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Side Effects: New Face: Younger but Blander

By JOHN O'NEIL

NY Times, November 26, 2002

Botox injections can smooth out a patient's forehead but may also limit the mobility of the eyebrows, according to a new study.

Thousands of Americans have flocked to have wrinkles temporarily removed through injections of botulinum A exotoxin (as Botox is formally known), which paralyzes the facial muscles that cause the skin to crease. But the paralysis has led to complaints that Botox is causing an outbreak of smooth but bland faces, as frozen muscles limit the delicate muscular movements that signal emotions.

In the new study, published last week in The Archives of Facial Plastic Surgery, researchers from the Indiana University Medical Center examined 29 patients who had received Botox injections in their foreheads.

The research found that the shots did not change the resting position of the eyebrows except in a few patients who habitually kept them raised.

But in almost all the patients, eyebrow movement was limited by the shots, said the study's lead researcher, Dr. Mimi S. Kokoska. While the restrictions were less than half an inch, that can be enough to limit expression and to change the appearance of the brow, making it seem flatter or "droopier," she said.

The problem, she said, is that the same muscle that creates horizontal creases on the forehead also plays a major role in lifting the brow. Dr. Kokoska recommended that patients use an experienced plastic surgeon and ask for a demonstration of the range of possible effects, either physically or on a computer.

On the same subject, an editorial published last week in BMJ, the journal of the British Medical Association, warned that the use of Botox was outstripping research on its benefits and side effects.

Sales have soared to a projected $430 million this year, from $25 million in 1993, the editorial said. "In this atmosphere of `Botox parties,' " it added, "it is easy to forget that botulinum toxin is a potent neurotoxin and that its very long-term effects are still unknown."

 


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