Intro  00:01

You're listening to the Amplify Podcast Network,

 

Sally Chivers  00:13

On Wrinkle Radio, a wrinkle is an invitation to dig a little deeper, find the story the lines want to tell.

 

Sally Chivers  00:26

Welcome to Wrinkle Radio, where the stories we tell about aging matter. I'm your host, Dr Sally Chivers, and I am so glad you're back with us after our summer break. I started out making an episode about why I called this podcast Wrinkle Radio, but I ended up somewhere a little different. In this episode, why I learned to stop judging and love Botox. Well, kind of.

 

Sally Chivers  01:02

We'll start in spring 2022. I pull up to the Bata library parking lot. I've got to figure out how you pay for parking at Trent University these days. The crab apple blossoms kind of seem to be cheering me on as I download an app, punch in my license plate number, or maybe they're just greeting the humid air that pushes against me as I trudge up a brutalist maze of concrete steps. I elbow the automatic door button and a shock of air conditioning stops me in my tracks. I drink it all in. On my left, I can see the Otonabee river flowing fast for this time of year. On my right, the living wall spills over with greenery I didn't think would survive. Students everywhere read, chat, sip Starbucks like they'd never left. This is where I belong. Just as I notice a tear prickling my eye I spot a colleague. I brace myself for that litany of questions about summer and meetings and accomplishments and how busy, busy, busy we all are. But he walks straight past me, no nod, no smile. What? This is Trent University, where everybody knows your name. We may not all like each other, but we definitely pretend we do, especially in public. "Hey," I call out, "it's Sally." He whips his head back, "wow." He says, "you're looking great." "Um, thanks. It's the Botox" he laughs a little too loud, and he welcomes me back.

 

Sally Chivers  02:55

I used to direct a research center right upstairs from where we were talking. The last time I'd been there, I armed myself with Dollar Store stretchy gloves before I hiked up those steps and pushed that automatic door button. I transformed an office chair into a dolly to rescue ginormous plants. I remember shouting, "gonna need you to take a step back" to a chivalrous, clueless guy who leapt to hold the door for me. I was one remove away from a close contact with Peterborough's second COVID 19 case, though we just called it the coronavirus back then. I wrestled our prized pink Siam aglaonema through the foyer, not that I knew that's what it was called at the time, and I went towards the stairs to the loading dock. Someone called out to me from behind the safety of the front library desk, "Let me guess you're moving your stuff out, and you think it's going to be a long time." I still don't know if they were mocking me, admiring me, or digging to see if I had any info. But like them and pretty much everyone else, I didn't really know whether my life was at risk. But I did know those plants were not going to die on my watch. I was a notorious plant killer, but even I knew they were going to need water over the couple weeks we were going to be shut down. Someone in the know had hinted to me it might even be a couple months. No one ever could have convinced me that for me, it'd be a couple years.

 

Sally Chivers  04:35

Every minute of those years shows on my body. My shoulders lean further forward, my hair glistens with about as much tinsel as brunette. My midsection swells. My clothes drape and flow. Age spots grace a thumb now green enough to nurture an adolescent pink Siam I propagated from that rescued plant. My head is an increasingly finely tuned machine that rewards regular sleep and carefully calibrated routines, punishes barometric pressure changes, stressful moments, late nights and encounters with rogue perfumes. My feet have grown half a size from standing desks and mental health walks and my heel throbs if I walk in the wrong shoes, but you will not find a hint of those years or of any expression of any kind on my forehead, thanks or no thanks to Botox.

