Alright world, Dr. Meghan here. I have been talking about this next topic so, so much over the past few months that I’ve realized it’s definitely time to put it on the blog. That being said, this topic is pretty controversial, so I want you to understand my perspective before you read it. The information presented below is meant to educate, not to tell you that what you’re doing is wrong, or bad, or anything of the sort. At the end of the day, I want you to be happy and healthy, and I fully respect that your version of that might vary a little from mine. That’s okay. I’m cool with it if you’re cool with it. So, can we still be friends?

That might be a little dramatic. But we’re about to talk nitty gritty about Botox, so it had to be said!

I’ve had a lot of people ask me what I think about Botox. I always struggle to answer, because while I have strong opinions about it, I don’t want people to feel judged. You’re not. As I stated already, I’m cool with it if you’re cool with it. That being said, I suddenly feel like I’ve missed an opportunity to share some valuable information and, as a health care provider, I feel a little bit like I’ve been doing a dis-service to those of you who’ve asked. So no more of that. I’m putting this out into the world for anyone to read.

From a Chinese Medicine perspective our nervous system is qi (or “chee”). It’s essentially the energy and communication system of our bodies. It’s the “yang” aspect of that yin/yang image we’re all so strangely familiar with. In contrast, blood is our “yin.” Blood is a more literal translation- basically, it’s our circulatory system including, shockingly enough, our blood! In ancient Chinese Medicine theory, qi carries our blood throughout the body. It brings blood and therefore nutrients to the organs, the muscles, and the skin (yes, you’re right- technically the skin is an organ). So if we translate that theory to the physiological functions of the body, our nervous system helps nourish our body by controlling the circulatory system, or the flow of blood throughout the body.

Botox, or Botulinum toxin Type A, or Clostridium botulinum if you want to get fancy and scientific, is a neurotoxin that has been used in humans for a wide array of concerns from migraines and sweating to the reduction of lines and wrinkles. Please understand that as far as this blog post is concerned, we are discussing the use of Botox for cosmetic reasons. I wholly understand that in some medical settings, the positive aspects of Botox outweigh the potential negative side effects.

Botox is injected into facial muscles in order to paralyze nerve conduction. As a result, the muscle relaxes and smooths, and therefore we see that ever so elusive and desirable reduction in the signs of aging. Sounds a-okay, right? So long as you’re okay with not being able to use full facial expression, what’s not to love?

Before we dive into the negative side effects of this, I want to clarify something important. I’m about to refer to some scientific research about the side effects of Botox. You should know though, that it’s not okay for scientists to study medical interventions with the intent to find the negative effects. That would be knowingly and purposely causing harm to participants, and I think we can all agree that that’s just not cool. Therefore, the included evidence is either conducted on animals or seen in studies utilizing Botox for other reasons. In other words, the negative effects were observed while studying other outcomes. There are no studies about “negatives of Botox used for cosmetic purposes” because, as we said, it’s not super cool to knowingly go into a study to see what harm an intervention might cause.

Moving on. Let’s start with the muscle itself, which is where the injection goes. What happens after repeated use of Botox? Turns out, the muscle will start to atrophy. Why? It’s actually pretty simple science. If the nerves of the muscle never fire, it never contracts. Just as with growing strong in the gym, this is important for the muscle health in terms of actual muscle mass. Sure, you don’t want a bulging forehead so you’re not trying to figure out how to lift weights with it, but if the muscle itself starts to shrink and wither away, the beautiful plumpness of your face will actually start to decrease. That firmness we seek in the world of beauty will grow soft and thin. Over time, Botox can become less effective, which is why we’re told to start young and prevent wrinkles instead of eliminate them. But what’s really happening is the significant reduction in contractile muscle tissue and as a result a reduction in the strength and structure of the muscle. If you’ve ever known someone with a spinal injury, one where nerve conduction to the legs is cut off, you might be familiar with the fact that the muscle mass in their legs continuously decreases without use. This is what happens with Botox injections in facial muscle. The science and beauty worlds are still waiting for research to answer whether or not the facial muscles can recover from this atrophy caused by Botox injections, but my question to you is this -what if it can’t? Combine that with decreased efficacy with repeat injections, and what will the end result be?

So what about the skin itself? Since I always like to bounce back and forth between Chinese medicine and modern western medicine, I’m going to revisit this Qi/Yang and Blood/Yin perspective. Over the past few months, I’ve worked with a handful of women to restore their skin after the use of Botox. In some cases, it was just undoing Botox that they didn’t like by re-stimulating nerve conduction, but the tougher cases are trying to recover that muscle tissue and build their thinned skin back up after long term use of Botox. Whoa, wait- did I just say “thinned skin?” Yes, I did. If we paralyze the qi (aka the nerve conduction), and the qi carries the blood, then is our skin still being properly nourished? In our medicine, the answer to that is a simple “no.” Over time, many women experience increased bruising with Botox injections. I have seen this many times in many patients. Simply put, if the blood isn’t optimally reaching the skin, not only will it dry and therefore loose elasticity and structure, but the replenishment of collagen and elastin will be stunted. Essentially we can address the folds and fatigue of the muscle with Botox, but the skin itself will continue to age, dry, and dismantle. So what we’re looking at now is a combination of atrophied muscle and thinned, broken down skin.

