In the youth-obsessed environment of the professional performer, BOTOX has emerged as a kind of magic elixir. The “BOTOX Party” has replaced the “Tupperware Party” of the previous generation of suburban housewives.
But botulinum toxin is not cosmetic; it is a powerful medication with many uses, some of which may be particularly useful for singers. Otolaryngologists, plastic surgeons and dermatologists administer the toxin as an injection.
It is well known that many of today’s most potent drugs come from poisons in the plant and animal world. These include digitalis and the anti-cancer vinca alkaloids (from the foxglove and periwinkle plants, respectively).
But surely, no agent has come as long a way as BOTOX. Short for “botulinum toxin,” this substance originated from a powerful paralyzing poison formed by bacteria that thrive on spoiled meat. When first described in Germany, in 1793, it carried the prosaic name of “sausage poison.” The bacteria (Clostridium species), if ingested, can cause severe cramps and diarrhea. If inoculated into a wound, it may produce severe blood infection, even shock and death.
So how did we get from rotten meat to magic wrinkle remover?
About 30 years ago, scientists purified the active agent in these bacteria, and found that it could weaken or prevent muscle contractions. Botulinum toxin does this by blocking the signaling chemicals nerve endings release, preventing them from activating the muscle, and thus preventing muscle contraction. They found that application of small quantities of purified toxin selectively block abnormal muscle contraction and spasm that are a feature of a number of disorders.
The original uses for this material were in conditions such as blepharospasm (twitching of the eyelid), strabismus (squint) or torticollis, a wry neck caused by chronic contraction of one or more of the neck muscles. Another important use has been for some voice tremors (spasmodic dysphonia).
When botulinum toxin was first released for medical purposes, it was available in only a few investigational centers, and for specific neurological conditions. I recall 20 years ago, when I worked as Chief of the Otolaryngology Program for the New Jersey Medical School, seeing Katherine Hepburn, who would come to Newark (not the most cosmopolitan of cities, even then) for injections to correct a tremor of the eyelids. Today, such treatment is available on almost any block on Park Avenue.
The advantages of BOTOX treatment for such medical problems are manifold. It is dose-related, meaning that the response can be controlled by increasing or decreasing the amount injected. Unlike medications taken by mouth, it can be localized to a specific site. It does not involve surgery. And, perhaps most important, the effect of the drug wears off in a few months, with no permanent changes.
The cosmetic application of botulinum toxin was first proposed in the early 1990s by the Drs. Carruthers in Vancouver, and Dr. Andrew Blitzer in New York. Since facial muscles contracting the skin cause frown lines, they reasoned that selectively weakening the pull of these muscles would cause a relaxation and smoothening of the overlying skin.
Does it matter who does your injections? Yes, since injection of the medication involves experience and some aesthetic finesse. The muscles of facial expression often pull in opposite directions, and weakening one set could result in the appearance of overcontraction of others. For example, over-weakening the frown lines between the eyebrows can appear to accentuate the pull of the lateral forehead muscles, giving a surprised, or “Jack Nicholson” appearance. On the other hand, the results from an injection normally last no more than three months, so there should be no permanent problems from even a less-than-perfect treatment.
What else is on the horizon for BOTOX? Two clinical studies may be of general interest to singers. One is the use of BOTOX to manage TMJ (temporomandibular joint) problems. Patients who clench and grind their teeth excessively seem to benefit from this treatment, which relaxes the muscle spasm associated with this condition. Even more exciting are the clinical trials for the management of migraine and tension headaches. In the New York area, both studies are under the direction of Dr. Blitzer, and more information is available to interested patients through his office.
The many potential uses of BOTOX are just beginning to emerge. Even if you are blessed with an immaculate complexion, at some point you may benefit from this powerful drug.
