Since it first hit the scene in 1989, Botox has gone through more reinventions than Madonna. Back then it was an ophthalmologic treatment for spastic eyelids, but it wasn't long before doctors noticed the smoothing side effects and started using it "off label" (for purposes other than the official FDA nod) in Canada. In 2002, the 'tox finally received FDA approval for treating wrinkles, kicking off the stateside face-freezing frenzy. Now it's the country's most popular cosmetic procedure and its second most recognized prescription name (after Viagra), pulling in an estimated $1.28 billion worldwide last year for its maker, Allergan. Yeah, the stuff is still ubiquitous as an antiager and medical fix-it, treating everything from migraines to "BlackBerry thumb." But with its bold new applications, Botox is making sure that even if the economy slumps, your face doesn't have to.
Most of us rely on eyeshadow and liner tricks to get that innocent, doe-eyed look, but some women are turning to dermatologists for a more intense fix. Many docs are injecting a minuscule amount of Botox into the center of the lower lashline's orbicularis oculi muscle to create "a widening of the eye and more of an almond shape," says Boston derm Dr. Ranella Hirsch, who performs the procedure. "It's especially popular with Asian women, but it's magnificent and very subtle on anyone." ($300 - $500)
Changing your nose used to mean thousands of dollars in plastic-surgery bills and a pair of shiners. Though Botox can't do anything for the bridge, some doctors use it to give patients a perfect swoop - with no recovery time. Dr. Nodar Janas of MesoBoutique in Great Neck, NY, injects it into the bottom of the septum to lift the tip of the nose, a procedure he does for more than a dozen patients per month. You get "plastic-surgery results," he says, especially when combined with a filler like Juvéderm or Restylane. Other doctors, like NYC dermatologist Dr. Patricia Wexler, use Botox to make an upturned nose slope downward by injecting the nostrils. "The change is pretty dramatic in making a straighter nose," she says. "You can raise or lower the tip by about three millimeters." ($150 - $250)
A few inches south comes the horse-teeth gummy smile - not the result of big gums or small teeth but rather facial muscles that are too strong. Some doctors treat it by injecting a small amount of Botox into five places around the upper lip, or into the band above the chin, so the top lip doesn't lift as high during smiles. But Wexler, who performs the procedure, warns that shots to this area require prudence. "Botox around the mouth can flatten the lip or cause asymmetry, giving people trouble pronouncing their P's or V's," she says. Dr. Macrene Alexiades-Armenakas, an assistant clinical professor at Yale University School of Medicine, recommends patients stick to a dermatologist or facial plastic surgeon with at least 10 years of experience, as opposed to a gynecologist trying to make some cash on the side. "Any doctor can legally administer Botox, but whether that's wise is a totally different thing," she warns. ($200 - $400)