 

Sally Chivers  05:40

There was a time when I would have laughed even louder than my colleague at the idea that I would even consider injecting myself with Botox. I'll never forget the first time someone offered it to me over 20 years ago. Back then, I still walked upright in whatever shoes I could afford, a couple stray silver strands were barely visible in my abundant dark brown hair, distinct parallel lines were starting to linger above my eyebrows, even when I wasn't thinking hard, but I didn't give those wrinkles a moment's thought. To me and to most of us, at most, Botox was the stuff of Hollywood hopefuls and wealthy women looking to upgrade their parties from Tupperware. I was in Chicago on a postdoctoral fellowship that was paid in Canadian dollars, so when I took a day off, I found something free to check out, and that's what landed me at Navy Pier. There's no charge to get into Navy Pier or to walk the short path around its perimeter, but it turns out it's basically a barely glorified shopping mall with a few amusement park rides, none of which are free. I watched children build their ideal teddy bear, marveled at just how much ice cream got piled into other people's Haagen Dazs sundaes, crawled my way along a complimentary Chicago exhibit, poring over every caption and blurb. I tried to really eke that one out, walking slower and slower. As I got to the end of the hallway, people were pushing past me to go into what looked like a ballroom. No one seemed to have tickets. No one was guarding the door. So I sped up to match pace with a group going in and landed smack dab in the middle of my first and only bridal fair. Jordan almonds, wedding cake, champagne tasters ... my eyes darted furtively from table to table, mouth watering as I planned a free sample tour. Not a soul in that fair would meet my eye, let alone offer me a morsel, except for one guy, wedding ready in his black dress shirt, white waistcoat and polka dotted bow tie, he held out a silver tray to me. I glanced down, no canapes, just cards that said $200 off Botox.

 

Sally Chivers  08:06

I'd love to say that I laughed as I flounced away, grabbing a couple party favors on my way out, but it was more of a shocked slink. I talked a big game back then about the folly of fighting age, but that coupon collapsed my youthful arrogance into gendered shame. I could deconstruct a fashion magazine ad for wrinkle cream for any audience at a moment's notice, but somehow I was ignorant about what the world saw when they looked at what I thought I saw in the mirror. But that moment isn't what made me turn to Botox. I slunk away, but I still resisted down to my very bones. In my head, I told that man where to put his pressure to take drastic steps to look young. A quieter voice insisted that I still looked younger than my 30 years. I mentally rehearsed a party joke about looking for free things to do on a Sunday afternoon. I couldn't afford a procedure where 200 US dollars was the discount. Too high a price for anything, let alone filling my body with poison to meet toxic social pressure.

 

Sally Chivers  09:24

Botox is a purified form of the botulinum toxin, the one that causes botulism. If you get botulism from food that's not preserved right, your body starts to seize up. You might not be able to swallow or speak. Your face might droop. Your eyes would probably refuse to focus. You'd struggle to breathe. These dangers were well known when a scientist isolated the toxin in a purified form in 1928 just in time for it to be available as a biological weapon during World War Two. We don't really know who planned to use it, because those things are always carefully guarded secrets. Suffice to say that Allied troops had plenty of antitoxin on hand ahead of the D Day Normandy invasion. But Botox doesn't have the weapon potential of, say, anthrax or smallpox. It's easy to make, but harder to turn into an effective weapon in global warfare. So this toxin found new life in the 1970s. Eye specialists needed a substance that would weaken eye muscles to help with treatments for conditions that entailed eye spasms or unwanted movements.

 

Sally Chivers  10:33

Anyone who's canned anything or eaten preserved food has encountered terrifying warnings about how to avoid botulism, so approval to try injecting botulism on purpose was hard won. The first experimental human patient had to remain in intensive care for three days, just as a precaution. That caution turned out to be overblown. The treatment worked without adverse effects. Still, it was hard to find backers for a toxin, so researchers worked for next nothing, even paying out of pocket to continue to test the treatment. In 1989 the FDA approved Oculinum for the treatment of blephorospasm and strabismus. Allergan bought it a couple years later for $9 million and changed the drug's name to Botox. They considered it a niche product, but they were a company known for contact lenses and eyedrops. That was their niche. They probably weren't banking on going to the bank thanks to Botox's side effects.

