Botox, a diluted form of the neurotoxin botulinum A, is, according to the statistics of the American Society for Aesthetic Plastic Surgery, the most  popular cosmetic procedure (including surgical  and  non-surgical procedures) ever to exist. While in  the  year  2000,  one  million  people  had  had  Botox  injections in  the  United States,  by 2002,  when  the  FDA  approved the  drug  as successfully reducing the severity of frown  lines for up to 120 days, the  number of users  had  already  risen to over 1.6 million, and to 2.4 million  by 2008. This  represents an increase of over 4,000  percent for men  and around 3,600  percent for women since 1997. Botox is injected subcutaneously, and  as a non-surgical cosmetic procedure it is followed in its popularity by the use of hyaluronic acid and  such  rejuvenation procedures as chemical peels and laser skin resurfacing.

The  drug, which  is manufactured in the United States by Allergan, is dedicated to reducing the appearance of fine lines and wrinkles on the face, particularly the forehead, for aesthetic purposes. It is named after the Latin  botulus (sausage). The substance was identified in 1895  by the Belgian physician Emile van Ermengem, who  named it after  its identification in  some  sausages that  had  been  poisoned with clostridium botulinum, a group of bacteria commonly found in soil. Consumed in larger  doses,  botulinum causes  a form  of botulism, a serious paralytic  illness. In the late 1980s, the substance was originally  tested  for eye problems like muscle spasm, tics, and  blinking by the  Canadian doctors Alastair  and  Jean Carruthers, who published the ground-breaking article “Treatment of Glabellar  Frown  Lines with  C. Botulinum-A Exotoxin” (1992),  which  formed the  basis  of today’s  cosmetic  application of the toxin.

For doctors, Botox  treatments are a cash  cow. In 2005,  doctors paid  $488  for a vial that  generated revenues of up to $3000. For the  U.S. consumer, costs  vary between $450  and  $800  per  treatment, or between $2,700 and  $4,800 per  year. Variations of Botox  can  be  found for  much less  on  the  black  market. Overall, Botox is well over a billion-dollar industry.

The  number-one selling point of Botox is the  effect of a youthful appearance, due  to the disappearance of wrinkles and  strong frown  lines. But the importance of communicating with  precisely  these  facial features during speech or  on  the stage—which by the  legendary Roman rhetorician Quintilian was held  to be absolutely  indispensable for a successful presentation—is seriously undermined by the use of this paralyzing  substance. Indeed, some Hollywood directors have been known to say that  they cannot work with actresses and  actors  who have lost the ability  to  express  emotion in  the  face  due  to  Botox  (Nicole  Kidman has  been thought to have had  Botox). Botox, according to one  scholar, can be understood as a pharmakon because of its ability to cure  while  poisoning. The  cure  in question  is of a psychological nature, and  appears to be stronger in the  minds of its users  than the  damage it causes. The  person who  uses  Botox  expresses that  he feels younger inside  and wants  to have that  feeling reflected  in his face. The  toxin can hence be understood as a necessary evil for the modern self, who lives in the zeitgeist  of makeover.

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