- The Washington Times - Tuesday, February 26, 2002

A new wrinkle in the cosmetic surgery field could increase the use of age-defying injections that paralyze facial muscles to create younger looking skin. The use of Botox, the solution smoothing out wrinkled brows nationwide, has risen from more than 600,000 procedures in 1999 to nearly a million last year, according to the American Academy of Cosmetic Surgery.

Now, a new strain of the wrinkle-fighting solution, dubbed Myobloc, is being slowly introduced by plastic surgeons as another means to fight Father Time.

Plastic surgeons say the main ingredient in Botox and Myobloc is a safe, diluted form of the food poison botulism, and injecting Botox or Myobloc is an effective procedure to smooth wrinkles on the upper third of a patient's face.

Botox is the brand name for pharmaceutical manufacturer Allergan's Botulinum Toxin Type A. The Irving, Calif., company's solution is injected into flexed facial muscles to temporarily paralyze them. Facial muscles, when contracted, produce wrinkled-looking skin. Shutting them down leaves the skin smooth and unlined.

Myobloc could offer a superior version of Botox, says Dr. Tina Alster, director of the Washington Institute of Dermatologic Laser Surgery in Northwest.

The initial results appear promising.

"It works faster," says Dr. Alster, who is conducting preliminary trials with Myobloc on several clients, herself included. "I have people coming back a day later and [they] say they're 'frozen.'"

Botox's effects will begin anywhere from three days to a week after the injection.

Dr. Alster says she hopes Myobloc treatments last longer than Botox, which must be renewed every three or four months, depending upon the patient.

Myobloc, created by Elan Pharmaceuticals, earned the Food and Drug Administration's approval in December 2000 to treat cervical dystonia, a disorder in which neck muscles contract involuntarily.

The Dublin, Ireland, firm, which produces Myobloc out of Botulinum Toxin Type B, doesn't have FDA approval to use its product to combat wrinkles. Nor does Botox enjoy the FDA stamp as of yet. It's not stopping doctors from using both to make their patients look younger, by request.

Botox has been used for smoother faces for about a decade, while Myobloc emerged as an alternative about eight months ago.

"The ultimate effect is to soften the lines, so when they do smile, it's not crunched up around the face," Dr. Alster says of treatments, which range in price from $350 to $800 per session and can be completed in about 10 minutes.

The treatments address primarily crow's feet, forehead lines and frown lines between the brows.

Dr. Alster, whose primarily female clientele falls in the 35-55 year range, tells patients not to exercise for about four hours following the procedure to prevent the injected neurotoxins from traveling to muscles that shouldn't be paralyzed.

Like any plastic surgery, Botox injections aren't perfect. Treated faces aren't as animated as they once were. Many patients, though, appear willing to tread the fine line between eternal youth and a less vivid range of expression.

As a teen-ager, Alexandria resident Susan Sleeman says she sported "deep horizontal lines" across her forehead.

About seven years ago, Ms. Sleeman decided to do something about it.

"I am constantly hearing comments that I don't look my age," says Ms. Sleeman, 44, who in addition to Botox treatments has had collagen injections to smooth out wrinkles, known as "marionette lines," around her mouth.

Ms. Sleeman says the Botox needle is "a little painful," and occasionally, the injections will leave slight bruising, what she calls "tiny peck marks" as if from a small bird. Some patients receive a topical numbing agent prior to the injection.

Ms. Sleeman says she doesn't mind the mild pain, nor the slight loss in facial movement.

"You're constantly animating your face," says Ms. Sleeman, who has the procedure about three times a year to keep her youthful appearance. "It's not a particularly attractive animation to start with."

Patients who undergo years of Botox treatments could, theoretically, develop antibodies to the solution, Dr. Alster says.

That's one reason, she says, that Myobloc may be welcomed into the plastic surgery market.

Myobloc also can help patients who develop antibodies after using Botox to fight muscular spasms over extended periods of time.

She notes it usually takes a long time for such antibodies to build up, if they ever do.

Dr. Richard G. Glogau, clincial professor of dermatology at the University of California, San Francisco, warns the effects from Botox and Myobloc may be more different than some predict.

"The problem that the public and the profession has grasping … is that these are not interchangeable molecules," Dr. Glogau says.

Doctors also may have to adjust their injection techniques, based upon how each treatment affects the patient, he says.

Still, Dr. Glogau says patients are pleased with the results of Botox, so curiosity for Myobloc may follow.

"What you're trying to do is relax their expression, not look like they're dead," he says of the predicted Botox results. "It's easy to use it and still maintain a very natural look."

Dr. Steven Hopping, with the Northwest-based Center for Cosmetic Surgery, says, "Botox is rapidly becoming… one of the most common things we do in the office."

"It's the simplest thing we do here," Dr. Hopping says.

Botox represents a different approach to combating wrinkles.

"All the other things we've had have been basically fillers, collagen, using patients' own fat," he says. "Botox is dramatically different. It actually reduces the muscle's ability to create that frown line. You're going to the source, if you will."

Still, patients will walk away a bit less animated than when they came it.

"It does reduce one's ability to animate vigorously, but you can still frown and scowl, but less so," he says.

Some Botox recipients will suffer mild bruising, headaches and drooping brows, if the injection is done improperly, he says. In rare cases, the patient may get double vision, though he says his office has never had such a problem.

A few patients seem a bit too enamored with the process.

"Some people want to come in every month," he says. "I don't think it's good to be doing it so frequently." He limits patients to three treatments per year.

In Hollywood, Botox is as prevalent as unsold movie scripts, but as secretive as a George Lucas movie set. Former Princess Leia, Carrie Fisher, admits to using Botox over the last five years, but few others will match her candor.

Patients in and out of Hollywood often prefer others not know how they achieved their new, improved faces.

"Amanda," a 56-year-old District resident who asked to go by a pseudonym, considers her Botox treatments "my little gift to myself."

Amanda's treatments help soften what she calls the "major furrow" above her right eye.

"I didn't realize how I contort my face sometimes," says Amanda, who has been getting facial injections twice a year since 1999.

She says the treatments, though expensive, give her confidence.

"I look great at the Christmas party," she says.

Ms. Sleeman, on the other hand, doesn't mind telling anyone who compliments her countenance, from friends to strangers, her beauty secret.

"I broadcast it," she says. "Why be ugly if you don't have to?"

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