The Age OfDeception

Raghavan Reddy, 38, tries Botox for his forehead lines and is left with more to worry about. His eyebrows and eyelids are drooping, and his forehead muscles are so weakened, he must now consider a surgical brow-lift.

We’ve heard about how Botox bashes are the latest fad among the kitty-party socialites and the Tupperware tea party housewives of Mumbai and Delhi. We’ve heard Kaya’s brand ambassador Pooja Bedi gush about the wonders of Botox at swish press conferences and fancy lunch parties for her Page Three compatriots. And we’ve had the paparazzi guessing and second-guessing the P3P circuit: Who is doing Botox and who isn’t?

But cut past the celebrity denial, brush aside the buzz—and a more treacherous tale of quackery emerges. One in which unskilled, profit-seeking practitioners mint money by pushing Botox on an insecure and uninformed public. And one in which Botox users like Aditi, Shanti and Raghavan all find out the hard way that Botox—the cosmetic brand name by which botulinum toxin Type A is popularly known—isn’t quite the anti-ageing panacea it is made out to be.

Aditi took Botox at the Kaya Skin Clinic last September for her forehead lines and crow’s feet. It was a treat ahead of her 47th birthday on September 21—and at Rs 48,000, it was quite an indulgence. Her birthday, though, was an utter disaster. Soon after the shots, she found small eruptions dotting her forehead at the points where she had been injected. Kaya put her on anti-histamines, then on corticosteroids. The drugs made things worse. Aditi was so nauseous on her birthday, she passed out an hour before a party she was throwing for her friends. By now, there were 18 bumps on her forehead and they had gotten larger. After that, as she says, "it was totally downhill."

By October end, the eruptions had grown eight-fold. It was soon becoming clear that they were giant abscesses. "I had 16 of them on my forehead, three on each cheek," says Aditi, cringing at the memory of it.

Aditi sought expert medical advice. Her doctors told her she had been injected in non-sterile environs and infected by an atypical mycobacterium (mycobacteria typically cause leprosy and tuberculosis). The abscesses would keep appearing and spread beyond her face unless she underwent a rigorous and painful treatment. "I went back to Kaya," says Aditi. "They reimbursed the cost of the procedure and paid me Rs 6 lakh for treatment. They wanted me to keep things quiet, but I’ve been to hell and back."

This isn’t an exaggeration: For one long year, Aditi will be popping more than 3,000 mg of antibiotics daily. The drugs leave her dizzy and nauseous; her liver and kidneys must be tested every fortnight to see how they are coping with the side-effects. She has had 17 excruciatingly painful aspirations so far, where the pus from her abscesses is drained with a needle; the aspirations will continue as long as the abscesses resurface. They will leave small depressions on her face that will never go. The expenses, needless to say, have already run into lakhs.

In a written response to Outlook, Kaya said: "[This] is a rare case of infection post the Botox service and is an aberration.... There are some known and consented effects of Botox like any other medical procedure." But Outlook obtained a copy of Kaya’s consent form and found that such risks are not spelt out.

What’s more, Aditi’s experience hasn’t made Rakesh Pandey, CEO of Kaya Skincare Ltd, treat Botox any less casually—he endorses it as a "lunchtime procedure". In fact, Pandey welcomes Botox bashes as the latest business op. "With the right doctor, you don’t need an operating theatre," he says.

With such no-holds-barred marketing, it’s no wonder business is good. Botox services are offered at all 42 of Kaya’s skin clinics across the country, with Botox accounting for 10 per cent of total business, up from 5 per cent the year before. And according to a highly placed sales executive at market leader Allergan, the demand for cosmetic Botox is growing at more than 100 per cent a year since 2002, when it received approval from the Food and Drug Administration.

These numbers only mean that people don’t know enough about what can go wrong. Senior cosmetic surgeon Dr Narendra Pandya says an overdose of Botox can leave the patient’s injected muscles completely paralysed. The result: an inability to lift the eyelids; or an asymmetry of the eyebrows, where one of them is unnaturally arched. Injecting it in the wrong place, such as the lower half of the face, could result in a paralysis of the neck muscles; or constant salivation of the mouth.

Shanti can tell you all about it. A few months ago, she went to her dermatologist for Botox for the crow’s feet around her eyes and for her neck folds. A fortnight later, she returned for a touch-up of the neck, only to be persuaded to take Botox for her laugh lines too. The bill was a whopping Rs 30,000—and the results were horrific to boot. Shanti’s lips were paralysed.

"I couldn’t talk properly, worst of all, I couldn’t smile," says a tearful Shanti. "My face was red and swollen. One of my eyebrows had shot upward and looked unnatural. My dermatologist kept telling me to apply rose water and wait for 10 days. But it has been months now."

Botulinum toxin A, derived from the bacterium Clostridium Botulinum, is a neuromuscular toxin whose muscle-paralysing properties were first discovered when it was used to treat spasms around the eyes. In its cosmetic application, it blocks the nerve impulses to the wrinkle-causing facial muscles when injected, temporarily paralysing the muscles and giving the skin a smoother appearance.

According to Pandya, Shanti was the wrong candidate for Botox. He puts the ideal age for Botox anywhere between 25 years and 55 years. "At her age, the muscles are much weaker and react more adversely," says Pandya, who has authored a book on Botox.

Shanti’s disillusionment is shared by Raghavan Reddy. "My dermatologist gave me four sittings over more than a year, at Rs 15,000 per sitting. But after the first week, the effect would fade and she would tell me to come in for another sitting and try again. Now the muscles in my forehead are so weak that I need a brow-lift."

So why aren’t we told enough about these risks? "Because doctors are thriving on this business," says cosmetic surgeon Dr Vijay Sharma. "These companies give us free foreign trips, gifts and commissions as high as 40 per cent. We don’t want to tell the truth any more."

Clinics market Botox to youngsters by suggesting that taking Botox early reduces the creasing tendency of your skin, thereby preventing wrinkles. As Kaya’s Pandey puts it, "People who have already aged are OK with ageing. It is the people who have just started developing wrinkles who are really worried. So the preventive argument is working much better for us." Dr Pandya dismisses the preventive argument as a mere "hypothesis". "Whoever tells you this is only trying to sell Botox," he says. But the hardsell works: "If we just told people to take Botox for crow’s feet, they wouldn’t take the leap," Pandey observes. "But if we offer Botox as one part of our anti-ageing solutions, they can appreciate it better."

So while clinics like Kaya indulge in canny marketing, or call it clever positioning, victims such as Aditi, Shanti and Raghavan don’t even want the world to know they’ve tried Botox. Which makes it easier for the truth about Botox to remain in the closet—and for its manufacturers and producers to mint money on the illusion instead.