botox (Botulinum toxin a) ($300 to $i, ooo)
Botox is the number one noninvasive cosmetic corrective procedure around the world. When injected into specific muscles Botox (botulinum toxin A) prevents muscle movement by partially and almost completely paralyzing them. Botulinum toxin inhibits the release of the chemical acetylcholine, which stimulates nerve endings attached to the muscle, thereby inhibiting muscle movement. The resulting inability to use those face muscles causes the wrinkles in that area to completely disappear.
Most typically Botox is used to eliminate the wrinkles of the forehead and reduce the wrinkles around the outside corner of the eye (the crow’s feet area). It has also been used for other parts of the face but those techniques are somewhat controversial and the naturalness of the appearance it imparts is less clear.
By now Botox is not new. It has been used by ophthalmologists since 1973 to treat patients suffering from disabling eye ticks, as well as to treat crossed eyes. It is also used by other medical specialists to treat spasmodic neck muscles, spasmodic laryngeal muscles, multiple sclerosis, cerebral palsy, some post-stroke states, spinal cord injuries, nerve palsies, Parkinson’s disease, facial spasms, and, most recently, migraine headaches. However, the research on the effectiveness of Botox for headaches or other analgesic benefit is inconclusive.
(Sources: Head and Face Medicine, August 2007, page 32; Cochrane Database Systematic Review, July 18, 2007, CD000319; and Journal of Neurology, February 2004, pages S119-S130.)
This history of extensive use (and the corresponding research) has shown that Botox has a great success rate, with minimal risk of detrimental side effects, but that doesn’t mean they don’t exist. An inexperienced physician, for example, may cause the most complications, since if they inject the wrong areas you may experience temporary facial or eye drooping, long-lasting bruising, or jaw and neck weakness. These problems almost always last only for the duration of the Botox, and so go away in three to six months, but there are rare cases where the problem has persisted.
Moreover, different formulations of botulinum toxin type A are not identical and may behave differently in clinical practice. The reportedly lower incidence of adverse effects with one formulation (from Allergan, Ltd.) relative to another (from Ipsen, Ltd.) may be due to differences in the degree of migration of the neurotoxin-protein complex from its injection site (Source: Journal of Cosmetic Dermatology, March 2008, pages 50-54).
(Sources: Skin Therapy Letter, July-August 2008, pages 1-4; Clinical Dermatology, March – April 2008, pages 182-191; Journal of Cosmetic Laser Therapy, September 2007, S23-S31; and Facial and Plastic Surgery Clinics of North America, February 2007, pages 41-49.)