 

Sally Chivers  11:48

If you Google Botox and side effects now, you'll face image after image of droopy eyelids, often specifically Simon Cowell's eyelids, and articles about throat dysphagia. Trust me, because I have freaked myself out doing it before and after going for my own treatments. But the magic that took Botox from niche to mass appeal was a side effect that many found the opposite of horrifying. Eye patients started to notice that Botox relaxed wrinkles, so much so that some patients started asking for injections, not just near their eyes, but in their foreheads. Different researchers and drug companies started to investigate, but it was a Canadian, Vancouver-based ophthalmologist, Dr Jean Carruthers and her dermatologist husband, Alistair Carruthers, who tested the toxin on the glabellar lines of 18 people. To quell public fears about side effects, Dr Jean Carruthers would present her own Botoxed face. "I go around now," she would quip, "saying, I haven't frowned since 1987." Okay, sure. Who wouldn't want to stop frowning?

 

Sally Chivers  13:01

Well, it turns out, the incapacity to frown had another side effect. Around the time that I was offered that $200 coupon off Botox, I was on the academic job market. When I gave job talks, I'd whip out a transparency with a Roz Chast New Yorker cartoon, and plop it the right way around on an overhead projector. Yes, I had it printed onto a transparency. If you know, you know, if you don't, then I guess we have some younger listeners tuning in to Wrinkle Radio. Welcome. Be very grateful for PowerPoint. This cartoon showed a theater stage draped in curtains. You know how if you look for an emoji that says drama, two contrasting masks come up? Well, in this cartoon footlights shone on two giant masks, except these had no comic smile or tragic, haunting frown. They had identical straight mouths, blank eyes, smooth, foreheads and cheeks, a dimple on each chin the only mark. Above them, a marquee banner announced Botox theater. I'd do this talk after I'd been flown to a campus to be on show for a couple of days, in front of colleagues I was hoping to get to work with for decades, I had to eat with the right fork, wear the right clothes, nail the hallway conversations. It is tough enough as a process, but I also had to convince people that I could teach literature and film, even though my topic was aging. They'd show up dreading a lecture on joint pain or long term care, when they wanted to talk metaphor and camera angle. I needed them to get it fast and remember me, and that's where the cartoon came in.

 

Sally Chivers  14:51

Even back when Botox had barely been approved for cosmetic use, this cartoon required no further caption. Everyone who showed up worried about their own aging or how they were going to take care of their aging parents could relax a little laugh at the silly, shallow women who fall into this esthetic trap, take pride that we're all in on the joke that is definitely not about us in any way.

 

Sally Chivers  15:15

But this was no diversionary icebreaker. My talk was about how those frozen faces show faster than anything else I've come across that when we sideline aging, when we don't let women age in plain sight, we lose cultural expression. In early Botox days, directors lamented that actresses who got Botox couldn't make the finer facial expressions that used to be essential to good acting. The wrinkle smoothing was a medical side effect, but this was the cultural side effect of Botox. My job talk would build on that to show that regardless of how old we are, we all miss out on a lot when we make people feel they need to look young to be seen. We all expect, or at least hope, to grow older. So do we not all have the right to relish that, understand that, benefit from that in ourselves and others? When I got to that part of my job talk, the audience laughs would give way to a combination of uncomfortable squirms and discerning nods. I got pretty good at telling from the ratio of squirms to nods whether or not I was going to get a job offer.

 

Sally Chivers  16:32

20 years ago, Botox was an easy joke because it seemed drastic. Doing something so extreme and so expensive was a shameful secret. Now, over two decades later, Botox humor hits different. In America's Sweethearts, director Kelly Finglass tells potential Dallas Cowboy cheerleaders that things are about to get stressful for everyone. "Don't over analyze our expressions." She tells them. She catches herself. "Well, you might not get much from me because I got Botox." That used to be a brave admission, but now it's more like joking about touching up silvering roots, and now I'm really in on the joke. "I'm shocked right now," I'll tell my students, "you can't tell because of the Botox." My students laugh knowingly, without fail, at least one student will nod sagely and tell everyone they get shots to ease their elevens, those parallel glabellar lines I used to have above my eyebrows. I miss them.

 

Sally Chivers  17:35

I didn't start Botox treatments to look different. That aspect still terrifies me, and if I'm honest, fills me with shame. I don't even wear makeup. I started Botox because I couldn't figure out how to manage without it. Back in 2002 as people started taking up those $200 off coupons, hosting Botox parties, easing their elevens, they noticed they got fewer headaches. Early studies were conflicted, but about a decade later, Botox received approval based on yet another side effect. Now you can get it as I do, as a preventative treatment for chronic migraine.

