Toxic Shocker Botox, A Chemical With Deadly Properties, Is Being Used To Smooth Out Frown Lines

The docs banter as Dr. Joel Sears eases a hypodermic needle away from his colleague’s forehead.

“You’re not smiling anymore,” Sears says.

Dr. Richard Herdener lies on an exam table, his hands jammed into his pockets, his forehead muscles filled with botulinum toxin.

“I haven’t seized yet,” Herdener quips.

It’s just doc talk. Neither of these Spokane dermatologists confesses any qualms about injecting the human body with the world’s most deadly poison.

Botulism has long been the home-canner’s worst nightmare. According to the United Nations, the Iraqis stockpiled the toxin as a chemical weapon during the Persian Gulf War. Now dermatologists around the world, including three in Spokane, have embraced this poison as their latest remedy for restoring youth. They inject it to eliminate frown lines.

While the U.S. Food and Drug Administration has never approved it specifically for this use, these doctors are confident in the drug now marketed under the trade name Botox.

“It’s very, very, very safe,” says Dr. Alastair Carruthers, the Vancouver, B.C., dermatologist who has been dubbed “the guru of Botox.” “It’s as safe as it is potent.”

Carruthers has trained Spokane dermatologists to inject Botox directly into their patients’ facial muscles. The result: Furrowed brows relax. Crow’s-feet smooth away.

“Now when I tell people I’m 55, they don’t believe it,” says Linda Lynch, a North Side resident who spends eights hours a day during the summer squinting in the sun to maintain her Japanese-style garden. She combined Botox treatments with laser resurfacing. “It took 10 years off.”

IN 1989 THE FDA APPROVED the use of Botox for the treatment of two common eye disorders, cross-eye, called strabismus, and uncontrollable blinking, called blepharospasm.

Ophthalmologists found that they could avoid surgery by injecting the toxin into the muscles around the eye. Crossed eyes relaxed. Blinking ceased.

Here’s why it works: The botulinum toxin attaches itself to the nerve endings in the muscles. When it’s eaten along with a serving of home-canned green beans, for example, it can paralyze the person’s chest muscles, causing him to die of suffocation.

When it’s injected in very small doses in specific muscles, the paralysis can be beneficial.

Like a child safety plug popped into an electrical outlet, the toxin binds to the nerve endings. It blocks the neurotransmitter acetylcholine from signaling the muscle to contract.

The muscles injected around the eyes become weakened or even paralyzed, but other muscles aren’t altered. The effects last from four to six months.

The leap from ophthalmology to dermatology occurred in the Canadian home of Alastair Carruthers. He’s married to an ophthalmologist.

One day his wife, Dr. Jean Carruthers, saw a patient she’d treated with Botox for blepharospasm. The woman didn’t appear to need another treatment. The blinking had stopped.

“Oh, but, doctor,” the patient said. “I get this lovely relaxed look when you inject it there.”

That night, Jean Carruthers came home with an idea for her husband, the dermatologist.

The couple tried the treatment on Alastair’s office receptionist. It worked beautifully.

“Once you’ve done it on one, you can’t wait to stand up in public and say, ‘Hey, look, you’re not going to believe this,” Alastair Carruthers says.

The guru of Botox was born.

SPOKANE’S RICHARD HERDENER first learned of Botox from a well-known Los Angeles dermatologist.

Herdener visited the man in his office. The doctor dashed from room to room, injecting Botox in forehead after forehead.

“I was watching this famous dermatologist just going, bang, bang, bang,” Herdener said. “I thought, ‘You’ve got to be kidding.’”

But like his colleagues in Spokane, Sears and Dr. Philip Werschler, he discovered that Botox was an easy, safe treatment for frown lines.

Herdener and Werschler traveled to Vancouver to train with Alastair Carruthers. Since his early experiments, the Botox guru has written articles and trained physicians from around the world.

“I have treated wrinkles in all kinds of ways over the years,” Carruthers says. “This is the simplest way of treating wrinkles, with the lowest side effect and complication rate and the greatest customer acceptance and enthusiasm. People get very excited about it.”