Alright folks, you’ve stuck it out this far. Now that we’ve addressed Botox and the skin and muscle, I want to address one more quick thing. What does injecting a known toxin really do inside your body anyway? This last bit of this post comes straight from my heart and soul. It comes from life lessons learned the hard way. Let’s talk for a quick moment about a topic you’ve all heard me rattle on and on about via Instagram post after Instagram post- Autoimmune disease. And before you shrug this off as something that doesn’t affect you, maybe read it through- just in case I surprise you.

The National Institute of Health estimates that over 23 million Americans suffer from autoimmune disease. However, that number only represents a small number of autoimmune diseases and the amount of undiagnosed individuals is estimated to be very high. Autoimmune rates are climbing, quickly. What’s even crazier is the little-known idea that autoimmunity comes in three stages: The third stage is the presence of autoantibody cells in conjunction with tissue damage. This is where most individuals finally get a diagnosis. However, many people live in the first two stages- the presence of autoantibodies without enough damage to warrant proper testing. People in this stage frequently come to my office after many trips to various doctors without finding an answer as to why they feel “blah” or “off” or “just not like myself.” Usually the progression of stage one or stage two autoimmune disease happens with a “trigger.” Sometimes it’s a traumatic event- a move, food poisoning, or even just stress (aka life). So why does this matter in the world of Botox? What do these things have in common?

Did you know that if you have an autoimmune disease you’re supposed to check in with your rheumatologist, immunologist, or endocrinologist before you get a Botox injection? In fact, the Botox insert itself recommends caution to individuals with neuromuscular disorders such as ALS and Myasthenia Gravis. Why?

Those of us hanging out in stage three of autoimmunity (aka with a diagnosis) have likely learned by now that foreign substances totally don’t jive with our system. In fact, they can out right piss it off. Trust me, I’ve learned that the hard way. When we inject something into our body, our immune system will react. That’s it’s job. It says, “hey, something is here that isn’t self, and we need to do something about it!” In other words, it activates the immune system. In autoimmune disease, we’re already over producing immune cells (those pesky autoantibodies I was discussing), and now we’re making more cells to fight the invader. I think you can probably see where I’m going with this…

Again, before you shrug this off as not important to you, remember that “blah” and “off” and similar “feelings” are commonly signs of those first two stages of autoimmunity. The stages where self-care is most important in order to prevent full-fledged disease. The stages that if presented with a trigger, such as exposure to a new foreign substance, might tip us from stage two to stage three. If you’ve ever had digestive issues, stress, unexplained infertility, reactive skin, joint pain, fatigue, temperature regulation issues, or if anyone in your family has been diagnosed with an autoimmune disease, you might want to consider a clean beauty regime. A really clean one. Combine an injection of a known toxin with stress, gut issues, aging, and two X chromosomes (aka you’re female), and you might stumble unknowingly and unwillingly into an issue much bigger than wrinkles.

Research into the possible detrimental side effects of Botox is continuously increasing. So is the number of women speaking out about their negative experiences with Botox injections. In fact, there are whole Facebook groups dedicated to this. As with smoking, it was avidly popular, everyone was doing it, and over time we started to observe that maybe it wasn’t such a fantastic idea to put a foreign, unnecessary substance into our bodies. Toxic things like tobacco and nicotine can be dangerous.

As I said earlier, I am not posting this as a form of judgement, but rather in hopes to help you make an educated decision on how you personally want to tackle your external aging regime. All across the country, alternatives to Botox are becoming more and more popular and I can’t help but wonder if it’s a bad thing- in that so many people are reacting poorly that now they’re looking to fix an issue- or if it’s a good thing- that as more research about the negative side effects surface, people are hunting for cleaner options.

Some of the information above comes from personal clinical experience as a Doctor of Acupuncture. Some of it comes from personal experience as an individual with autoimmune issues! And some of it comes from scientific research (if you’re curious there are some references listed below). If you’d like to hear more about this topic, please comment below and let us know so we can keep the info coming. If you’d like to hear about clean beauty combined with internal health care that offers you an alternative to injections and fillers, please stay tuned for part two of this blog post in which I’ll discuss the benefits of cosmetic acupuncture and gua sha therapy.

Borodic, G. (1998). Myasthenic crisis after botulinum toxin. Lancet (London, England), 352(9143), 1832. Retrieved from http://search.ebscohost.com.uws.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=9851395&site=eds-live&scope=site

El-Heis, S., Burke, G., Gibb, W., & Ardern-Jones, M. R. (2017). Myaesthenia gravis exacerbation caused by axillary injection of botulinum toxin A for treatment of hyperhidrosis. Clinical And Experimental Dermatology, 42(3), 357–359. https://doi-org.uws.idm.oclc.org/10.1111/ced.13036

Fortuna, R., Aurélio Vaz, M., Rehan Youssef, A., Longino, D., & Herzog, W. (2011). Changes in contractile properties of muscles receiving repeat injections of botulinum toxin (Botox). Journal of Biomechanics, 44(1), 39–44. https://doi-org.uws.idm.oclc.org/10.1016/j.jbiomech.2010.08.020

Glass, G. E., Hussain, M., Fleming, A. N. M., & Powell, B. W. E. M. (2009). Atrophy of the intrinsic musculature of the hands associated with the use of botulinum toxin-A injections for hyperhidrosis: a case report and review of the literature. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(8), e274–e276. https://doi-org.uws.idm.oclc.org/10.1016/j.bjps.2007.11.047

Patient awarded $212 million for adverse reaction to Botox: inadequate warning of potential autoimmune reaction alleged. (2011). Biotechnology Law Report, (4), 482. Retrieved from http://search.ebscohost.com.uws.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.263440571&site=eds-live&scope=site

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