 

Sally Chivers  18:25

I used to get eight to 10 migraines a month. That's a frequency the medical world calls episodic, like a mini series that you're hoping doesn't get renewed. Sounds bad, right? That's a lot of time to be either out of commission or pushing through. But I long for the days when I could take medication that mostly worked well enough for me to be able to keep teaching and researching in some semblance of everyday life. I don't think I need to remind anybody how brutal those early days, months or even years of COVID 19 were. We're all still feeling it in different ways. My migraines doubled to 15 to 20 a month at that point, a frequency the medical world calls chronic, as in the opposite of acute, though these felt pretty darn severe. I could still take medication that worked okay, but only 10 times a month. I was always starting or recovering from a migraine, trying to crack the code to prevent the next one, or at least bring it down a notch so that the medications would at least touch it ... if I could even take them.

 

Sally Chivers  19:29

If you're about to send me an article or let me know what worked for you, thank you. I appreciate it. I really do, but I've tried it. Acupuncture, trigger point injections, amitriptyline, Topiramate, propanolol, gabapentin, heat, cold, massage, chiro, physio, osteopathy. Cutting sugar, gluten, caffeine, wine, happiness. Sleep hygiene, darkened glasses, exercise, meditation, Qigong, yoga, feverfew, rigoflavin, magnesium, peppermint, psychotherapy. Some of these things help. Some of these things help me feel like I'm doing something.

 

Sally Chivers  20:12

The one thing I hadn't tried was Botox. I knew I'd hopped the magic line between episodic and chronic, and that made me a candidate for Botox treatment. People would tell me they got their tight jaws treated and suddenly didn't get tension headaches. I wish my problem was headaches. I have a neurological disorder. The pain sucks, but it is the least dastardly of my symptoms. I was getting more than desperate, but the voice inside my head from that day in Chicago reminded me I wasn't someone who would go get a wrinkle treatment and pretend I did it for my headaches or even my migraines, no matter how many miracle cure stories I heard. Even though I knew I was medically eligible, I would have had to get a referral from my family doctor, and at that point, like so many people in the province where I live, I didn't have one. I maybe could convince a telehealth clinic doctor to refer me, but then I would have had to navigate a funhouse maze of migraine triggers during a pandemic to trek to Toronto, the closest place I'd be able to find a specialist who could inject botox properly. I definitely wasn't going to go through all that for a treatment that seemed as ridiculous to me as the masks in my Botox theater cartoon.

 

Sally Chivers  21:32

So instead, I'd crawl out of bed, strap an ice pack on my head, and log in to respond to my students on VoiceThread. I'd sprinkle peppermint oil on my forehead as I stumbled over my words on Zoom, glibly joking, "Oh, it's another migraine day." I'd wake up in the middle of the night in such agony that I'd wonder whether I needed to continue to exist. Wonder if I could.

 

Sally Chivers  21:58

One of those agonizing nights I read a Facebook post from a friend who found a nurse practitioner closer to home who had injected her jaw. This was a friend who knew a migraine from a headache. She had found relief. I hopped online and booked a consult, no referral needed. I figured it was worth a shot, so to speak.

 

Sally Chivers  22:26

The first couple of times I would walk into that spa and feel like I'd worn Birkenstocks to the Danbury ball. The nurse practitioner promised me a little lift as part of the medical treatment. So after my first treatment, I wiggled my forehead so vigorously to prevent that, that I gave myself a new set of headaches. But despite my resistance, the migraines backed off. Now, when I notice the lines I miss so much appear on my static brow, I slip on my Birkenstocks and waltz right in. I climb up onto the most glorious plush pleather treatment chair to get 35 injections in my traps, my scalp, my temples, my jaw and yes, my forehead. I still stare befuddled at the before and after product posters that hang in the spa bathroom. I honestly cannot tell which part is supposed to look better. The last time I was there, I noticed a new wall hanging in the treatment room. It had a quotation about inner beauty, beauty that comes from thoughts and love and social connection and the soul. So I asked the nurse practitioner to tell me about it, and she explained that that was the basis of her practice. She had left a long term care job to start this spa. She trained in Botox for migraine prevention because she knows the suffering and the relief personally, and she also backs all the esthetic treatments they offer. She told me how frustrating it is that shame and judgment stop women from getting the treatments they might need or even just enjoy. That's me, I thought as I squeezed the little ball that distracts me from my transformation into a human pin cushion.

