Bride of Botox

Botox has overtaken Hollywood in a big way. The shine reflecting off those smooth, wrinkle-free foreheads is blinding. We need a new term for these shadowless faces. Suggestions anyone?

Approved for cosmetic use by the FDA in 2002, Botox (Botulinum Toxin Type A) has numerous established therapeutic applications. It is a neurotoxin protein produced by a bactierium, one of the most poisonous naturally occuring substances in the world. It acts by blocking neuromuscular transmission, the body's signal for movement. Used in minute doses, it treats conditions caused by muscle spasms, from blepharospasms and dystonias to hyperhidrosis. (That's tics, spazzes, and flop sweat for the lay person.)

It also happens to work quite well on those wrinkles that come with facial muscle movement. In fact, physicians refer to them specifically as "lines of expression," which is also the secret to verifying it's Hollywood use: can the actor in question emote using a full range of natural facial expressions?

Who admits to it? Teri Hatcher confession is perhaps the most common: "In the past I've had Botox and collagen." The picture at right gives the lie to that. It's the same claim made by the author of Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery. Alex Kuczynski (39) says botox was her "gateway drug" before she swore off everything. One look at her television promotion for the book tells you she isn't clean just yet.

But a few are open fans. Vanessa Williams (43) endorses it: "I think it's fine...It's a reality that so many people are incorporating into their lives...bring it on!" Virginia Madsen (45) is actually the spokesperson for Allergan, manufacturer of Botox and Juvederm. There's probably not a virgin face in Hollywood over the age of 12 right now. Even the youngest of actors is indulging in 'preventative injecting.' Early intervention immobilizes the movement that causes eventual wrinkling.

Botox is the gold standard for treating crow's feet, brow furrow, and forehead lines. It works by partially paralyzing the muscles creating those wrinkles. Done well, it provides a 'chemical browlift' and rejuvenates the upper third of the face. But a heavy-hand with the needle yields an immobile forehead like Nicole Kidman (40), Marcia Cross (45)...Nicollette Sheridan (43) won't comment. All exhibit shiny foreheads so frozen, it's almost frostbite.

What are the giveaways? Sometimes a still picture is more than enough. A grinning 40-year-old Caucasian woman has wrinkles. Inept technique can yield 'Spock' eyebrows, arched too far laterally or sprung apart medially. In motion, the face no longer emotes within anthropological norms because the eyes and brows don't move. Women in particular express a great deal with the upper third of their face (ask any man). Bad Botox really flattens an actress's range of emotion.

This mixed message has implications elsewhere, as well. Outside of Hollywood, Katie Couric fell victim to incautious use of Botox. John Kerry's presidential bid was almost derailed by a venture into Botox (or the appearance of it). Too much Botox garbles the visual cues for the observer, the face doesn't 'read.' When that happens, the viewer is liable to think all sorts of things.

What's exciting are the new, emerging uses of Botox for pain disorders in dentistry like TMJ (temporal mandibular joint disorder), bruxism, and temporal masseteric fasciitis pain syndrome. How you might ask? Botox works on smooth muscle fibers and, as it turns out, some pain fiber nerve termini– a source of many pain syndromes. Blocking the nerve transmission in pain fibers yields relief for all sorts of neuralgias such as migraines. Major medical research centers are actively exploring new treatment avenues using Botox for many intractable medical problems involving hyperfunctioning of muscle fibers. Emerging uses at Mayo Clinic (search on the word 'botox') include treatment of BPH (benign prostate hypertrophy) and irritable bladder syndrome. There really is a lot to be said for Botox, but don't expect to hear it out of the mouths of Hollywood stars.

Jane Fonda (69) famously blurted out: "No, I have not had Botox. I will see a woman in Hollywood walking towards me and I'll think that I know her but I don't know who she is. It's terrifying. Everyone looks the same....What I like about England is that people look like they're supposed to look."

Now Jane Fonda has had plenty of work done, but she still looks natural and age-appropriate. In moderation, Botox can look natural. Her objection has legitimacy, however. Many of these younger women who seek to emulate a creaseless existence have ended up erasing their individuality, who they are. In some cases they take it to an extreme and change species (think Joan Rivers).

As Cate Blanchett (37) shouted "...just live your life, death is not going to be any easier just because your face can't move!"



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