Botox: Sounding the Right Note

10/10/2013 10:03 BST | Updated 23/01/2014 23:58 GMT

Fleetwood Mac's Stevie Nicks - currently wowing audiences on the supergroup's triumphant world tour - claims Botox is 'an ugly thing' she will never have again. She says she will never turn to the wrinkle-defying injection again after a bad experience. "My eyebrows fell," she confessed to an interviewer. "I looked like the sister of Satan."

What makes this unfortunate is that when it comes to Botox, there are generally very few adverse effects.

Since 2002, when Botox was approved by America's FDA, millions of procedures have been carried out worldwide. When correctly administered, there are only two significant complications - a headache that those new to the treatment may experience in the first 24 hours - and the "drooping eyelid" phenomenon that Stevie seems to have had. This is rare and can happen even in the most experienced hands.

In almost all procedures carried out by experienced, qualified practitioners, the treatment goes according to plan and, within five to eight days, the unwanted wrinkles or lines that it is designed to target are significantly reduced.

In a paper published in the Journal of Plastic, Reconstructive and Aesthetic Surgery, together with my colleague Miles Berry - who practices alongside me at London's Surgical Aesthetics clinic - we looked carefully at adverse experiences with Botox. The results may surprise Stevie.

For a substance that's inherently toxic - it's been estimated that a gram of the stuff is sufficient to kill one million people - Botulinum Neurotoxin A has had a remarkable career of its own. It was first used for therapeutic purposes in the 1970s, originally as a non-surgical treatment for patients with crossed or misaligned eyes. Medical uses have since expanded at an exponential rate. It's been used to treat neurological movement disorders such as blepharospasm - which can be a hugely disruptive and disabling condition - and cervical dystonia, chronic pain, and even migraines.

It should be noted that, when it's used for clinical purposes in this way, Botox doses are three to six times those we use for cosmetic treatment.

Our research found that, despite the millions of doses administered, fatal complications occurred in less than 28 cases and, of those, all but two of the patients had underlying conditions that heightened the risks considerably. None occurred in cosmetic patients.

The figures are even more impressive for cosmetic applications, where the dose is much smaller. The few serious incidents we discovered had involved unlicensed "black market" preparations and unscrupulous practitioners.

Set in the context of the vast numbers of procedures carried out daily in clinics around the world, this suggests the likelihood of anything going wrong in the hands of an experienced professional is very limited.

The research that Miles and I carried out also showed that patient satisfaction among those who've been administered Botox for cosmetic reasons is correspondingly high. The vast majority of patients who undergo the procedure like what it does and report a positive experience.

But what came across loud and clear from our study was that careful technique in each case is crucial. If you're choosing a practitioner, don't be tempted to go for someone who isn't qualified or who is operating from a clinic you don't wholly trust.

Qualified practitioners will be registered on the General Medical Council's Specialist list. The Association of Facial Plastic Surgeons can also offer support and advice.

Much of the negative speculation surrounding Botox therapy is based on hearsay rather than scientific fact. As Stevie Nicks and Fleetwood Mac know only too well - at least according to the title of their world-beating 1977 album Rumours - gossip often strays a long way from the facts.