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A Fountain of Youth in a Vial of Poison

In new cosmetic procedure, injections of botulism toxin smooth facial wrinkles.


She has a husband, a public relations business, scrupulous eating habits, and--as she puts it--"a really good body for 33." In what has so far been a full and chaotic life, she has survived a broken marriage and made a happy new one; she has conquered a drug habit that bedeviled her in her 20s and sworn off alcohol.

But nothing continues to betray her like the vertical lines that have etched their way between her brows and into her psyche. She can live with not looking like a model. Her olive skin and almond-shaped eyes give her a slightly exotic-white-girl look, a distinction in L.A.'s sea of prettified faces. What she can't live with are these frown lines.

As she looks up from the chair in her doctor's examining room, you can see the creases that torment her--but just barely.

"Frown," Dr. Andrew Frankel instructs his patient.

In one gloved hand, Frankel, a plastic surgeon, holds a 30-gauge needle, slender as a strand of hair. He studies the lines that form when Kelly Cutrone scrunches up her face. Like a pastry chef dabbing at the sugar flowers on a cake, he pricks the musculature that makes his patient frown. Tiny dots of blood bead up on the surface of her forehead. Frankel swabs them with gauze.

In 10 minutes, Frankel is done, dismissing his patient with the admonition not to exercise that day or lie down for four hours.

Cutrone walks out into the afternoon sunlight, a little pink welt between her brows. "I have to tell you, it's so great," she says. Delight gushes from her voice as the deadliest toxin on the planet creeps through a tiny segment of her forehead. Frankel has just injected Cutrone with Botox.

Frown lines, forehead wrinkles and crow's feet are caused by the constant use of muscles--the ones that purse your forehead, raise your eyebrows and crinkle your eyes when you smile. Derived from the bacterium that causes botulism, Botox temporarily paralyzes the muscles into which it's injected. The paralysis wears off in about four months.

The difference between Botox, the therapeutic treatment, and botulism, the scourge of home preserving, is about 35 vials of the toxin. That's how many Botox vials it would take to give you a 50% chance of dying. Frankel administered a third of a vial to Kelly Cutrone.

In the garden of the face, where we have long pruned and plucked away what we don't want, now we have poison; Botox has become the easiest and most popular cosmetic weedkiller around. What started as a treatment for the muscular problems that cause strabismus (crossed eyes) and blepharospasm (eye spasms)--and remains approved by the Food and Drug Administration only for those two conditions--has become the potion of choice for dermatologists, plastic surgeons, cosmetic surgeons, and patients in search of wrinkle-free faces.

"It's the fastest-growing cosmetic procedure," says San Francisco dermatologist Seth Matarasso, who lectures on Botox and is compiling statistics on its use.

According to the American Society for Aesthetic Plastic Surgery, there were 65,157 Botox treatments for cosmetic purposes in 1997. That figure rose to 157,439 in 1998--a 142% increase. According to the group's statistics, that makes Botox the sixth-most-common cosmetic medical procedure today.

The company benefiting from this boom is Allergan, an Irvine-based pharmaceutical firm. Sales of Botox climbed from $25.3 million in 1993 to $125 million last year. Allergan officials--who are forbidden to promote the off-label uses of their product--say less than 30% of that figure is attributable to cosmetic uses. Matarasso begs to differ.

"Bull," he says. "I have 49ers. I have politicians. I have priests, doctors, lawyers. I have women, men, Asians, African Americans. It crosses every potential boundary."

Poison your face? If you don't do it, you think it's appalling--another act of lunacy by those yoga-chanting, Zone-dieting Westsiders. If you do partake, it ranks on the continuum of cosmetic procedures somewhere in the territory of acrylic fingernails. It's not surgery. It's grooming.

"It's just like a quick fix," says Allison Mayer, a 34-year-old Palos Verdes Estates stay-at-home mother who Botoxes away her frown lines. She took along two friends the last time she had it done at her doctor's office. "We went to Crustacean for lunch and then we walked up to the doctor's office and had our Botox done--one, two, three."

On Some Faces, Marks of Character

Wrinkles in a face historically have denoted character--especially in the faces we worshiped. Barbara Stanwyck became the picture of a steely woman because of her seasoned face. You can't imagine Paul Newman in his prime--and a bit beyond--without wisps of crow's feet garnishing his eyes and making him bemused. Humphrey Bogart wouldn't have been the tough guy with a wounded soul without his Sharpei-like face. A Botoxed Georgia O'Keeffe? People would laugh. She'd look like Joan Rivers.

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