That Deadpan Look

By BRUCE HANDY

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."

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. Treatments can affect not only eyebrow raising but frowning and squinting as well, leading to a stereotype of vacant-faced Botox patients--the zombies of Bergdorf's. On the other hand, one can think of people with limited facial movement who remain expressive--Ernie and Bert come to mind. "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 appears to be adequately animated (though her bangs could be a kind of diversionary tactic). "If you need to raise an eyebrow to put on eye shadow," she adds, "you can always use your finger." And who, besides 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.

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 cost as much as $1,600 a visit, aren't covered by insurance companies. "Unlike Viagra," Maggie adds dryly (and not entirely correctly). "Well," Wexler sighs, "they don't cover Armani either."

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

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