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September 23, 2013

"Natural Botox"

What happens when an antiaging virgin plays guinea pig for a line-smoothing cosmetic procedure that isn't FDA-approved yet? Beauty reporter Sophie Schulte-Hillen previews the "forehead freeze."

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Photo Credit: Max Cardelli/Folio-ID

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A dermatologist once told me: "Until you're 35, you have the skin you were born with; after that, you have the skin you deserve." I think I'm in trouble. I've spent the past few decades tempting my genetic fate with seaside tans and cigarettes. In the past, I've biorhythmically conditioned my complexion (it's a thing) and slathered on youth elixirs powered by rare orchid extracts—presumably harvested by barefoot virgins during the full moon—but my approach to beauty is still kind of granola, so I'm not quite ready to go nuclear on my frown lines with lasers or injections.

But, you know, I just turned 35.

And one night, while out with friends in Berlin, I get an e-mail from my editor asking me if I want to try Iovera, a cosmetic treatment approved earlier this year in Europe. She explains that it "freezes" nerves in the forehead muscles using extreme cold instead of botulinum toxin. Frotox, they're calling it. Hippie Botox! I think. Count me in.

I head to Darmstadt, Germany, to see dermatologist Dr. Gerhard Sattler, one of the first doctors worldwide to offer the treatment. As the owner of the Rosenpark Clinic, he is famous for his artfully placed Botox injections and a natural aesthetic. I know I'm in good hands for my first foray into antiaging cosmetic procedures, but in the taxi from the train station to the clinic, I start to get nervous. "Do you work there?" the cab driver asks carefully. "No, I am having my forehead cryogenically frozen!" I announce a little too cheerfully. We spend the rest of the drive in silence as he gives me sad eyes in the rearview mirror.

Located in a villa lined with trimmed hedges, the office looks more like a romantic inn than a clinic, which reassures me almost as much as the organic smoothie a nurse hands me during my consultation. "You don't have many wrinkles," Sattler says, inspecting my forehead. "Look surprised." I comply. "Oh. Yes, you are a good candidate."

Since Iovera is most effective on mild to moderate wrinkles, the treatment is ideal for women ages 30 to 45. Unlike Botox, which targets muscles directly, Iovera goes after the nerve, blasting it with nitrous oxide at a temperature below minus-4 degrees Fahrenheit in order to cause nerve damage. This in turn blocks signals from the nerve so the muscle relaxes. (Huh. Nerve damage—not quite the kinder, gentler approach I had hoped for.) Sensing my urge to go hug a tree, Sattler insists the nerve regenerates after about three months, at which point the results wear off. And since he's not injecting any substance that will stay behind, he says there's no way to use too much and leave me with Spock brows.

Right side first. Sattler runs an electrode that looks like a headphone plug along my temple until my eyebrow twitches (a sign he's located the nerve that controls my forehead muscles), then he marks the spot. After injecting a local anesthetic, he brings out the Iovera, a wand-like device with a triple-needle tip powered by a nitrous oxide cartridge inside. As the needles go into my skin, I barely feel a prick. Then comes the 60-second subzero blast. It feels … hot, like an intense headache that retreats as quickly as it starts. He repeats this four more times while I watch with a hand mirror.

Unlike Botox, which takes three to seven days to kick in, the effects of Iovera are immediate. Moment of truth: I raise my eyebrows, but only my left one goes up all the way—the right side's pretty much knocked out. That one horizontal crevice on my forehead looks much softer on the treated side but not completely ironed out. Interestingly, I can still push my brows together. This is the best thing I've ever done.

Now comes the left side. Sattler gives me a little more anesthetic and I don't feel a thing as the needles go in. But it suddenly occurs to me that my left eyebrow shoots up a lot when I talk, whether I'm showing surprise or disdain or trying to be sexy. I will miss you, agile left eyebrow. "OK, that's as much as I can do," Sattler says. "I couldn't completely knock out the nerve."

As I lift both eyebrows in the mirror, the left one still rises enough to look sarcastic. I am delighted. Sattler, on the other hand, is more into symmetry. "It's possible that the nerve is too deep beneath the skin and that the needles can't get to it," he explains. "The device is still being honed."

I spend the ride home sending my friends selfies with one eyebrow raised just so.

Later that night at Berlin's Soho House, the natural habitat of smooth-skinned professionals, I pull my hair into a high pony and rock my bruised, puffy temples with the same enthusiasm I reserved for visible bra straps in junior high. My friends, some of them (tactless, German) Botox veterans, note the results are equal parts natural-looking and hilarious—but they still want to know when Iovera will be more widely available.

The treatment is awaiting FDA approval, so it's unlikely to be available in the U.S. for another year or so, says Dr. Neil Sadick, clinical professor of dermatology at Weill Cornell Medical College, who is helping to conduct clinical trials in the States. When it premieres, it will likely cost about the same as injectable neurotoxins (from $500 per treatment).

"It's exciting technology, but it's not for everyone. If you want the Hollywood freeze, you'll probably be disappointed," Sadick says. In other words, if Botox is a smoky eye, Iovera is a couple coats of mascara. And while its effects are instant and subtle—and it may appeal to those scared of shooting "toxins" into their face—it isn't necessarily safer or less invasive than injectables like Botox, Dysport, and Xeomin. It also has its own set of side effects (two weeks later, my temples are still sore) and doesn't have the benefit of years of study. "Cosmetic Botox has been around for 11 years, and there's just no evidence it, or other neurotoxins, poses any health risks," Sadick points out.

Even after it's approved, experience using the device will be key. "Just as Botox has improved with new techniques and more experienced doctors, Iovera will be more viable as time goes by," says Sattler. My opinion: Wait a few years before considering Frotox. Until then: Ich bin ein guinea pig.


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