 

Sally Chivers  24:18

Last spring, the CBC, our public broadcaster, had me on for a couple hour long call in shows. On one of them, listeners were asked to speak to the prompt "Chasing youth. What do you regret?" The host prodded people to call in with their stories of Botox gone wrong, horrifying mistakes with fillers, other missteps. The caller I can't get out of my head said she feels no shame for getting Botox, but she knows that she now looks to the outside world how she feels inside. She used to look annoyed. Now she looks chill. She doesn't miss her glabellar lines. I'm glad there were lots of callers who spoke about the folly of trying to look young and their Botox mishaps. But this caller opened the door for me to say that I regret that I've been judgmental about Botox. I wish I hadn't made fun of women actors at my job talks, even if I was trying to criticize the system. We don't need to judge anyone for getting Botox, but we do need to point out the ageism that makes people think they need to stay in line by preventing lines on their faces.

 

Sally Chivers  25:32

The first patient that Dr Jean and Alastair Carruthers injected with Botox was Cathy Swann. She was also Dr Jean carruthers's receptionist. Unlike Dr Jean Carruthers, she has stopped the treatments. "I'm in my 60s." She says, "I actually think I look pretty damn good. I have very few wrinkles. I have beautiful silver hair. I'm a little chunky." But she stops short of judging people who stick with Botox, as she puts it, "we don't all age the way we want." I love the spirit of her comment, let's not judge people if they dye their hair or if they don't, if they get Botox, or if they don't, whether they have very few wrinkles or very many. Swann is talking about the skin, and I've explored the surface notion of wrinkles in this episode, but the point could be deeper.

 

Sally Chivers  26:31

Some people get to age more the way they want than others do. Some people get to worry about wrinkles and gray hair, while others have no chance of ever retiring. Others still have to flee their homes due to war and climate crisis. Some people adamantly declare they prefer home care. They want to die at home. Others know a nursing home is their best likely fate. Some people think not choosing what they get to eat in institutional care is tragic. Others finally get three hot meals a day, if they're lucky enough to age in a nursing home.

 

Sally Chivers  27:04

Wrinkle Radio as a title kind of rolls off the tongue. Lots of people love it. Some hate it, and I get it. Reducing people to a mistaken assumption about what happens to their skin gives people pause. Besides the alliteration, I chose the title because I started the podcast when I was battling those chronic migraines. Life was not smooth, and even though I suffered a lot, I relish what I gained from that time. I would not want to smooth it out. What I learned about myself and the harm we do when we don't slow down, even when our bodies scream at us to stop? that means everything to me. So I wanted to honor the wrinkles we face in life and refuse to iron them out.

 

Sally Chivers  27:59

Botox and the conversation about it is a symptom of the society we live in. We can't stop at the surface any more than we should smooth away the wrinkles of life. So yeah, if you tell me, I'm looking great, if you tell me, I seem to be doing well, I will tell you, "thanks. It's the Botox" and the whole story behind it that really changed the way I live my life.

 

Sally Chivers  28:34

This has been Wrinkle Radio. I'm your host. Sally Chivers, thank you for listening. You can find the full transcripts and show notes at Sallychivers.ca/wrinkleradio. In those show notes, you can find links to the CBC call in shows I mentioned. I was not granted permission to use clips of my own self in my own podcast. If you like this episode or you're just plain interested in aging, please tell your friends, tell your neighbors, tell your aesthetician, and remember, don't panic, it's just aging.

 

Music  29:10

I wanna grow older, I wanna grow wiser. I wanna grow flowers in a house that's made of you, sit and watch the sunset. Get some wrinkles on my forehead. I want to build fires in a house that's made of you.