Published December 10, 2008 By Dr. Adam Lowenstein

The other day I was riding my bike through the beautiful Carpentaria country side, and met a fellow rider with whom I began to chat. We discussed bikes (of course), and then ventured into a discussion of plastic surgery in Santa Barbara. She asked some excellent questions about facial anatomy and the changes that come along with the aging process. She also had questions about specific areas, and in particular the vertical lines on the forehead which we call “glabellar frown lines”. I explained that the quick and easy way to treat these were with Botox and this was done very commonly. I was interested to hear her response, however, which was concern about Botox as a “poison” that would make you sick.

It is not infrequently that I have this type of conversation in both the professional plastic surgery as well as the casual setting, as classic teaching is that botulism toxin, which Botox is made from, is poisonous when ingested in large doses (as from bad food). This substance is poisonous because it paralyzes many muscles in your body when ingested in large quantities. When refined and used in minuscule amounts with specific placement, as we do with injections of Botox in my plastic surgery office, this toxin does not affect the entire body- only the individual muscle that it is applied to. By paralyzing the very small muscle that contracts just under the skin, the Botox injection prevents the contraction of that muscle and therefore prevents the wrinkle in the skin overlying that muscle from appearing. In this application, Botox is therapeutic, and not poisonous at all.

Lots of research has gone into development and purification and safety of Botox. I would not use it on my patients if I had reservations about it, and it ranks highly as one of the most satisfying patient therapies short of surgery. We must remember that like so many of the medications and even vitamins that we take, the proper dosing of the therapy is key. Too much vitamin A can kill someone if taken in overdose amounts. Similarly with Botox, the right dose, indication, and application by a certified professional are key to a safe, youthful appearance.

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