Study Puts Wrinkle In Botox

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The New York Sun

Will there soon be a 12-step program for Botox buffs?

It’s not as outlandish as it sounds, given a soon-to-be-unveiled study that says the FDA-approved, wrinkle-smoothing injections can be addictive.

Based on surveys completed in 81 clinics, the study, spearheaded by a British psychologist, shows that four out of 10 people receiving regular botulinum toxin injections, known commercially as Botox, had “a compulsive motive” for doing it. Botox users can develop behavioral addictions to the treatments but do not become chemically dependent on the toxin, according to the findings.

Botox injections, shown to diminish the appearance of wrinkles and frown lines for up to six months, can cost more than $1,000 a treatment.

An Upper East Side cosmetic surgeon, Paul Lorenc, said that while about 90% of his cosmetic Botox patients return for twice or thrice-yearly follow-up injections, the medical community shouldn’t mistake their enthusiasm for a dangerous addiction. “It’s positive reinforcement that brings people back,” he said. “They get a very nice result.”

Dr. Lorenc, the author of the 2004 book “A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon,” said he has encountered patients who have unhealthy obsessions with cosmetic procedures other than Botox injections. “It’s our job to screen out those people who are pathologically addicted,” he said. “Have I seen them? Yes. Have I operated on them? No.”

A cosmetic dermatologist, Francesca Fusco, said she occasionally has to “put the brakes on” when a patient too frequently comes in for treatments.

Dr. Fusco, who practices at the Wexler Dermatology Group on East 32nd Street, insisted that there is nothing inherently addictive about the chemical makeup of the injections. “It’s not like you start needing more and more Botox every time you come in,” she said. “There are no physical withdrawal symptoms if you stop.”

In a written statement to The New York Sun, a spokeswoman for Allergan, the Irvine, Calif.-based company that produces Botox, said, “The term ‘addiction’ is inaccurate and should be more appropriately and accurately described as ‘high patient satisfaction’ following treatment.”

The spokeswoman, Caroline Van Hove, said clinical studies have found there are no long-term adverse effects associated with Botox use.

The gotta-have-my-Botox folks aren’t necessarily addicts, some mental health professionals say.

“People talk about ‘shopping addictions’ or ‘Botox addictions,’ but I hesitate to use that term,” a New York-based clinical psychologist, Rene Zweig, said. “These are excessive behaviors with symptoms that are probably more similar to obsessive-compulsive disorder than they are to substance abuse.”

Ms. Zweig practices at the American Institute for Cognitive Therapy in Midtown.

“There are many things we do on a day-to-day basis like brushing our teeth that aren’t addictions,” an associate professor of psychiatry at Yale University School of Medicine, Marc Potenza, said. “One element of addiction is continued engagement in a behavior despite negative consequences — on our health, at work, or with our family.”

Cravings and diminished self-control are other signs of addiction, according Dr. Potenza, who directs the Problem Gambling Clinic and the Women and Addictions Core of Women’s Health Research, both at Yale.

He said psychiatrists often classify destructive behavioral fixations — gambling, kleptomania, and pyromania, for example — as impulse-control disorders, rather than addictions. “We don’t fully understand the biology of these disorders, nor do we have optimal treatment strategies for them.”

A cosmetic surgeon who practices in Midtown, Eric Berger, said Botox injections are no more an addiction than regular teeth cleanings or hair colorings. “It’s not an addictive behavior,” he said. “It goes with good grooming, and wanting to look your absolute best.”

The British study, which will be presented in its entirety Friday at a British Association of Aesthetic Plastic Surgeons conference in Bath, England, also found that more than half of Botox users reported “feeling” younger, in addition to looking younger.

“Of course, you’re going to feel better,” Dr. Berger said. “It’s like when a woman goes to the hair dresser and comes out with a good cut and perfect highlights, and she walks out of the salon feeling euphoric. It’s the same thing, when she looks in the mirror in the morning, and doesn’t see the wrinkles on her forehead.”

Botox has been approved for use in more than 75 countries for 20 different indications, including treatment of certain neurological disorders and severe underarm sweating.

One Botox user, who asked not to be identified because she said she keeps her treatments a secret even from her husband, said she understands how the injections can become de rigueur for well-to-do women. She said her budget allows for only twice-yearly Botox injections to smooth the wrinkles on her forehead and around her eyes. “It makes you feel so good,” she said. “I’m 43, but people always tell me that I look like I’m in my early 30s. I can imagine doing it more often, but I can’t imagine getting to the point where I was addicted.”


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