The Latest Botox Buzz: ‘Teen Toxing’

August 12th, 2010. By Hunter West

Am I missing something here? 

The last time I checked, cosmetic Botox was approved for wrinkles in the brow between the eyes. 

That’s it. Oh, there are other approved medical uses for Botox—therapeutically in children as young as 12 with abnormal twitching of the eyelid or crossed eyes. It can also help patients 16 and older with involuntary contraction of neck muscles, and by people 18 and up to combat excessive sweating..

However, cosmetically Botox has an extremely limited footprint (or face print, if you will) according to the original approval for cosmetic purposes by the US Food and Drug Administration (FDA). 

Does that surprise you? 

Little wonders that it does, given the astounding degree to which Botox is used off-label cosmetically. 

It’s outrageous. According to the American Society of Plastic Surgeons, outline toxin—which is sold here under the brand names Botox and Dysport—was injected into Americans ages 13 to 19 nearly 12,000 times last year, including some teenagers who benefitted from multiple doses. The number represented a 2 percent increase from 2008, the society said. 

The New York Times reminded us yesterday of singer and actor Charice Pempengco, the young Filipino phenom and soon to be a star of ‘Glee.’ Last month she had various Botox injections—including one into her jaw—because she wanted “to look fresh when I appear before the camera.” 

On ‘Glee’—a show with a theme of self-acceptance. 

Nice. 

The medical and therapeutic benefits aside, ever since the vain citizenry discovered that Botox could hide wrinkles, people have been going nuts. Botox injections for crows’ feet, and laugh lines. Botox parties, where the injector comes to your house with vials of Botox and syringes like so much Tupperware. 

And now the Botox buzzwords are ‘facial shaping.’ 

That’s when Botox is injected into the jaw to combat a squared look that stems from a robust set of masseter, or chewing muscles. A Botox injection can relax the muscles and soften the look of the jaw—a boon for women, but also for men. 

Phu Pham, who is 19, wanted to soften his ‘bodybuilder’ jaw that he felt was an incongruity with what is otherwise a soft face. He paid $800 for a Botox injection. Now, not only are the contours of his jaw softer, but his parents thought he had lost weight. 

Ah, do you hear it? The clarion call of another potential use for Botox—face-shaping to make the face appear to be thinner, in order to make the rest of you appear thinner, too. How many times have you overheard the line, “have you lost weight, [insert name here]? Your face looks thinner…” 

Teens are having Botox injections to alter what is perceived as a ‘too-gummy’ smile. It relaxes the muscles that control the smile, so the lips only spread so far… 

Can we remind ourselves of something here? 

Botox is the commercial name (or one of them) for botulinium toxin. If the word reminds you of botulism, the horrific reaction to bad food that can turn your good health around fast and potentially even kill you, there is a good reason. They are related. Botulinium toxin is just that—a toxin that can do serious damage, or worse. 

The key is that the medical community has found a way to control it, to use it for good. Thus the use of Botox for neuromuscular and eye disorders, as well as other medical uses for Botox already mentioned. 

But ever since the FDA approved Botox for cosmetic use in 2002—and in the off-label euphoria that has followed—we have lost sight of the fact that there is a risk with Botox. It’s botulinium toxin after all, which serves to paralyze any muscle it comes into contact with. 

That’s the secret to the cosmetic use. Wrinkles in the skin, gummy smiles and square jaws (aside from bone structure) have more to do with over-active muscles than skin. A controlled paralysis of the muscle for a temporary period, which is about four months, achieves results akin to turning back the clock, softening the face or taming a smile without invasive surgery. 

Supporters say that it’s not much different than giving a teenager a nose job for her 16^th birthday. 

Philosophically, that’s a valid point. And it should be noted that there are always risks inherent with the invasion of the human body. Infection from a surgical procedure is always possible, and complications can ensue. 

But so, too can complications from Botox, including the potential for the botulinium toxin to migrate where it isn’t supposed to go. While such migration is rare, it has happened. You don’t want muscles you depend on for breathing, or swallowing, to become suddenly incapacitated. 

And there can be other complications from Botox injection, according to The New York Times account. Dr. Rod J. Rohrich, chairman of plastic surgery at the University of Texas Southwestern Medical Center who selectively does “lots of Botox” for wrinkles on patients starting in their late 20s, cautions that this off-label technique requires a highly skilled dermatologist or plastic surgeon who’ is “very attuned to injecting Botox in these areas.” Problems like facial nerve paralysis and weakened chewing can occur. Dr. Lisa M. Donofrio, a dermatologist, said that complications of using Botox to treat a ‘gummy’ smile could include an asymmetrical smile or speech impairment. 

There are those who wonder when all this cosmetic, elective use for Botox is going to peak, and at what point? And is there any way for the FDA to clamp down on off-label use? Accepted practices would have to change for that to happen. Surgeons, and medical doctors have always posessed the right and professional privilege to use a product for off-label use. What’s more, so long as a manufacturer refrains from promoting or marketing their product for any use beyond it’s approved application, it’s all perfectly legal. 

But is it safe? Is it healthy? And if a product’s off-label use (at least for cosmetic purposes) far outdistances the original FDA approval, what does that say about the original approval? Should the FDA not update the file? Or should the agency be given the power, with the original approval in hand, to clamp down on such blatant off-label use? 

Michele Borba, an author on parenting, writes on her web site that, “If your daughter is begging for Botox, believe me, an injection is not the cure,” Ms. Borba writes. “There’s a much deeper issue at stake and I’m betting it’s self-esteem. Say no to that injection. Address her feelings of ‘inadequacy’ and not her need to cover up a so-called wrinkle.” 

Meanwhile, when you tune in to catch the second season of ‘Glee’ this fall and spy the recurring presence of an exchange student from the Philippines, that ‘fresh’ look you see on the face of the young woman on the show that promotes ‘being yourself,’ is anything but…

Tags: Botox

This was posted on Thursday, August 12th, 2010 at 11:14 am and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.