Burlington County Times, May 20, 2002

My mother-in-law was at her weekly hair salon appointment last week, and mentioned that she had to call her doctor to arrange for her next Botox injection. “Botox!” said one of the other customers. “So that’s why you always look so great. You’re getting Botox!” My mother-in-law jokes, “It’s genetic. My Dad had no wrinkles at the age of 94.”

As my mother-in-law told us this story, over her thin-crust Mother’s Day pizza, she shook her head in disbelief. “I was surprised. I told her that I was getting it for a medical condition, but all she could say was, “Now we know why you look so good.’”

My mother-in-law has a condition called blepharospasm, a form of dystonia, which causes involuntary contractions of the muscles controlling her eyelids. There is no cure and no one knows what causes it. It often appears in middle age, which is when it first manifested itself, over 20 years ago, in my mother-in–law. As it got worse, she sought medical advice. Her doctors told her it was psychosomatic, or stress-related, or a nervous tic. They were right that it was caused by nerves, but not in the sense they meant. It’s a neurological condition, not a psychological one.

As the syndrome progressed, my mother-in-law got to the point where she could no longer drive, as she never knew when her eyes would clamp shut and not reopen. She couldn’t go shopping by herself, because she would trip over chairs and bump into people.

Later, her tongue and vocal cords were affected, making speaking and even swallowing difficult. There were times when she ate nothing but soup and pasta. Her food processor became her most important kitchen tool.

About 15 years ago, she became, one of the first – although, she insists, not a pioneer – to receive injections of a form of the botulin toxin. That’s “botulin,” as in “botulism,” and “toxin,” as in “poisonous.” She was receiving, experimentally, a bacterium that paralyzes the nervous system and can cause death from respiratory failure. At that time, it was not yet approved by the FDA. The researchers picked up the tab for the injections at that time, but it became the patients’ financial responsibility after FDA approval was granted. The price ranged from $700.00 – $1700.00 each time depending on the part of the country. The toxin was often in short supply, and sometimes my mother-in-law had to delay getting a needed injection because it wasn’t available. She used to go to New York City for treatments, until it became available in Philadelphia. One member of her support group flew to North Carolina each month for the shots.

Botox, as it is now known, has helped my mother-in-law tremendously, but not without a cost. And I’m not just referring to the financial price of the shots themselves. The effects, which can be dramatic, are not guaranteed. Each time she receives the injections, which are given around her eyes and on the outside of her throat, she has no idea if they will work well or not. And the effects diminish gradually over time, and are completely gone within three to four months. Her eyes now stay open, and she can talk and swallow, although she still prefers foods that are easy to chew, such as thin-crust pizza and home-made soups and pasta.

Two treatments ago, my mother-in-law began to see double. The toxin had leaked into the muscle around her eyes. The problem cleared up in about a month. And she often has black and blue marks around her eyes the day after the treatments are given.

Most troubling, to her, is that she can no longer smile naturally, but has to force one when we take pictures. She told me. “These women taking the shots for wrinkles don’t know what they’re getting into. Wait until they’re not able to produce a smile.”

I asked if the shots are painful. “Only when receiving them,” she said. “I’m not trying to make light of it,” she continued. “Believe me, this little bit of discomfort is worth it.”

I have deep vertical furrow between my eyebrows, exactly the type of wrinkles eliminated by the cosmetic use of botox. But, even though approved by the FDA, I could never bring myself to take it. A good moisturizer and growing my bangs long will take care of the problem. At least my eyes stay open long enough for me to see my wrinkles in a mirror.

As my mother-in-law says when people compliment her about her smooth skin, “It’s no longer about how you look; it’s about how well you see.”


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