Drawing a line

GP Kirshni Appanna, the owner of Jeunesse Appearance Medical Clinic, at the reception counter with dolls named after staff members.
GP Kirshni Appanna, the owner of Jeunesse Appearance Medical Clinic, at the reception counter with dolls named after staff members.

One of the most common requests at Jeunesse Appearance Medical Clinic is from women wanting to get rid of what owner Dr Kirshni Appanna calls the “mummy frown.”

Every eight months, she gets her own mummy frown taken care of and also what she refers to as the “sad face” — the lines either side of her chin. She is one of the lucky ones — Botox can last as little as  three months and as long as nine months.

And unlike some practitioners, the 43 year old believes “subtlety is what it’s all about.”

“I have Botox all over my face, but every single part of my face still moves.”

Appanna says she tends to soften crow’s feet rather than erase them. She always likes to leave some because “smile lines are nice — they’re good lines.” She has turned patients away who want something more artificial, saying she doesn’t want plastic-looking people representing her business in the community.

“Someone who wants more and more done in their lips and doesn’t want any lines when they smile, I’ve said, No, I can’t do it. It’s just not appropriate.”

Appanna has owned Jeunesse on Peachgrove Road in Hamilton for nearly five years and Botox is the most popular treatment at the clinic — roughly 10-15 customers every week. Appanna says it is becoming increasingly popular because TV has made it more acceptable and also because Kiwis are not too flash at looking after their skin.

And while more men have been signing up for treatment at the clinic, they only make up around 3  per cent of the client base. The most popular group are women aged 35 to 40. Appanna also reports that a lot of young girls come to the clinic seeking help for excessive sweating. They are given a large dose under each arm, which usually lasts six to eight months and can see them through warm weather.

Botox is measured in units and each unit costs $19.50 at Jeunesse. For excessive sweating, around 100 units are used; for the mummy frown,  around 20 units.

It’s considered a very safe procedure, she says — safer than paracetamol.

Associate professor of dermatology at Waikato Hospital Marius Rademaker agrees that while medically there might not be much wrong with Botox, “there’s nothing wrong with wrinkles’’ either.

Because it has been proven to treat children safely, the issue is social, not medical, he says.

“Most of us would think it was reasonable for someone at 50 to use Botox; 40 would be pushing it. Thirty and 20? You really want to be concerned about what’s wrong with that person’s self-image.’’

Rademaker recommends taking preventative measures to keep skin youthful: using sunblock, not smoking, a good diet.

Appanna says she still advises people to take care of their skin with “sunscreen, sunscreen, sunscreen — vitamin A and medical grade skin care.” And she sends them out the door with the message she is most passionate about: “Everybody is beautiful and we just try to encourage them to love the way they look.”

What is Botox?

Botox is a purified form of botulinum toxin type A, a chemical toxin that is produced by Clostridium botulinum bacteria, which is the same toxin that causes botulism (a type of infection that can result in life-threatening muscle paralysis). Botox is safe to use as an injectable medicine because it’s used in small doses and injected directly into specific sites.

The procedure

Someone arrives at Jeunesse Appearance Medical Clinic and asks for Botox. Here’s what GP and owner Kirshni Appanna says to expect:

“We get customers to fill out a questionnaire and then go through and have a consultation, asking them what they are here for. I also do a skin analysis under the Wood’s lamp to see what’s going on with their skin — besides just talking to them about Botox. Because Botox is fabulous, but it’s not the answer — you need to take care of your skin for long-term change and medical-grade skin care is the way to go.”

“There’s only one thing that has been proven to make your skin change and it’s vitamin A — and sunscreen, of course. The rest of it is not scientific.”

“So I go through their regime and what they’re doing and if they decide they want to have Botox, we talk more about Botox — what it can and what it can’t do and the expectations. Most times I prefer that I send them away with a package, to make an informed decision, unless they’ve had Botox before. Because it’s a choice — not a must have.”

If the client has had Botox or is coming back for it after reading all of the information:

“They sign a consent form. I take them through the whole process, we take photographs before and then we do the Botox.

“If they are having their frown done, we get them to keep frowning because we are actually looking at the function anatomy — how their muscles actually contract, because everyone is different. The muscles they use to frown are actually part of the eyebrow muscle, so it just depends on which muscles they are using as to how we try to get the best result.

“Basically, in five minutes, the Botox is injected.

“It probably feels like a little sting, but it’s momentary and it’s gone.

“Afterwards, the company recommends not to lie flat for four hours — I tell them they have to be sensible — as long as they recline, they’re fine — and not standing on their head for four hours, because the Botox can diffuse.

“No facials or massages for two weeks. We say to have no alcohol that night because it can increase bruising and to apply gentle pressure on the face when washing. We also have a two-week follow-up, where we take before and after photos and do a top-up if necessary.”

Dangers and side effects

“The fact that millions of people have had it indicates it's a fairly safe compound,” says Waikato Hospital associate professor of dermatology Marius Rademaker.

He adds that Botox is “actually fairly side-effect free”.

“Obviously, if you inject a muscle in the wrong place, you can paralyse a muscle” — but that would only be temporary, as the effects of Botox wear off after three to nine months.

More common side effects are drooping of the eyelid, which gives the patient a sort of lazy eye look. Also, pinpoint bruising or bleeding at the injection site can occur.

The Health Ministry’s regulatory body, Medsafe, says Botox is classified as a prescription medicine in New Zealand, which means it needs to be prescribed by a registered health professional. It is recommended the Botox injection be administered by a doctor familiar with the technique.

Jeunesse Appearance Medical Clinic GP and owner Kirshni Appanna says research indicates “there are more problems with paracetamol than there have been with Botox”.

Waikato Times