dr Nicholas Lowe says: "There's no bad Botox, just bad Botox practitioners." If you are a medically trained doctor, and therefore legally allowed to inject, then you can inject Botox. However, a steady hand with a syringe doesn't automatically give you an aesthetic eye for improving an ageing face. And this is what really makes the difference.

Bad Botox freezes a face, removing appealing expression lines along with ageing frown lines. Good Botox stops the excessive, and usually unconscious, movement of certain muscles while still allowing you to scrunch up your forehead in anger or raise your eyebrows in surprise. You should look like you, just more like you used to look five years ago.

Dr Jean-Louis Sebagh (the man I trust for my Botox) calls it "emotional Botox." "It's about relaxing, not freezing, the muscles, so you remove the overexpression, not all the expression. You need to find that balance."

It's not always the doctors who are to blame. Some women want an immovable face, either because they like the look or because they want that blank canvas. "I have women who tell me they don't want to show anything, or any emotion, for whatever reasons," says Sebagh. These are often the true desperate housewives, whose husbands are having affairs or whose children have gone off the rails, and they want to hide behind a bland mask of superficial serenity.

The clever doctors constantly hone their work. For example, in my early Botox days, I noticed that, while my crow's-feet slowly disappeared (even when it has worn off, my lines are better now than they were six years ago), some new lines developed right under my eyes. This, Lowe told me, was a common effect: as one muscle is weakened, another takes over. Now, with a bit of adjustment in the injection sites, this problem has gone.

It's also important that the doctor looks at your face, studying it closely each time, because faces change and, as I've discovered, the way we want them to look changes, too. Over the years, I've asked to have less round the eyes, and I now like a few lines on the forehead. I've also found I need and want less than I did a few years ago. But the frown line between my brows seems to be fighting back, so that has to be zapped more frequently.

Last time round, Dr Sebagh injected just under the corners of my mouth, and the result is quite astounding. Instead of my mouth turning slightly down (age and gravity) it now curls up slightly. Every few visits now, there's a new place to be jabbed, a new muscle to be lifted or relaxed, but as the effect is subtle -- and short-term -- and because I trust my doctor, I am happy to go along with this work in progress. As for my age, judge for yourself. I tell everyone something different. Today, I'm 41 (a lie, but near the truth.)

NEED TO KNOW

• Botox, which is a trade name, is a prescription drug used in a medical procedure, so only go to a clinic or surgery where a qualified doctor injects it. Dysport is another, slightly stronger and widely used form of the botulinum toxin. Many doctors use both, depending on the muscles treated.
• Think before you have the procedure done. If you go to a Botox party, beauty salon or spa, they won't have a range of treatments on offer. "If you only have a hammer, you can only bang in nails," says Dr Nicholas Lowe. "To get the best results, we often combine different procedures. Botox doesn't do everything."
• Ask the right questions. How long has the doctor been injecting Botox? How many patients do they regularly do? The longer they have used it, the more experienced they are.
• Less is more. Going back for a top-up is better than looking like a death mask for three months.
• Get to know your face. While you can "freeze" the negative (angry frown lines), expression lines on the forehead and around the eyes look better when just "relaxed."

Original Source: Newby Hands, Harper's Bazaar Health & Beauty Editor; The Times Online;

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