New Ways of Smoothing Things Over

San Francisco Chronicle – Monday, February 21. 1994

Injected toxins paralyze brows, killing wrinkles before they start. Los Angeles plastic surgeon William J. Binder, M.D., 46, is a pioneer of the botulinum toxin treatment “for purposes of vanity.” (It’s long been used for neuromuscular disorders such as tics and crossed eyes.) The pamphlet Binder sent me, called “Botox- A New Treatment That Eliminates Wrinkles,” informs me that Botox is safe (9,000 injections, no complications) and that its effects last three to six months.

Two-Year Study

Binder and several colleagues at Columbia University Medical Center recently finished a two-year study to pinpoint optimum doses and refine technique. Getting the dosage right is important because if too much toxin is injected, surrounding muscles could be affected, resulting, for instance, in droopy eyelids. As it turns out, Botox eliminates wrinkly expressions – furrows, squints, puckered brows. It does not eliminate the permanent creases and wrinkles from forming, once they’re there, it won’t get rid of them. For that you need a “filler substance,” such as injectable collagen or fat. (Collagen is purified, goopified cow skin; fat is thigh jiggle – your own, “harvested” via liposuction.) For example, the 61-year-old owner of the gold lame open-toe platforms is getting collagen because Botox wasn’t around 30 years ago, and she has developed deep frown lines. The 38-year-old actress is getting Botox because she lives in fear of looking like the 61-year-old (who actually looks 49). “Here in L.A.,” she confided, “It’s the kiss of death to be over 19.” She is also fond of Botox because she frowns easily and doesn’t like the way it makes her look. “Before Botox, it was like, I’m thinking about my grocery list and I look like I’m planning a murder.”

Dr. Binder calls me in. William Binder is the sort of guy you like right away. He has long, deep, wonderful laugh lines, and when he talks he raises his eyebrows way up high so his forehead looks like the fretboard of a 12-string guitar. He doesn’t get Botox injections. His nurse has absolutely no lines at all. She’s 26. I ask her if she’s been getting Botox injections. “They all do,” says Binder. “The staff gets the leftovers. Botox doesn’t keep. Like champagne, once it’s opened, you have to finish it off. Binder readies the syringe. “So”. I’m stalling. “What would happen if you tipped and fell and on the way down the syringe got stuck in my stomach?” “Nothing,” says Binder. “You have to realize, when you talk about botulism, you’re talking about ingesting zillions of bacteria that continue to live inside you and produce more toxin.” He’s giving me 15 units of pure toxin, sans the bacteria. It takes 3,000 to 30,000 units to cause symptoms of botulism. “For people with torticollis (neck contractions), they’re using 200 units.” He picks up the needle. “This is just playing.”

Brow Lifts

I ask Binder if there are any permanent treatments for frown and worry lines. He says, “brow-lift.” That entails making an incision across the top of the head, peeling back the scalp and forehead and flipping them down over the eyes, snipping the frown muscles, putting the scalp back up, and pulling the forehead taut. “And then there’s Gore-Tex,” Binder says. This new millimeter-thick strips of medical grade parka fabric are cut to fit and are threaded through the fat beneath a wrinkle to lump it out. In addition to being waterproof and breathable, Gore-Tex also happens to be exceptionally non-creative. Binder is eyeing the area above my mouth where many people have an upper lip. “Gore-Tex is great for lips. We can pump lips up permanently! What do you think about it?” I think it’s time to go home now.