Doctors turn to a deadly toxin in the fight against wrinkles
People – June 1, 1998

Botulinum toxin has been marketed as Botox® over the past decade as a cosmetic surgery staple for close to 100,000 patients annually.

According to Dr. William J. Binder, a Los Angeles plastic surgeon who has coauthored five papers on Botox, it is safer than its origin suggests. He spoke with correspondent John Hannah.

What exactly is Botox?
Botulinum toxin type A is one of several different toxins produced by Costridium bacteria, so potent that half a teaspoon could kill all of Great Britain. But it¹s also one of the safest drugs that we use.

How can it be safe?
We are not talking about injecting the bacterium itself. The toxin is a protein manufactured by the bacterium. You get food poisoning when you ingest the bacterium, which keeps on making hundreds of thousands of toxins. It¹s the overdose of toxins that can cause fatal paralysis.

How much of it do you inject?
For wrinkles, you inject 10 or 20 units per site, maximum 40. It would take three to four thousand units to make a person sick.

So how does Botox work?
When injected, it temporarily paralyzes the muscles underlying wrinkles, smoothing out the skin on top. It inhibits the nerve terminal, so that the muscle will not respond. You literally cant frown after the treatment, but you dont lose sensation. The nerve is still there, and the end of the nerve eventually sprouts a new terminal.

How long does the effect last?
The effect lasts anywhere from three to six months. In low doses, the treatment can be continued indefinitely.

How much does it cost?
The cost is expensive, from $300 to $500 per problem area, but no more expensive than collagen injections, with less risk of an allergic reaction.

Is it painless?
If people have an aversion to needles, we use analgesic cream.

Any side effects?
Eyelid drooping can occur if the Botox seeps below the eyebrow and hits the muscle that controls the lid, but that is rare. Since 1990, I’ve had just one case of that happening.

Has Botox been approved for medical use?
Botox was first approved by the FDA for treating such conditions as crossed eyes and uncontrollable blinking. Since then, it has been used for some 15 to 20 different conditions, including wrinkles.

How de we know it’s safe?
I have treated probably over 1000 patients and it is amazingly free of complications.

Would you use it on your wife?
I have used it on my wife many times. She loves it. She had her crow’s feet done.