| I've Got a New
Forehead, but It Doesn't Move
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AFTER:
Buzz McClain post-BOTOX.Cosmetic, unable to furrow his brow.
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By Buzz McClain
Special to The Washington Post
Tuesday, February 19, 2002; Page HE01
The phone is chirping, e-mails are waiting and Morgan the mailman is
ringing the doorbell, but right now I'm staring into the foyer mirror
wiggling my eyebrows.
Or trying to. Up, down. Up, down. This is hard.
My eyebrows used to be so pliant, so responsive, so . . . arch. But
now, nothing. Or very little. I feel like Jack Nicholson looks.
My forehead – a former terrace of wrinkles – is now nearly as flat
as a mountain lake at dawn. My crows' feet – which used to be
multi-tined pitchforks creasing my temples – are nearly as imperceptible
as footprints on a sidewalk. The double wrinkles between my eyes (on a
section of the face called the glabella – a great trivia question, by
the way), once so deeply furrowed they appeared to create a vertical slot
to accommodate coins, are gone. And my eyebrows, formerly a pair of
recklessly loose-limbed parentheses, are now calm horizontal frames,
thanks to eight injections of a refined version of a deadly toxin.
At a New Year's Eve party I met Michael R. Abidin, who with his partner
Iyad S. Saidi operates Metropolitan ENT in Alexandria. After discovering
that Abidin, a board-certified 39-year-old ear, nose and throat specialist
(ENT), also does plastic surgery on accident victims, the party
conversation steered toward, um, recommendations for, you know, guys like
me: 46 with a face starting to resemble an aerial view of Tora Bora.
"I wouldn't recommend surgery," he said. "We could fix
you up with Myobloc. Smooth out the forehead, take care of these," he
said, lightly touching the corners of my eyes.
And Myobloc is . . . ?
"It's like BOTOX."
Ah, yes. BOTOX.Cosmetic. Derived from botulinum toxin, the stuff famous for
causing food poisoning. The idea of voluntarily – heck, recreationally
– injecting botulism into my face to paralyze the offending muscles was
. . . oddly appealing. The effects last only three to six months, so if I
didn't like the New Me, I'd be back to normal around Memorial Day.
And then I heard the price: $350. Sure, the results are just temporary,
but it's a lot cheaper than a face-lift, which goes for $5,555, and that's
for the surgeon alone, according to the American Society of Aesthetic
Plastic Surgeons (ASAPS). And since I'm not pregnant or breast-feeding,
the only known contraindications for Myobloc, what the heck? It's not like
a tattoo or something, right?
The March of
Science
Myobloc is the baby sister of BOTOX. Both are derived from botulinum
toxin, "the most potent biologic toxin known to mankind," says
Chris O'Brien, a San Diego neurosurgeon and vice president of medical
affairs for Elan Corp., the Dublin-based company with the Myobloc patent.
In fact, O'Brien says, botulinum toxin derivatives were originally –
and this will set your mind at ease – developed in the '60s by the
Department of Defense for use in biological warfare. "Nanogram
quantities can be fatal," O'Brien says, and this particular form of
death isn't pretty: Your muscles become paralyzed and you stop breathing.
Happily, he adds, "it's hard to weaponize."
As science marched onward, an ophthalmologist, Alan Scott, reasoned
that a tiny quantity of botulinum toxin Type A (Botox; Myobloc is Type B)
injected into an overacting muscle could be used to treat strabismus –
crosseye – in children. He was right. It was later approved for use in
blepharospasm (facial twitching) as well.
A Canadian ophthalmologist, Alastair Carruthers, noticed that not only
did the paralysis of the muscle correct the target condition, it also
smoothed out the lines near the injections. Carruthers and his wife, Jean,
a dermatologist, published their observations and Botox came to be used
widely as a wrinkle treatment. Myobloc quickly became some doctors'
preferred toxin when it arrived on the market at the end of 2000.
"It's a win-win," says Malcolm Paul, a Newport Beach, Calif.,
plastic surgeon who is president of ASAPS. Using either Botox or Myobloc,
"it takes 10 minutes to perform the procedure, there's no downtime
and the results appear within 24 hours to seven days. Last year it was the
most frequent, nonsurgical cosmetic procedure worldwide," with some
1.4 million patients injected.
