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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Dish - By Request

Pull up a saucer and get ready: today we do our Dish By Request show. Meow! Thanks to all of you listeners who emailed in your must-know video clips and photos featuring knifestyles of the rich and famous.

First we'll start with the boys. I very recently refused to see Wild Hogs, the film about middle-aged men gone wild, but apparently most of you did pay the $6.50! The four men on a roadtrip (Tim Allen 54, John Travolta 53, William H. Macy 57, and the baby of the bunch Martin Lawrence 42) all play their age and have the bodies to match their parts. They look unoperated. The only juicy tidbit I could discern was Travolta's dependence on an elaborate hair system in his public outings - and, well, other sorts of public outings.

Now supporting actor Ray Liotta (52) is a different matter. Sometime after the wrap and before August 2006, he underwent eyelid surgery and what appears to be microfat transfer to his face. (The patient's own fat is carefully withdrawn, processed, and re-injected in micro droplets where acne scarring is present.) His handsome bad boy look has been replaced by a freakish squint and distorted mouth. He has what may be the worst upper lid blepharoplasty I've seen in a male star - look carefully and you'll see the incisions. His hooded eyes are now slits, a permanent squint and even lower brow line. About 50% of the transferred fat will reabsorb by one year's time, but it accentuates the creases of his oral commissure and unbalances the lower third of his face.

Katie Couric (50) is the nightmare patient: the surgeon's work is on high-definition view every evening for the world to judge (okay, CBS only pulls in 7 million). Fans everywhere panicked when America's smiley cheerleader transformed into a glowering anchor - a forehead that didn't move, eyebrows sharply arched. Oh no! Oh yes: botox injections require quite a bit of finesse and there was an obvious learning curve here. Her glabellar muscle was over-treated, springing the eyebrows apart and depressing the medial (inner) two-thirds of the brow. The outer third of the brow is released upward by injecting the lateral canthal area of the obicularis muscle which encircles the eye orbit. Too much and the result is that classic look-of-death that children receive from their mothers when teetering on the edge of public misbehavior. What you see on-camera now is a more skillful application of botox. The injections weaken, but don't freeze, the muscles of the forehead and the eyebrows retain some natural expressiveness.

And everybody's favorite girlfriends? Courtney Cox (43) says:

There are huge changes in my body and my face, and I obsess over them. I just try not to have too many mirrors around.

Her new show Dirt is all about remaking her into a mean, evil muckraker. The lighting, make-up, and camera angles all conspire to erase her charm and good looks. Combine that with weight loss and the natural facial fat atrophy that occurs with the onset of one's 40s, and you have the changes on display. Courtney Cox's only obvious surgical intervention has been lip fillers. Her surgeon has done a good job maintaining the natural lip proportions for someone of her ethnicity (the lower lip is 1.5 times the size of the upper lip). But she could look a lot better if she gained some weight.

And all that broo-ha-ha about Jennifer Aniston's (38) cleavage at the People's Choice Awards? Puh-leeze, ask any tranny, adhesive tape is a girl's best friend. Combined with a tight-fitting bodice you get the look Aniston was sporting that night. She has openly discussed the revision septoplasty recently performed by a prominent Beverly Hills facial plastic surgeon (her first was 12 years prior). Straightening her c-shaped deformity probably required some work on the nasal pyramid as well; it's difficult to straighten either the external nose or the septum in isolation.

And sadly, we have to report that Sharon Stone (47) has effectively erased her glamor. The lovely, subtle threadlift she underwent a few years ago has been poorly revised along with the installation of a set of breast implants. Basic Instinct II has been called

....a prime object lesson in the degradation that can face Hollywood actresses, especially those over 40.

Her face is now strangely inert and ill-at-ease, her breasts Barbie-like. She's become oddly generic and striving, the opposite of her former cool, blond self-assurance. Let's just remember Sharon as she once was (at right). See the movie if you want reality.


Hear Anne live on the Kevyn Burger show 11:00 to noon every Thursday featuring Knifestyles of the Rich & Famous.