That Deadpan Look

It's really a philosophical question: Would you trade 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, or Botox, as it is known commercially. The toxin paralyzes local facial muscles and thus eliminates 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, 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 Oprah than a dermatology clinic. The injections she administers--"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, about which she is unconcerned. "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 can make a capable germ-warfare agent--now offers hope for 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 increasing numbers of men too. The drug has also been found to be effective in treating vocal-cord disorders, anal fissures, teeth grinding and "problem" sweat glands.

Injecting a deadly toxin into your face may sound ill advised, but the doses are slight--usually 15 to 60 units, vs. the 3,000 required to kill somebody. In addition to smoothing worry lines, Botox is used to erase crow's feet and furrows between the eyebrows. While results are relatively short-lived (four to six months), any unintended side effects--a droopy eyelid, say--eventually go away too. This is good for doctors as well as patients. "By the time somebody consults a lawyer," says Dr. Monte Keen of Columbia Presbyterian Hospital in New York City, "it's worn off."