Exploring the Botox craze

She spoke through gritted teeth as the needle poked and pricked the left side of her face. "I really don’t like you right now," she growled at Dr. Larry Leverett, the Hawaiian-shirt-bedecked professional working the syringe. Kariann Jackson, who prior to the treatment had warned Leverett that she was "a bleeder, and I curse," had come to the Ahwatukee Center for Aesthetic and Reconstructive Plastic Surgery, along with about 10 other women, to have a needle repeatedly inject a neurotoxin into various segments of her face. "How you doing?" Leverett asked midway through the procedure. "I’m living," Jackson said. "You having fun?" "I will afterwards."

Jackson’s recalcitrance notwithstanding, the atmosphere in Leverett’s office was light.

This was, after all, a party, albeit a different sort of affair.

Welcome to the Botox party.

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Botox is the brand name for botulinum toxin, a poisonous protein manufactured by bacteria that causes botulism. It’s most commonly found in poorly handled meat, and even the name is derived from "botulus," the Latin word for "sausage."

Botulism is one of the deadliest toxins in the world, with a median lethal dose of 1 nanogram per kilogram, meaning that a few hundred grams of the stuff could theoretically kill everyone on earth. Strychnine, for perspective, has a median lethal dose of 1 million nanograms per kilogram and would require 400 tons of the rat poison to kill everyone on the planet.

That said, Botox, as a medical or cosmetic procedure, is entirely safe.

"It doesn’t spread and it doesn’t go through your bloodstream," Leverett explained. "Certain parts (of the toxin) have been denatured."

Botulinum toxin affects humans by interfering with nerve impulses, forcing muscles to relax. At the turn of the century this was a problem, and about 70 percent of botulism cases would end in death, mostly from lung failure.

Today the mortality rate is only about 5 percent, and focused, controlled botulinum toxin treatments can force only desired muscles to relax. The ones that control frown lines, crow’s feet and wrinkles around the lips are popular targets of modern Botox treatment.

"It’s the most common cosmetic procedure worldwide, because it works," Leverett said. "It’s easy, it’s inexpensive and it’s very prevalent."

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Leverett has operated in Ahwatukee Foothills for 12 years, and he’s an expert at what he does. Most patients who underwent the procedure at last Tuesday’s Botox party didn’t report any pain.

Even the sensitive Jackson was pleased after her procedure was done.

"It’s worth it," she said. "On a scale of one to 10, the poke of the needle and all that being right there, it’s about an eight. But it’s worth it."

The procedure does not come cheap. Botox wears off within two or three months, necessitating frequent treatments to maintain the wrinkle-free appearance it produces. At Leverett’s clinic, one Botox treatment costs $325 per area, and up to four areas can be treated per session.

"Botox is usually every three months," Leverett said. "In men, where the face muscles are stronger, we may have to use more units per treatment sessions or repeat the injections at a shorter interval."

Leverett estimates his Botox clientele at about 90 percent female and 10 percent male.

"People start in their 30s," he said, "and will often do it into their 70s."

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Paige Swaine gets Botox done three or four times a year, generally to ease the wrinkles near her eyes or on her forehead. She attended the Botox party to have work done on the latter.

"It works very well," she said. "Around my eyes it lasts around three or four months. Around my forehead it doesn’t last as long, because I think those muscles are stronger."

From alcohol swab to completion, Swaine’s session lasts about 45 seconds. When Leverett had finished, there were 10 bumps along Swaine’s forehead and a few of them were producing small blood droplets.

"The most common side effect is bleeding," Leverett said. "That happens from taking aspirin-containing products, vitamins with vitamin E, or herbals."

Swaine’s bleeding stopped shortly after the procedure terminated, and the bumps, having been subjected to an ice pack, had almost completely receded within six minutes.

"It only looks like I’ve had injections for about 20 minutes," Swaine said. "By the time I get home no one can tell."

Swaine, a self-avowed "exercise nut" who competes in triathlons, said she does Botox to hide the wrinkles she started getting in her 30s and prefers the injections to more permanent cosmetic treatments.

"It’s worth it," she said. "Most definitely. And there’s no down time. If I had a forehead lift I would have a lot of downtime."

Denise Leverette, the good doctor’s wife and office administrator, said that view was common.

"That’s a big reason many clients come to get fillings or injections," she said. "It’s less downtime and less expensive than brow-lifts, blepharoplasty or facelifts."

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Side effects from the procedure are rare. Cases of inadvertent botulism after Botox have occurred, but those are considered the exception and not the rule.

Leverett said that common side effects are generally the result of Botox not working well enough or working too well.

"When it doesn’t work enough it’s usually because you didn’t use enough," he said. "Sometimes a patient will ask to use less than she needs."

When Botox works too well, it’s typically because a patient has gone out of his or her way to minimize the effects of aging. For example, someone who perpetually raises their eyebrows to hide forehead wrinkles might be shocked after the procedure is finished.

"Botox takes care of lines of expression," Leverett said. "When you have those lines and you relax the muscles, the brow may sag and it resumes its normal position. It puts the muscles in their normal state of rest, which may be normally not high enough."

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Botox may not be for everyone, but those at the Botox party were certainly pleased.

"This was the first place I ever went for Botox, and it will probably be the only place I go," Swaine said. "I like the work Dr. Leverett does, and I trust him. Especially around my eyes."

Everyone in attendance was a return customer, so Leverett must be doing something right. For the uninitiated, Swaine encourages an adventurous spirit.

"I would definitely, definitely say try it," she said. "For everyone who’s scared of needles - I’m scared of needles and I can handle it - it’s definitely worth the outcome."