Saving face

A desire for an ever youthful
appearance and the availability of cosmetic options contribute to the growing
popularity of Botox injections
Sunday, January 7, 2007 | 12:00 a.m. CST; updated 9:18 a.m. CDT, Tuesday, July 22, 2008

The injection occurred at 4:54 p.m. CST inside a conference room at University Hospital. There were 10 witnesses.

“Furrow your brows,” David Chang said softly after he had swabbed Alyssa Tauber’s skin with rubbing alcohol. “Really mean.”


University Hospital nurse Alyssa Tauber receives a Botox injection from David Chang during his presentation on plastic surgery at University Hospital in November. Chang works as an assistant professor at MU School of Medicine’s department of otolaryngology. (IKURU KUWAJIMA/Missourian)

Chang pushed a 30-gauge needle between her eyebrows. He continued to swab the area with rubbing alcohol between each of the remaining four shots of Botulinum Toxin Type A, more commonly known as Botox.

“There was a little bit of stinging. Very minimal,” Tauber said, once the demonstration of the procedure was complete.

The nerves connecting the facial muscles to the skin stimulate muscle movement by releasing a neurotransmitter called acetylcholine. Once injected, Botox is absorbed by the nerve and blocks the release of acetylcholine, preventing muscle contraction. When certain facial muscles are unable to move, creases and wrinkles in the face are likely to diminish.

“The doctor said that it could take 72 hours, but I saw results almost immediately,” Tauber said.

If Tauber used Botox on a regular basis, she would receive her next set of five injections about three to four months after this one, but the demonstration in November was only her second time trying Botox.

Tauber is a nurse in the department of head and neck surgery at the University Hospital. Chang works in the same department as an assistant professor at MU who specializes in cosmetic surgery and facial rejuvenation, among other areas.

“People are definitely becoming more interested in (Botox),” Tauber said. “The number of people ... who are getting Botox is increasing.”

A business search of “Botox” on produced 15 listings of surgeons and practices available in Columbia. The same search in San Francisco produced 53 hits.

“One thing that has really revolutionized plastic surgery is public awareness,” Chang said. “It is no longer confined to Hollywood.”

And television shows such as “Dr. 90210” on E, “Nip/Tuck” on FX, and “The Real Housewives of Orange County” on Bravo contributed to this awareness when they brought plastic surgery to the small screen. In 2002 when the FDA approved Botox, more than 1.1 million people had the procedure done, according to the American Society of Plastic Surgeons. The number of users in 2005 was 1.2 million.

“It has created a new resurgence in cosmetic surgery that has allowed people to be aware of what possibilities are out there,” Chang said. Most of the procedures featured on these shows are complex surgeries, however, unlike the “minimally invasive” procedure of Botox injections.

“It is such a booming area, for many of them can do it on their lunch hour and then go back to working,” said Karen Calhoun, chairwoman of MU’s Department of Otolaryngology Head and Neck Surgery. “With the hectic pace of peoples’ lives right now, very few of them can say, ‘I want to take three weeks off now to have elective cosmetic surgery.’”

Tauber said that she received compliments from medical students and residents for up to two weeks after the first time she had the procedure done in September.

Despite the potential benefits, the procedure has its risks. Chang warns his patients against massaging the injected area because doing so could spread the Botox to other areas and unnecessarily paralyze surrounding muscles. Other risks include infection, bruising, inflammation and an allergic reaction.

The U.S. Food and Drug Administration also added botulism, a life-threatening illness, as a possible side effect.

Chang has never seen a case of botulism that resulted from Botox injections, but he did recall some cases of botulism that emerged in Florida in 2004 after an unlicensed physician injected enormous amounts of unlicensed, laboratory-grade botulinum toxin into four patients.

Amounts of Botox are measured in “mouse units,” abbreviated as “U,” one of which is lethal to 50 percent of mice, Chang said. Although the exact lethal dose for humans is not known, extrapolated animal data calculates it to be around 3,000 units.

In their 2004 research paper titled “The story of Clostridium botulinum; from food poisoning to Botox,” Anatoli Frieman of McGill University and Patricia T. Ting, a medical student there at the time, wrote, “Depending on the medical condition, 30 to 300 U Botox injections are required two to six times per year.”

Chang said Tauber’s procedure probably would have cost her about $150, which would add up to anywhere from $300 to $900 per year, depending on how lasting the effects of the Botox are on the individual.

“(The price) is definitely a consideration,” Tauber said. “If it weren’t a fringe benefit to working with this organization, it definitely would not be an option.”

She added that she is still relatively young. Later in life, as more wrinkles appear, she thinks that the price of the procedure will be worth the improvement of her appearance.

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