Botox a Fraud That Increases the Need for a Facelift?

A doctor in India, Dr. Vijay Sharma, was quoted in The Hindustan Times as saying that Botox is a fraud.
He is quoted as saying “In the case of frequent use, the damage to the muscles may force a patient to undergo a face-lift at an early age. This scam allows for doctors and dermatologists to set themselves up for a steady income from their patients.”

Doctor Answers 22

Botox is not a fraud

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Dr. Vijay Sharma's statements sound more like sensationalism for himself and have no scientific merit. In fact, it seems to me that Botox has actually lowered the number of facial cosmetic procedures performed - although this is just my observation.

It certainly has lowered the amount of forehead surgery such as brow lifts. Additionally, in general, Botox is used in the periorbital region and above (forehead, glabella).

Facelifts address the lower face, an area where Botox is not typically used. Botox or not, people continue to age. So, if there is any correlation between Botox and facelifts, it would be that Botox patients already are familiar with plastic surgeons and, when it comes time for them to have a facelift, they have one.

Doesn't make sense

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Botox is mainly used for the upper 1/3 of the face. So if the doctor's rational was correct he would imply browlifting. However, in a relatively young patient in their 30's, 40's and sometimes 50's, Botox can help improve the wrinkles associated with muscle overactivity. Yes, down the road a browlift may be better, but most of these people do not need a full browlift until may years later.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Botox and facelifts

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Wrinkles and an aged appearance result from repetetive use of facial muscles --smiling produces laugh lines and crow's feet. Frowning creates frown lines. Botox prevents those muscle actions from occurring excessively.

We can learn from an experiment of nature - facial paralysis from a stroke. In those patients, the paralyzed side literally is wrinkle free.

Of course in the paralyzed face, the tissues droop as well, so maybe Dr. Sharma does have a point!

Most doctors believe that after 3 months the effects of Botox go away and the muscle activity returns to its previous state. There is some (weak in my opinion) evidence in twins that repeated use of Botox over the years results in fewer permanent wrinkles.

If a patient gets Botox over a ten year period, say from age 35 to 45, they will cross a threshhold where they will probably benefit from a facelift. But that is not the fault of Botox, but rather of 10 years' passing.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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False sensationalism.

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Dear Tom,

1) Botox has an excellent safety profile.

2) Botox is extremely effective at temporary facial improvement ( lifting the eyebrows, lifting the corners of the mouth, relaxing neck bands, erasing wrinkles in the forehead and around the eyes, etc. ).

3) There is absolutely no evidence that using Botox will cause patients to need earlier facelifts. In fact, the opposite is true.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Perhaps "Dr. Sharma" should stick to his own "profession"

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The use of Botox to improve the appearance of rhytids of the periocular, glabellar and forehead regions has been proven safe and effective. Moreover, the use of Botox in the perioral region could in no way lead to atrophied muscles and the need for a face lift. Dr. Sharma clearly doesn't understand the anatomy of the aging face. More then likely I suspect he is trying to sell his own "snake oil."

Oh Come on Now Dr. Sharma .....Get Real!

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As you can see by the multitude of responses this assertion is silly. The plastic surgery community as well as dermatologists, etc... have been injecting Botox for years. The statistics indicate millions of treatments. dont you think that an untoward effect potentiating the aging process would have been well documented by now??? Those of us who are legitimate plastic surgeons base our recommendations on peer reviewed scientific observation and not conjecture

Robert A. Herbstman, MD, FACS
East Brunswick Plastic Surgeon
5.0 out of 5 stars 5 reviews

Use of Botox does not lead to earlier facelifts

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Since Botox is used mostly in the glabella, crow's feet and forehead area, I find the comments to make no rational sense. Facelifts are mainly sought for issues of the lower face (jowls, neck) while Botox treats the upper face. Whatever a patient has done to the upper face will not affect the aging of the jowls and lower face.

I have been using Botox in my practice since 1998, and I find no correlation between the use of Botox and the need for a facelift sooner. In addition, many of our facelift patients benefit from Botox after they have had their facelift since they look great in the lower face but still have issues around the glabella and crow's feet.

I find Botox and facelifts to be complementary treatments and not adversarial treatments and I will continue to advise younger patients to use Botox without fearing that the use will lead to premature lower face aging.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

There is no good reason to believe this

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The dominant use of Botox is to block the frown lines between the eyes. Other areas are of course treated but most are in the upper face. Relaxation of these muscles should not have anything to do with early aging leading to premature facelift surgery. If anything, I would expect the exact opposite to be true, namely that early prophylactic use of Botox and medical grade skin care and sun protection may prevent many people from ever needing a facelift.

Evidence based medicine and Botox

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Modern practitioners of every discipline today generally adhere to evidence-based medicine.  This means that medicine is practiced based upon the evidence supplied by randomized placebo-controlled clinical studies.  To the best of a physician's ability, treatment is based upon fact.  Botox studies are numerous and convincing.  Hundreds of trials exist thoughout the world confirming its safety and efficacy.  The collective advocacy of millions of practitioners versus one naysayer should speak for itself. 

Jason Hess, MD
San Diego Plastic Surgeon

Botox and facelifts

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Botox is a very effective in power for medication that is absorbed by muscles and helps them relax. It's method of action is very different from the concepts we use when we perform a facelift. In a facelift, we generally re-organize the deeper structures of the face to create a more youthful appearance. We then gently excise skin to create a smoother appearance over this rejuvenated framework. Some areas of the face are best treated with Botox, such as the crows feet and portions of the brow. Botox will not increase the like possibility that you will need a facelift. Botox can complement the good results from a facelift.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.