FACIAL SCULPTING

"Within the infant rind of this weak flower Poison hath residence and medicine power"
- William Shakespeare

History is rich with examples of man's attempts to harness the medicinal qualities of poison. Shakespeare understood and wrote about it. Paracelsus, the Renaissance physician considered by many to be the father of modern medicine, opined, "All things are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy."

Arsenic, that murder weapon of choice of killing pests and spouses, nowadays is used to treat leukemia; it works by bludgeoning the wayward protein that prevents the normal development of white blood cells. A quicker way of killing is probably with the venom of a rattlesnake. But again, the poison is now used to save rather than kill: in this case, the venom is employed as a means of dissolving blood clots commonly linked with heart attacks and strokes.

And of late, the buzzword du jour is Botulinum Toxin.

A mini science lesson is approprate before the eyes glaze over from an overdose of medical terms: Botulinum Toxin A (BTA) is a protein produced by Clostridium botulinum and is the most poisonous toxin known. It is notorious agent of biological warfare and was even believed to be part of Saddam Hussein's arsenal of weapons of mass destruction. One gram of it in its crystalline form can kill millions. The malicious molecule does this by latching on to nerve endings at the points where nerves join muscles, thus blocking signals for the muscles to contract. The result is weakness and paralysis from the head down, affecting among other things the muscles that regulate breathing. One literally suffocates to death.

However, as dear ol' Paracelsus said hundreds of years ago, the dose doth make the difference. The BTA that is used for both therapeutic and cosmetic purposes is diluted to such an extent that it merely contains a few trillionths of anounce, meaning it would take 70 times that amount to kill someone.

Increasingly, doctors have turned to BTA to treat muscle disorders like hemi-facial spasms (uncontrollable, continuous facial twitching), excessive blinking and sweating, post-stroke spasticity and torticollis (uncontrollable turning and twisting of the neck). But it has perhaps gained its greatest fame cosmetically for ironing out wrinkles.

And though it must be noted that BTA is effective only for wrinkles caused by muscular contractions and useless for those caused by exposure to sun or other degenerative processes of the dermal tissue, BTA treatments are still a godsend for many patients in their late thirties to early fifties.

Other uses for this wonder drug have been popping up like rabbits out of their burrows. Lately, it has been used to ameliorate headaches and back pain. In addition, scientists have developed more cosmetic uses for BTA, notably facial sculpting and eyebrow lifts.

(Un)hip To Be Square (Jawed)

The Singapore government really does know what is best. With its ban on chewing gum, it not only ensured the green city remains evergreen and clean, but it also greatly reduced the chances of its people being afflicted with the condition know as masseteric hypertrophy. The masseteric muscle is the muscle that raises the upper jaw and enables closing of the jaws. And hypertrophy refers to a condition of over-enlargement. So in lay terms, this translates into oversized facial muscles, especially in the jowls, often resulting in a "square" jawline.

The British Journal of Oral and Maxillofacial Surgery lists gum chewing is one of several non-organic causes of enlarged cheek muscles. Also on the list are teeth grinding (bruxism) and even the innocuous act of cradling the jaw while reading. Some have resorted to surgery to remove part of the masseteric muscle, while others opt for injection of toxins to relax and hence reduce the size of the muscle. The latter is, of course, where BTA comes in.

Since 1994, BTA has been used as a means to contour the lower face, with great short-term results. According to Dr. Ranjit Singh, a youthful-looking 50-year-old consultant dermatologist, three to four injections are needed for each side, depending on the extent of enlargement and gender of the patient. Dr Singh, who has been using BTA for facial sculpting for almost four years, added, "Men generally require more injections because their cheeks muscles tend to be more tightly contracted than women's."

Patients are required to return eight to 10 weeks later for a second dose. Generally, an improvement in appearance may be seen after about two months. In Malaysia, each treatment will cost an average of RM1000. There is no downtime and no post-treatment bruising. Here, masseteric treatments are commonly sought by women in their mid-or late-twenties.

However, one must not mistake chubbiness for enlarged cheeks. The doctor has had to turn away naturally chubby people who think they could reduce the size of their faces with BTA jabs.

How Does It Work?

BTA inhibits the release of a certain chemical substance (acetylcholine, for your Biology buffs) that causes muscles to contract. In certain muscle disorders such as cerebral palsy, too much of this chemical substance is released, resulting in muscle spasm.

Local injection of small doses of BTA into a muscle therefore produces local paralysis, and individual muscles can be selectively weakened. In the case of enlarged masseteric muscles, once the muscles are relaxed they unclench, resulting in a less rotund look.

Raising Eyebrows

Eyebrow lifts may be attained by surgery. Doctors make incisions in the brow (if the brow is thick enough) or in the hairline, with the latter producing a more natural look.

Alternatively, BTA can put things right, too-albeit temporarily. BTA injections for eyebrow lifts typically last six to eight months. In Dr Singh's experience, BTA is not only used to lift drooping eyebrows but can also be employed to correct asymmetrical or slanting brows. According to the doctor, two jabs of BTA are needed on each side, on the specific groups of muscles that control the upward and downward movement of the brows. Such treatments will set one back RM400-RM500 fr both sides.

Other Uses

In recent years, BTA has been used for a host of other purposes. For instance, it has been successfully utilized to treat what doctors call "bunny lines" -so- called because the nose resembles that of the animal due to excessive scrunching up. This relatively minor treatment will cost only around RM100.

Dimples (for those who hate the Kirk/Michael Douglas look), naso-labial lines, lip-lines caused by a predilection for the ciggies - all of these may be removed by BTA jabs.

And then there is the bane of miniskirts: what the Japanese and Koreans call "radish" calves: calves that are hugely oversized compared to the rest of the body. Like the face, calves only have a superficial layer of fat. Thus liposuction which works so well on other parts of the body will have little or not effect - unless of course, one is grossly overweight and has excess fat deposits on the calves. As such, based on the fact that BTA works by relaxing selective muscle groups, Korean doctors are now in the experimentation stage of using the toxin to trim oversized calves.

Side Effects

For a treatment that requires such a high level of precision, problems arise not so much in the form of side effects as complications due to human error.

Injecting too high a dose or the diffusion of toxin to unintended sites would obviously have adverse effects. Nearby muscles may experience temporary weakness. Some patients may also react negatively to the protein content in BTA, leading to the development of flu-like symptoms.

Nevertheless, these effects are rare. In its extensively purified form, BTA is unexpectedly safe for something that is reputedly one of the most dangerous toxins know to mankind.

The Bottom Line

The use of botulinum toxin A to remove wrinkles has become so commonplace in Hollywood that some have compared its use to mere good manners, akin to brushing your teeth. A lesser-known fact is that it is also used for a great variety of other cosmetic purposes, for instance, facial sculpting, eyebrow lifts and erasing dimples. No doubt further uses of this toxin to pump BTA into themselves.

It may be the most lethal toxin known. But for many, BTA flows in the fountain of youth.