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.