The Food and Drug Administration’s recent approval of Botox injections to smooth facial wrinkles has some Lancaster physicians jumping on the Botox bandwagon. And residents who have had the procedure are ready to testify as to its appeal.

“I’m in a business where looking good is important,” said Betty (not her real name), a cosmetologist in her late 50s. “I think (Botox) is a good precursor to a facelift,” she said, adding that she plans to stave off her facelift by going the Botox route for as long as she can.

The Botox procedure is simple. A patient identifies the facial wrinkles she wants to get rid of, and the muscles whose movement causes those wrinkles are injected with a tiny amount of Botox. Within three to 10 days Botox renders those muscles inert and the skin flattens, leaving the area wrinkle-free.

“There’s no pain involved,” said Ruth (not her real name), another local woman in her late 50s, who works in the field of real estate management. She added that the injections cause a slight tingling sensation. Ruth decided to try Botox injections because she disliked the prominent vertical line that had developed on her forehead between her eyebrows.

“When I talk and laugh I use expression,” Ruth said. “And over the years, that line grew deeper and deeper, until it became the focal point when I looked at my face.”

After each of the two Botox treatments Ruth has received, the line disappeared completely. Also after her treatments, which lasted 10 to 15 minutes apiece, Ruth went right back to work at her office.

Betty did the same.

“It’s a lunch-time procedure,” she said.

Though Botox is a byproduct of the bacteria causing botulism, Lancaster doctors Alice Cohen and David I. Silbert say this should not be cause for concern.

“Used medically,” said Cohen, a family practitioner who specializes in skin rejuvenation and esthetic medicine at Community Hospital, “it’s in a very purified form and injected in very small doses.” Among the hundreds of thousands of patients who have had Botox treatments, “there have been no reported cases of systemic toxicity,” Cohen said.

Besides, said Silbert, a specialist in eyelid disorders with Physicians’ Day Spa and Family Eye Group in Lancaster, Botox has been around for many years. It was initially approved by the FDA to treat eyelid disorders such as spasms and tics. That approval came in 1989, according to the FDA Web site.

Physicians administering Botox injections to get rid of eye spasms noted that wrinkles in the injected areas disappeared. This prompted some to begin using Botox for cosmetic purposes. Silbert has been using it to treat patients with disorders and those seeking to improve their appearance for almost nine years.

Areas commonly injected are the glabellar region — the area between the eyebrows where vertical lines commonly occur — the forehead, the “crow’s feet” that appear at the outer edges of the eye and the wrinkles that develop just below the eyelid, Silbert said.

Unlike plastic surgery, whose effects may last several years, Botox treatments are a temporary fix. During the first year of treatments, Cohen said, clients must generally return for injections every three or four months to remain completely smooth. After that, the need for return visits is less frequent, Cohen said.

“We have found that the longer Botox is used, the length of time a client can go from one treatment to the next is prolonged,” she said.

The FDA lists headache, respiratory infection, flu syndrome and nausea among the potential side effects. But neither Cohen nor Silbert have ever known patients to complain of these effects. However, Silbert said, a physician’s lack of knowledge and precision in injecting just the right muscle with the right amount of toxin can lead to droopy eyelids or eyebrows that look slightly raised, Silbert said. Botox injections can also lead to a lack of expression in the face. Botox has been liberally used among actors in Hollywood, Silbert said. It hasn’t always achieved a desirable effect.

“Too many actors can’t make expressive faces,” Silbert said. “It’s a problem if they can’t lift their eyebrows.”

To prevent such facial immobility, physicians experienced with Botox injections use very small dosages, especially during the initial treatment, and are extremely careful about which muscles they inject, Silbert said. Because muscles around the mouth allow for the ability to chew and speak, Cohen said, injections there must be very precise.

Not only have the two doctors given injections to their clients. They have used the procedure on themselves. Silbert injects the area between his eyebrows to smooth out wrinkles and keep from having “that fatigued, angry look.”

Cohen, explaining the injections she gives herself, said, “I want to see the face I’ve always known. I don’t want to see the face that’s aged with time.”

The cost of the procedure varies according to how much Botox is used, the doctors said. Treatments at Cohen’s office cost between $200 and $500 per visit, and treatments at Silbert’s office may average between $350 and $450. The cost is high because Botox is expensive, Silbert said. It comes freeze-dried in a vial, to which a saline solution is added. Each vial costs between $400 and $500 and contains enough Botox for two or three patients, Silbert said.

Until now Silbert has dedicated about two days a month to doing Botox injections. Now that the FDA has approved it for cosmetic purposes and it can be advertised directly to consumers, he expects the demand for the procedure to increase.

Cohen, believing that many people might avail themselves of Botox if they knew about it, is advertising in the paper.

This article originally appeared in the Lancaster Intelligencer-Journal.