A Peril of the Veil of Botox
By: RICHARD A.
FRIEDMAN, M.D.
NY Times, August 6, 2002
The woman fantasized about having a face-lift for
years, but had an insurmountable fear of the knife. So when Botox was
approved in April for cosmetic use by the Food and Drug Administration,
she jumped at the opportunity.
Recently divorced and a recovering alcoholic, she had
just turned 48 before the first Botox injection. And like the 1.6 million
Americans who used Botox last year, she hoped to recapture her youthful
appearance. At about $600 a pop every four to six months, she considered
this an endlessly renewable face-lift.
Except for a quick sting, she barely felt the
injection of Botox into her forehead and went back to work later that day.
By the end of the week, she noticed the effect. Standing in front of her
bathroom mirror, she was stunned to see that the deep wrinkles that scored
her forehead had been erased, and that her skin was smoother. Though she
was pleased by her new look, she felt ill at ease without knowing why. It
was obvious later — her physical and psychological self-images were
suddenly incongruent.
The sense of strangeness subsided over several weeks,
and she was clearly satisfied with the results. Then something odd
happened. First her close friend casually mentioned that the woman seemed
unusually calm. "Too tranquil; it's not you," she recalled. Her
boyfriend accused her of being unsympathetic, and her mother asked whether
she was feeling down.
She was certainly not depressed and had lost no
affection for her boyfriend. And she was definitely not feeling calm. She
found their reactions unexplainable.
Frustrated and on the verge of tears in my office,
she suddenly made me understand. For while she claimed to be puzzled, she
did not look at all distressed or baffled. In short, her facial expression
did not fully reflect her emotional state. And she was completely unaware
of it.
Unlike a face-lift, where the skin is stretched taut
like a drum but facial expression is unaffected, Botox paralyzes the
underlying muscles that control facial movement and produce wrinkles.
Botox, or botulinum toxin, is the neurotoxin derived from the bacteria
Clostridia botulinum, the cause of botulism.
Botulinum toxin is the most poisonous substance known
and is a potentially potent bioweapon. A single gram of the purified
toxin, widely dispersed and inhaled, could kill a million people.
Ingested systemically, botulinum toxin kills by
paralyzing the diaphragm, the muscle used in breathing. The toxin prevents
neurons from releasing acetylcholine, the neurotransmitter that causes
muscle contraction. But injected locally, it paralyzes just a small area
of skeletal muscle. The effect is temporary, lasting three to four months.
Little is known about the long-term cosmetic effects
of Botox. But there is evidence that prolonged use can cause some people
to produce neutralizing antibodies against Botox, which diminish or block
its effect over time.
Botox had wiped the wrinkles from the woman's brow
but had also robbed her face of some human expressiveness. It made her
appear not so much youthful as lifelike — a frozen imitation of youth.
Unlike this woman, many Botox users receive extensive
injections above the nose, around the eyes and across the forehead, which
deeply alter their expressions.
It made me wonder: Should we become a Botox nation?
What are the implications for human relationships? I'm not too worried
about the adults; they can figure out that their friends and loved ones
are poker faced not because of lovelessness but thanks to Botox. But what
about infants and children?
Infants are exquisitely sensitive to facial
expression long before they communicate with language. It is not hard to
imagine that a Botoxed parent with diminished facial expression might
elicit a different response from her infant and that this could have an
effect on mother-infant bonding. Given the extremes to which some parents
go to provide their babies with enriched environments, the possibility of
an expressively dulled parent would be ironic, to say the least.
At the end of Choderlos de Laclos's "Liaisons
Dangereuses," the scheming countess gets her comeuppance: she is
stricken and disfigured with smallpox, her beautiful face now an object of
revulsion — a just punishment, de Laclos writes, because God has now
made her ugly soul visible for all to see.
The peril of Botox is just the opposite. Some Botox
enthusiasts may discover that their paralyzed faces cannot respond to
their emotions; they could not bare their souls if they wanted to. Who
knows? They might grow wistful for a wrinkle or a frown.
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