The alternatives have greater risks, or a higher nuisance factor. With face lifts, there are the complications of surgery. Collagen treatments are safer, but require more pain and annoyance for the patient.

Werschler has performed more than 300 Botox treatments.

The treatments aren’t cheap. The typical fee among Spokane doctors is $300 per injection site.

Still, the dermatologists say nearly all of their patients are delighted.

Werschler has only heard of one disgruntled patient, a Spokane CEO, who wound up missing his frown lines.

The procedure on his deep eyebrow creases worked perfectly. But at his next board meeting, the CEO was astonished to hear the board’s discussion veer toward disaster. After the meeting, he asked a staff member what went wrong. The board members were stymied, the man said. They’d always gauged the CEO’s reactions by the depth of his furrows. With his frown lines disabled, they had no idea how to vote.

The CEO swore off Botox permanently.

The treatment never seems to handicap women patients.

A 36-year-old patient, a Spokane professional woman who asked not to be named, says, “People who are attractive do better in business, especially women. It’s so sad that we are so superficial, but it’s the way it is.”

“My wife hasn’t frowned for six or seven years,” says Alastair Carruthers. “I haven’t missed her frowns a bit, and neither have our children. They still know when she’s angry.”

Adds Lynch, “There are other ways to tell somebody you’re mad.”

The FDA has never been enamored of the cosmetic use of Botox. Strictly speaking, the FDA has no power to regulate doctors. Its power is aimed primarily at drug companies.

So the use of Botox by dermatologists is legal. But it is against the law for the company that manufactures it, Allergan, to advertise that use.

In 1994, the FDA denounced the promotion of the cosmetic use of Botox as “an egregious example of promoting a potentially toxic biologic for cosmetic purposes.”

Larry Sasich, a research analyst for the Public Citizen Health Research Group, a Washington, D.C., consumer watchdog group, says doctors shouldn’t use drugs for non-FDA-approved purposes, at least not without warning patients that it’s experimental therapy.

“Sometimes the docs get lucky and sometimes they don’t,” Sasich says. “From a scientific standpoint, luck doesn’t count.”

Werschler argues that a number of drugs are used “off-label,” meaning that the FDA has not specifically approved a particular use.

Tetracycline, the antibiotic most commonly used to treat acne, for example, has never been formally approved by the FDA for that use, Werschler says.

Werschler and his Spokane colleagues believe that the eye disorder studies that won FDA approval also apply to their procedures, which target some of the same muscles.

“Clearly, if it’s safe to inject it around the eyes, surely it must also be safe to inject it in less important muscles in the forehead,” Werschler says.

Carruthers believes in the results he’s seen.

“My wife has done over 10,000 injection sessions over the last 13 years and has not had any significant complications,” he says.

The only two side effects, which have happened rarely, have been a drooping of the eyelid or a bout of double vision. Both have been temporary.

In one study, Carruthers says, out of 10 people who experienced a drooping upper eyelid, nine came back for subsequent treatments. “For them,” he says, “this was no big deal.”

On a recent afternoon, Carruthers left a patient battling skin cancer that had invaded the brain to talk about Botox.

It was a relief.

For dermatologists, Botox treatments can be a delightful respite from “real medicine,” the world where terror and loss can reside. This is a poison patients have learned to love.

“They bubble in and they bubble out, and, gosh, how often does that happen?” Carruthers says.

, DataTimes ILLUSTRATION: 2 Color Photos

MEMO: This sidebar appeared with the story: HOW TOXIC IS IT? Botulinum toxin is 6 million times more toxic than rattlesnake venom. The original tests on Botox were conducted on cross-eyed monkeys in 1978. The United Nations believes Iraq has produced enough biological warfare agents, including botulinum toxin and anthrax, to kill every man, woman and child on Earth. Botox has been injected in the vocal cords to prevent stuttering. Botox may be used in the future to treat the muscle spasms of both cerebral palsy and multiple sclerosis.