Doctors warned that the "Barbie Botox" fad, which sees women as young as their 20s rushing to get toxin-based operations to replicate the actress Margot Robbie's appearance from the movie, may cause resistance among users and impede medical use in the future.
A class of medications known as botulinum toxins or Botox are injected into the trapezius muscles of the upper back during a treatment termed as "Trap Tox" by doctors to treat migraines and shoulder pain.
However, there has been an increase in demand for its use as a cosmetic operation since the premiere of the "Barbie" movie in July. On TikTok, the hashtag BarbieBotox had 11.2 million views.
The procedure "supposedly slims the neck and somehow that got attributed to the actress that's playing Barbie", says Revance Therapeutics CEO Dustin Sjuts.
"They're not treating wrinkles or lax skin. They want less girth to their neck, a slimmer, more contoured neck," said Scot Glasberg, president-elect of Plastic Surgery Foundation, who practices in New York
The use of the injection in the trapezius is "off-label" because only operations affecting the face are permitted to utilise such injections for cosmetic purposes.
Health experts must determine whether "off-label" uses are "medically appropriate" according to the U.S. Food and Drug Administration.
While "Barbie Botox" has gained popularity recently, according to Revance and Evolus Inc, which provide comparable toxins under the brands Daxxify and Jeuveau, respectively, they do not expect the trend to significantly increase sales.
AbbVie Inc, a producer of Botox, declined to comment.
In the past, persons over 40 years old would choose to receive injections containing toxins; this industry is thought to be worth over $3 billion in annual sales in the United States.
The experts expressed concern about the use among younger women, and six of them cautioned that operations performed by employees who were not properly trained at some medispas increased the risk of problems.
The increase in usage among younger women, whose immune systems are normally stronger, increases the possibility that the products will eventually lose some of their effectiveness.
"If they're doing high amounts of Botox very frequently... they may lose its effect over time, not just with Botox, but with the other products in the market too, because they all have some similar molecule," Kheterpal said.
The possibility of administration by individuals who may not be fully competent was again emphasised by doctors, particularly at medispas where there is no control.
"There are no regulations on the type of doctor that can run a medispa," said Melissa Levoska, assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York.
"So, a family medicine physician or OB-GYN physician can technically open up a medispa, and now increasingly there are also physician assistants and nurse practitioners who are doing injections."
Although the toxin injections are normally harmless, there is a chance that they could weaken nearby muscles for months if not done correctly.
"The science isn't quite there yet, in order to support the clinical profile of it," said Evolus CEO David Moatazedi.
"However, we do know neurotoxins have been used at doses significantly higher for therapeutic purposes than the level of being used for aesthetic purposes and we know the products are safe."
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