Every Wrinkle is a Policy Failure

The government's war on beauty

A lot of people blame their frown lines on their job, the tanning salon, or aging. I blame the government. 

There’s a treatment for wrinkles—Botox and similar toxins that freeze your face in place.. It can be pricey. The average price of a Botox treatment is above $400, depending on how many doses or units you get injected. But Botox isn’t patented so why is it still so expensive? 

Some of the cost comes from buying the chemical itself. Allergan which owns Botox doesn’t have a patent on it- but it does have a trademark for the brand name. And Botox isn’t just the botulism toxin that paralyzes your face- there are a few additive chemicals mixed in and Allergan’s manufacturing process is a trade secret.

But wholesale Botox is still kind of cheap- you can get it for $3.50 a unit but the price the consumer pays is around $20 in urban areas.

If you’ve ever gotten Botox or its equivalent, you know you are not getting highly tailored and personalized injections here- you can get a same-day appointment, walk in, get injected, and walk out. 

This should not require a medical degree.

Unfortunately, in some states only physicians or nurses supervised by physicians are allowed to. The obvious solution is to just let more people inject Botox- I can’t imagine a state just fully deregulating injection rights, but allowing pharmacists (who already handle a huge share of vaccinations), pharmacy techs under pharmacist direction, or registered nurses could make getting Botox way cheaper and make the number of facilities where you could Botox way larger.

The cost savings to the consumer might actually be larger than what you would think given the difference in labor costs. There are already cheaper alternatives to Botox that work just as well like Dysport or Xeomin (which is pure toxin without the additives) . But in the U.S. where we’re already paying so much for labor, the cost difference of the injectable can be overlooked. But in other countries, Botox alternatives are outcompeting Botox.

Liberalizing injection laws would make Americans look younger and spend less per treatment.

Are You Using Tretinoin?

Botox regulations aren’t the only way the government tries to make us look our age.

I think most of my readers here are straight men but if I could give you some non-policy advice, it would be that you should consider using tretinoin. It’s a cream you can use for acne but unlike a lot of woo-based anti-aging products it actually works to reverse the effects of sun on skin aging.

Unfortunately, you need a prescription to use it even though it’s incredibly safe as long as you aren’t pregnant- and if it irritates your skin just stop using it. So every time I see an urgent care doctor for whatever reason at the end of the appointment, I always ask “could I have a prescription for this?” It has never failed. 

Tretinoin is still pretty cheap but the necessity of the prescription drives up the price in terms of time and inconvenience. Federal rules require it to be prescription-only but states have a lot of discretion to make “prescription required” a fairly nominal requirement. For example, states could allow pharmacists to prescribe the cream so instead of scheduling a telehealth or doctor’s appointment, you just show up at the pharmacy and ask for it. States can also make laws friendly to telehealth.

While I think every state should do this as well as make it easy to inject Botox, Nevada or Florida seem like the perfect first-movers. Both attract a ton of tourists, both have a lot of sun (photoaging!), and both just have the Botox-friendly vibes. You could also throw in easy-to-prescribe finasteride rules to help out balding men.

Can the First Lady Save Us?

Ideally, tretinoin would simply become over-the-counter so everyone could access it. That’s a federal decision, the FDA is in charge. Scope-of-practice laws are decided at the state level but even they could benefit from a prominent national champion.

Why not Melania Trump, the model turned First Lady? She’s publicly defended the celebration of the human form in modeling so championing easy access to Botox and other skin care products seems a natural fit. 

I can hear the tagline now- “Not everyone can be Melania, but everyone can be magnificent.” 

As First Lady, Lady Bird Johnson beautified our nation’s highways, can this First Lady beautify our foreheads?