For our coverage of this procedure, we interviewed Dr. Stephen Pearlman, a plastic surgeon who is also an ENT and came recommended by our regular health columnist, Dr. Anthony Jahn. We also spoke with two singers who had the procedure done, one in New York City and one in Los Angeles, to get their reactions.
FINDING A DOCTOR
LA: I’m usually more careful but I didn’t want to ask for recommendations because I didn’t want anyone to know I was even thinking about it. I simply saw an ad for a plastic surgeon and called, pretty impulsively. The woman who answered the phone said, “I had it done, my doctor had it done, and so did my family.” She sounded convincing, so I made an appointment–I didn’t use a very scientific approach.
NYC: The dermatologist told me I should do Botox to get rid of wrinkles. I checked prices and decided to stay out of New York City and use the same doctor.
COST
LA: I paid $300. My doctor charges by the facial area affected and did eight injections in a circle around my forehead. For $350, he promised to do a one-month adjustment if I didn’t like it. He did the work in two areas: the forehead and between-the-eyes area, and outside the eyes.
NYC: I paid $350, which included two facial areas–the outside corners of my eyes and also between my eyebrows.
IS IT SAFE?
LA: I told the doctor, “I want a 1,000 percent guarantee that this won’t affect my vocal cords.” He said, “You got it.” I also told him that I was allergic to everything. He said, “No one is allergic to Botox. I don’t even do a test patch anymore.”
NYC: I was very nervous after I saw the disclaimer the doctor wanted me to sign, but she told me she’d never had a single reaction except in her husband, who had bruised quite a bit. She seemed confident, so I went ahead.
THE PROCEDURE
LA: The doctor put a piece of ice on my forehead, which wasn’t comfortable. I also didn’t like the sound of the injection going into my skin. But it only took five minutes.
NYC: The injections hurt a lot, but I didn’t mind a bit. I just wanted the wrinkles gone.
AFTERMATH
LA: I looked like I had mosquito bites on my forehead–because they were in a circle, I looked like a Klingon! They swelled up to about the size of a grape. The lumps took about an hour to go away.
NYC: Afterward I had one small bruise above my eyebrow and got a migraine headache, but I get those any time I do anything unusual. I was able to sing that night but it seemed like it was harder to warm up. I felt fine the next day, except for a strange feeling of numbness where the shots had been. This disappeared in a few days.
ANY UNWELCOME SURPRISES?
LA: I did lose some expressive ability. For the first time in my over-emotive life, a stage director said to me, “I’m not getting enough from you.” I haven’t found a way to make the specific expressions I did before the procedure–but I look great, and part of me doesn’t care so much. If they deaden the frown lines between your eyebrows, it affects the eyebrow muscle as well–you can’t move the front of your eyebrows, but you can move the end. I left the crow’s feet underneath my eyes and didn’t want him to do the frown line between. It’s a sign of intensity.
NYC: I don’t feel like I’ve lost anything–except wrinkles. I can’t knit my eyebrows together or narrow my eyes on the sides but still feel like I have strong expressions…maybe different expressions, but strong. I use my forehead muscles more to express emotion.
ARE YOU GLAD YOU DID IT?
LA: I feel now like I am a complete mystery woman. The thirty-something singer in my cast is thinking, “How old IS she?” The overall look is 10 years younger. I don’t have a single wrinkle from my eyebrows up.
NYC: I can’t believe the difference this made in my confidence level. It’s as if the playing field has been leveled again. It does not feel strange to sing young roles again.
A Doctor’s View
Botox Explained
By Dr. Stephen Pearlman
Dr. Pearlman, a noted plastic surgeon in the NYC area, explains
the effects of Botox and what facial areas it will best modify.
Botox is wonderful for the lines in the center of the forehead between the brows and for the horizontal lines across the forehead. The most significant potential complication of treatment in this area is drooping of the upper eyelid, a condition called ptosis. This complication is very rare, however, and should not happen if the treatment is used conservatively. Another possible side effect is reduced ability to raise the eyebrows. This would only cause a problem if the person has an expressive brow and depends on that for expression. I can see how a professional performer might wish to maintain some forehead expression for stage presence. Some brow elevation may be preserved if the technique is modified. However, lack of brow elevation is still possible.
Treatment of crow’s feet is also very popular and effective. If the lines are from squinting, Botox prevents contraction of these muscles. Some new, still-experimental techniques include placing minuscule amounts into the lower eyelid for fine lines. However, at the moment these are still better treated by laser or peels. As for the lines from the nose to the mouth, treatment would render the upper lip motionless and therefore not good for a singer/actor. Again, newer techniques place minute amounts into the small lines around the lips. As for the neck, Botox will not “elevate” a sagging neck. If part of the problem is thick muscular bands in front of the neck (platysma banding), these can be relaxed with Botox to improve neck contour.
The cost in Manhattan is usually $400 to $500 per facial region. Some doctors discount for two or three regions. The duration of the treatment’s effects is three to five months. Some authorities do claim that after a number of treatments the muscle becomes “permanently paralyzed,” but there is no scientific proof of that as of yet. Experts who have been using Botox for many years for other medical applications have not made that observation. There can be some minor bruising from the injections, but these can be covered with makeup right away. There should be no problem working the same day. The injections take from four to seven days to work.
Dr. Stephen Pearlman is the Eastern Region Vice President of the American Academy of Facial Plastic and Reconstructive Surgery (1-800-332-FACE).