Despite the popularity of the two drugs for cosmetic treatment, the
Food and Drug Administration has not yet approved the toxin for cosmetic
use – though approval for Botox is under consideration, and some
observers are expecting action this spring. The FDA won't comment on
pending applications. (Myobloc is not as far along in the process for
approval for cosmetic use.) Should Botox be approved for cosmetic use, one
likely result will be a high profile marketing campaign for the
wrinkle-beating procedure, perhaps leading more Americans to try it.
Meantime, Botox and Myobloc injections for cosmetic use are considered
"off-label" uses of the drug.
Myobloc is more convenient than freeze-dried Botox, which needs to be
reconstituted just before injection. Neurologists, dermatologists, ENTs
and other specialists have begun selling Myobloc treatments. It's the
ultimate lunchtime vanity fix.
But there needs to be artistry in the application: With fine-tuning of
dosages and injection locations, "often you'll build on the success
of the previous injection," O'Brien says. "And a few hundred
dollars for elimination of frown lines sure beats $4,000 or $5,000 for a
brow lift."
But Paul warns that Myobloc's ease of use is a temptation for doctors
who are a bit lacking in the artistry department. "Don't cut corners
where you have it done," he says. "I'd be opposed to having this
done in shopping centers."
But an ENT using Myobloc, that's okay?
"An ENT, they're well trained to inject Myobloc. I have no problem
with that."
This May Hurt
Well, that's good. Because that's where we are now. Abidin and Saidi have
done up their Metropolitan ENT office to appear more like a tony hotel
lobby than a doctor's office. Abidin leads me back to the minor procedure
room where I sit in a wide easy chair and, after cleaning my forehead with
an antiseptic, he dabs my face with numbing Emla cream (because I'm a
weenie) where he is to make the injections.
But he swabs only my forehead and glabella, not the suitcases under my
eyes. "You want the result to be 'age-appropriate' and to look like
no work has been done," he says. "We could do under your eyes,
but you'd look like this," and he pulls the skin of his face back to
comical effect. "You'd look expressionless, like you were stoned all
the time."
He loads up the syringe. The amount of Myobloc he's about to inject
into my face is enough "to kill 50 puffball mice," he says,
which gives me pause as I ask, what's the worst that can happen?
"One doctor injected it too close to the throat and the patient
couldn't swallow for three months. We're not coming anywhere near that. Or
your eye might droop for three months; it'll open just in time for the
depositions to be taken."
(In the drug's package insert, Elan offers a more detailed description
of the risks: Dysphagia – difficulty swallowing – is a "commonly
reported adverse event" of all botulism shots, at least among people
with cervical dystonia, the neurological disorder for which the FDA has
approved Myobloc. No word on how many other folks would commonly have this
reaction.)
Using his Palm handheld computer, Abidin calculates how much to inject
at each spot. I'm getting eight injections, and a total of 1,550 units of
death juice. The shots feel like little bee stings, and he warns of small
bruises. Most reported side effects from Myobloc are from the injections
themselves: bruising, numbness and swelling. (For the record, I had no
side effects.)
In a few minutes, he's done. There's a tightening sensation across the
forehead. I go home and wait.
Was It Good for
You?
A day later my wife says she can see a difference, but for me it's like
watching a clock's hands move. A week later Abidin calls. "I don't
think it worked," I say. He laughs. He hears that all the time.
Seven days after the injections he shows me the "before"
photos as we take the "afters." Yikes! Who moved my eyes? My
forehead seems spread out, the gash in the glabella a mere shadow of its
former self. The skin up to my hairline is nearly smooth. I quickly look
in the mirror and now I can see the difference. My face is a bit less
expressive – those eyebrows don't jump the way they used to – but the
feeling is not uncomfortable. It takes me a bit to get used to the change,
but my friends don't even notice that the Old Me is now the New Me.
Yes, but is it an improvement? If I were terribly vain, ahem, I'd say
yes. And considering the relatively insignificant risks and expense, it
seems like a decent choice for those needing a lift regarding their
appearance. We live in a time when hair color, skin texture, facial hair
and body fat are entirely adjustable. If it's safe and makes you happy,
why not?
But would I do it again? Ask me around Memorial Day.
Buzz McClain is a regular contributor to the Post's Style and
Weekend sections.
© 2002
The Washington Post Company |
