If injections of a lethal toxin can eliminate wrinkles, who cares if it also paralyzes your face?

By BRUCE HANDY

t's really a philosophical question: Would you give up the ability to make certain facial expressions in order to look years younger (or at least "well rested")? Maggie, a 52-year-old who wants to be identified only by her first name, would say yes, and so she is sitting in a Manhattan doctor's office, having her forehead injected with a dozen or so shots of botulinum toxin A. Botox, as it is known commercially, paralyzes the facial muscles and thus eliminates certain kinds of wrinkles caused by muscle contractions--in this case the worry lines in Maggie's forehead.

"The goal is that she won't be able to raise her eyebrows," explains Dr. Patricia Wexler, a dermatologist who wears cat glasses, sports a '60s-style bubble haircut and has a teasing, just-between-girlfriends way with patients that makes her office seem more like a hair salon or Oprah than a clinic. The injections she administers with her small-gauge hypodermic--"Don't worry! It's only a baby needle!"--leave a series of bloody little welts across Maggie's forehead. Though they look like nasty mosquito bites, they will disappear within minutes as the toxin is absorbed into the muscles; within four or five days, Maggie's forehead will be immobile. Not that she's concerned. "People aren't that observant," she notes. "They don't say, 'Hey--you can't raise your eyebrows.'"

It is one of the less publicized wonders of modern medicine that the planet's most lethal toxin, the one that causes botulism in badly canned vegetables and makes a capable germ-warfare agent, now offers hope to the vain. A less messy alternative to face-lifts and chemical peels, Botox was first approved by the FDA in 1989 for the treatment of spastic eye muscles. It didn't take long, however, for doctors to discover its "off-label" cosmetic applications. Last year, according to the American Society for Aesthetic Plastic Surgery, more than 65,000 Botox procedures were performed--mostly on women but on an increasing number of men too. The drug, which is turning out to be a workhorse, has also been found to be effective in treating vocal-cord disorders, anal fissures, teeth grinding and "problem" sweat glands.

While the idea of injecting a deadly toxin into your face may sound ill advised, the doses are slight--usually 15 to 60 units, vs. the 3,000 needed to kill somebody. In addition to smoothing worry lines, Botox is used to erase crow's feet and furrows between the eyebrows. The procedure is fast (rarely taking longer than 10 minutes) and the results are relatively short-lived (four to six months), but that means any unintended side effects--the occasional droopy eyelid, say--eventually go away too. "By the time somebody consults a lawyer," says Dr. Monte Keen of Columbia Presbyterian Hospital in New York City, "it's worn off."

There are limits to what Botox can do. It can't eliminate wrinkles caused by sun exposure, and when used around the mouth, it can cause problems with drool; also, with prolonged use, facial muscles may actually atrophy. And there's still that thorny question of trading beauty for expressiveness. Typical treatments affect not only eyebrow raising but frowning and squinting as well, leading to a stereotype of the vacant-faced Botox patient. "The upper one-third of the face doesn't have to be mobile for normal facial expression," insists Wexler, who gives herself Botox treatments and whose face seems perfectly animated. "If you need to raise an eyebrow to put on eye shadow," she adds, "you can always use your finger." And who, besides maybe Clint Eastwood, really needs to frown or squint? "My wife hasn't frowned in 10 years, and our children have no difficulty knowing when she's angry," says Dr. Alastair Carruthers, a Vancouver dermatologist whose wife uses Botox regularly.

Back at Wexler's office, Maggie is asking for the works. "When I do this," she complains, squinting and showing off her not-all-that-bad crow's feet, "I can store quarters." Conversation turns to the fact that Botox treatments, which in Wexler's practice can run up to $1,600 a visit, aren't covered by insurance companies. "Unlike Viagra," Maggie says pointedly (and not entirely correctly). "Well," Wexler sighs, "they don't cover Armani either."

--With Reporting by Michelle R. Derrow and Alice Park /New York