Ironing Out the Wrinkles

Home » Doctor Article » Ironing Out the Wrinkles

Bonnie Brown is the first to admit she’s an expressive woman – all smiles, frowns and squints. But she also admits she doesn’t want the wrinkles and creases that accompany those expressions to ruin her looks.

Vanity, thy name is wrinkle-free.

“You see these deep wrinkles in my forehead?” she asked. “It runs in my family. I see what my mother’s (wrinkles) are like and I don’t want them to look like that.”

Brown, a 42-year-old financial planner from Westchester County, N.Y., is among the growing number of adults seeking ways to iron out those wrinkles.

Greenwich, Conn., dermatologist Dr. Michele Gasiorowski recommended injections of Botox, a purified form of the botolinum toxin – which causes food poisoning – for the wrinkles on Brown’s brow. Botox, Gasiorowski said, temporarily paralyzes the nerves, preventing muscle movement. Reducing muscle contractions, such as squinting of the eyes, results in a smoother skin surface.

Typically, patients want forehead frown lines, crow’s feet around the eyes, deep furrows between the eyebrows or frown lines around the mouth smoothed by a series of the injections.

“It’s a prolonged relaxation of the muscle,” said Gasiorowski. “It takes the stress out of the face. It gives a serenity to the face.”

For filling out Brown’s lips, Gasiorowski recommended injections of collagen, a component of skin and bone found in both humans and cows. Basically, the collagen gives the lips a slight bee-sting appearance – as evidenced by Hollywood stars such as Angelina Jolie.

So Brown signed on for the treatments. First, pain-numbing lidocaine cream is applied to the skin. Then come the injections, which take about 30 minutes. Brown was injected around her eyes, forehead and mouth.

Then comes the waiting. Generally, patients won’t notice an improvement until four to six days after the injections.

In Brown’s case, she was pleased with the results of her first Botox injections and has returned for subsequent injections (and added collagen for her lips). The effects last an average of three to five months.

According to the American Society for Aesthetic Plastic Surgery, nearly 1 million injections for wrinkle treatments were administered in 1999, nearly double the previous year’s total.

Dr. Laurence Kirwan, who has maintained practices in Fairfield County, Conn., and his native England since 1987, said people seeking Botox injections fit into “what we call the youth corridor. The average age is probably 35 on up – and they probably aren’t beyond 60. It’s the youth window – people too young for eyelid and face lift surgery.”

Others believe that the youth corridor is getting wider, and that people in their late 20s opt for Botox injections as a preventive measure.

There are some potential drawbacks to the treatments. First is the price.

Botox and collagen injections can range from $400 to $600 per treatment, depending upon the size of the area to be treated, and they aren’t covered by health insurance.

And there are potential side effects.

Dr. Harold Gewirtz, a Stamford, Conn., plastic surgeon, said he provides only collagen treatments. “I’ve been using it for about 20 years now and never had any serious problems,” he said. “It is just a nice adjunct to the surgery that we do … to finish things off.”

As for Botox, Gewirtz said: “When it first came out, I saw a couple people who were treated by other doctors. I had a patient who had double vision for about six months. It then wore away. I don’t mean to knock Botox, but when someone has double vision for six months, you have to ask, ‘Is it worth the risk?’ ”

“If you’re not careful,” Gasiorowski said, “and inject too much around the eyelid, there can be some drooping of the lid – but the drooping, within a couple weeks, wears off.”

There are also concerns raised by the fact that Botox and collagen have yet to be approved for cosmetic use by the FDA. Still, it’s legal for physicians to use it cosmetically, said Kirwan, because “off-label use” is “based on a physician’s own judgments.”

Some physicians use it on themselves.

Gasiorowski decided to start using Botox “after a patient commented that if I thought the product was so good, why didn’t I use it. I thought, I guess I really need it and, she’s right. If I don’t believe enough in it to use it, then I shouldn’t be using (administering) it.”

While Brown, who bears a striking resemblance to actress Suzanne Somers, keeps her body buffed with gym workouts four times a week, cycling, running and in-line skating, she can’t exercise her face. “The rest of my body doesn’t show it (wrinkling),” she said. “Why should my face?”