On the lawn in front of his clinic, the highly controversial German surgeon Julius Hacketal, who died two years ago, had put up a sign with the following warning:

Beware - surgeon!

A surgeon is, in fact, the highest risk in any, not only aesthetic, operation. If he or she is not well trained or lacks sufficient experience both in surgery and the avoidance (and treatment) of complications, and if he or she is not aware of that insufficiency - there is serious danger.

Botulinum Toxin has long been known as one of the most powerful neurotoxins. It blocks an enzyme at the transition of nerve- and muscle fibre and thus paralyses the muscular system. The consumption of minimum amounts of contaminated food will already have a fatal effect. A swelling lid on a meat can is a typical sign for contamination. Pharmacologically transformed and reduced, the same substance can remove muscular spasms: squints, eye lid spasms, throat dystonia. It can eliminate axillary hyperhidrosis (excessive armpit sweating) and may improve treatment of face wrinkles caused by facial gestures.

Peter Misra, MD, a specialist for neurophysiology at London's National Hospital for Neurology and Neurosurgery, published a remarkable article in the highly regarded British Journal for Medicine. In "The Changed Image of Botulinum Toxin" he describes the effects of medical indication (throat distonia): 80% of all patient cases turned out successfully (20% failure). Effective after 5-7 days, the results last for 10-12 weeks.

Negative side effects were registered in the study at 3-90%. Unambiguous proof of Botulinum Toxin' effectiveness in sensory neurones remained missing. As Misra emphasises, long term effects of Botulinum Toxin are unknown. Meanwhile, according to his observations, non-licenced use of the ‚lifestyle poison' increases dramatically, completely uncontrolled. This is due to the work of beauticians, medical assistants and dilettante "magicians". Consequences can be disastrous.

In 2001, 1,6 Million treatments were conducted in the USA on the basis of this beauty poison. In 1993, Allergan Pharmaceuticals, has made a profit of $ 25 Million with the medication called "Botox"®. Estimations for the year 2002 reach $ 430 Million which equals an increase of 1700%. These numbers were passed on to the author directly from the company.

The media raves about the new poisonous beautification, champagne-serving "Botox-parties" are being organised. This deserves a serious note of warning! The pharmaceutical company "MERZ" which distributes "Botox"® in Germany adds the following lines to its prescription:

"Rare cases of sudden deaths have been registered following Botulinum Toxin treatment, occasionally accompanied by dysphagy (difficulty in swallowing), pneumonia and/or other conditions of weakness."

Serious plastic surgeons will only employ this substance after thorough information and will conduct the treatment together with stand-by special anaesthetists (Fachanästhesisten). Re-animation with artificial respiration can become necessary.

A short effective period of 3 months, a high percentage of failure (up to 20%), numerous, occasionally serious side effects and a lack of long-term results should limit the excitement. "Botox-Parties" - goodness,no! Otherwise a Persian saying could apply: "Bokosh mano va khoshgelam bokon" (Kill me - but make me beautiful.)

Chinese BTX-A

Even Chinese institutions and physicians have taken up Botulinum Toxin A. The Neurology Department at PUMC Hospital (CAMC & PUMC, Beijing 100730) examined the effects of their product BTX-A on 785 patients and compared the results with those of Botox® by Allergan Inc. USA.

The Chinese substance was tested and approved of by the official China State Drug Administration (SDA - comparable to the American authority FDA). The authors of this particular study conclude the therapeutic effect is comparable with that of the American product. The Chinese substance has, however, a lower toxicity and therefore lower side-effects. We can say - also with regard to Botulinum Toxin A - the Chinese are coming! (more information under "li cui" e-mail < btxa2002@yahoo.com.cn)